bluuebunny/crossref_metadata_2025 huggingface dataset:
One-Year Trial on Safety and Normal Linear Growth with Flunisolide HFA in Children with Asthma
Authors: Gillman Sherwin A. , Anolik Robert , Schenkel Eric , Newman Kenneth
Published: June 2007

Flunisolide hydrofluoroalkane (HFA) has efficacy equivalent to that of flunisolide chlorofluorocarbon (CFC) at one third the dose of the CFC formulation, a reduction from 250 pg/puff for flunisolide CFC to 85 pg/puff for flunisolide HFA. Flunisolide HFA delivers a smaller particle size (1.2 pim) in solution, resulting in improved lung deposition as compared with flunisolide CFC (3.8 pm), which is delivered in suspension. An added built-in spacer has reduced oropharyngeal deposition that may result in fewer adverse events and make it easier to use. The objective of this study was to compare the year-long safety of flunisolide HFA (daily dosage 340 pg) with that of CFC beclomethasone dipropionate (BDP) (daily dosage 336 pg) and cromolyn sodium (daily dosage 6,400 pg) in children 4-11 years old with mild-to-moderate asthma. The effects of these drugs on linear growth and growth velocity were also compared. The study was a 1-year open-label, parallel-group trial. Changes in physical examinations (including growth), adverse events, vital signs, electrocardiograms, cosyntropin stimulation tests, mouth and throat cultures for Candida albicans, and laboratory findings were analyzed. Patients 4-5 years old received flunisolide HFA only. In total, 235 children were evaluated (152 receiving flunisolide HFA, 39 BDP, and 44 cromolyn). The incidence of adverse events was comparable among treatment groups; most were mild or moderate and considered unrelated to treatment. Among patients 6-11 years old, mean changes from baseline height at week 52 were 6.2 cm for the flunisolide HFA and cromolyn groups and 5.1 cm for the BDP group. Thus growth in children receiving flunisolide HFA was unaffected by 1 year of treatment. Changes from baseline in other parameters, including response to cosyntropin stimulation, were insignificant and similar among the 3 treatment groups. At the dosages studied, and following 1 year of treatment, flunisolide HFA with its small particle size and built-in spacer is safe and well tolerated in children 4-11 years old. There are no adverse effects associated with HFA, including linear growth in children 6-11 years old when compared with BDP and cromolyn sodium.
Smoking Cessation Counseling: Training and Practice Among Women Pediatricians
Authors: Malarcher Ann , Easton Alyssa , Husten Corinne , Frank Erica
Published: June 2007

We examined characteristics associated with smoking cessation counseling among a national sample of 579 women pediatricians. Fifty-two percent of women pediatricians had received at least some training in cessation counseling and 41% counseled smoking patients at least once per year. Prevalence of counseling increased by amount of training; 20.7% of those with no training counseled at least once per year versus 62.0% of those with extensive training. Pediatricians 50-70 years of age were 1.8 times as likely as those 30-39 years of age to perform frequent counseling (p<0.01). Programs to promote smoking cessation training and counseling among pediatricians are needed.
Ease of Administration of the Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) During Pediatric Well-Child Visits
Authors: Pittock Siobhan T. , Juhn Young J. , Adegbenro Adedunni , Voigt Robert G.
Published: June 2007

Barriers to early identification of children with developmental delays include time constraints during well-child visits and lack of easily administered, quantitative measures that can be used by pediatricians. This study assesses the ease of administration of the Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) during well-child visits from 2 to 36 months of age. During a single visit 177 children were assessed by either a developmental pediatrician (n = 121) or a third-year pediatric resident (n = 56). The mean time required to complete the CAT/CLAMS for all subjects was 6 minutes and 10 seconds (SD 2 minutes 44 seconds); less than 10 minutes was required in 92% of children assessed. There were no significant differences in the time required by the 2 examiners at any age level. Its ease of administration and psychometric properties make the CAT/CLAMS an excellent choice for the assessment of early development by primary care pediatricians.
Prevalence, Predictors, and Attitudes Toward Cosleeping in an Urban Pediatric Center
Authors: Weimer Stephen M. , Dise Theresa L. , Evers Patrice B. , Ortiz Myriam A. , Welidaregay Wodajo , Steinmann William C.
Published: June 2007

Cosleeping is the normative practice in many of the world's societies but is not endorsed by the Consumer Products Safety Commission or by the American Academy of Pediatrics. A survey was performed on 101 caregivers in an urban setting, designed to assess the prevalence of cosleeping and parental attitudes for this practice. Cosleeping rate was 88% with predictors being as follows: single parent (p=0.006), high school or less education (p=0.035), 2 or fewer rooms used for sleeping (p=0.023). A majority (65%) stated that cosleeping was acceptable.
Knowledge of Neonatal Car Seat Location in a Predominantly Disadvantaged Prenatal Population
Authors: Robinson Dale C. , Reitan Rachel E. , Jones Glenn N. , Gist Richard S.
Published: June 2007

In order to assess knowledge of correct car seat location in prenatal patients of predominant lower socioeconomic status, an anonymous survey was performed at 2 inner city obstetric clinics. The survey participants (n=688) were asked to select from among 3 drawings the correct location of a neonatal car seat. The choices showed an infant facing backward in the rear seat, forward in the rear seat, and backward in the front seat. The correct location of the car seat was selected by 61% of the participating subjects. Knowledge of correct location was related to age (p=0.047), race (p=0.002), and parity (p=0.001) on univariate analysis. Education, survey site, and attendance at prenatal classes did not significantly correlate with car seat knowledge. Multiple regression analysis revealed that Caucasian race compared to African-American race predicted correct knowledge of car seat location with an Odds Ratio of 2.11 (CI 1.38-3.24). Multiparous women were more likely to know where to install a car seat relative to nulliparous women with an Odds Ratio of 1.63 (CI 1.12-2.38). Age was not significantly correlated with car seat knowledge on multivariate analysis. Knowledge of neonatal car seat location was suboptimal in our predominantly disadvantaged population, particularly in nulliparous, African-American women. Further prenatal education is needed during pregnancy or before hospital discharge to address this knowledge deficit.
Needle Aspiration for Suppurative Cervical Lymphadenitis
Authors: Serour Francis , Gorenstein Arkadi , Somekh Eli
Published: June 2007

In a 10-year prospective study, we used needle aspiration as the treatment of suppurative cervical lymphadenitis that required drainage procedure in 35 consecutive children aged 4 months to 13 years (mean 2.2 years). Twenty-seven patients underwent 1 puncture, 7 patients had 2 punctures, and 1 had 3 punctures. There were no major complications. Patients were followed up for 2-6 months. None required an open drainage of the cervical abscess. There was complete regression of the nodes in all patients within 21 days, with no relapse or scar formation. Needle aspiration seems to be an effective and safe treatment of suppurative cervical lymphadenitis that may avoid open drainage.
Outcome of Very-Low-Birth-Weight (<1,500 Grams) Infants Born to Mothers with Diabetes
Authors: Rehan Virender K. , Moddemann Dianne , Casiro Oscar G.
Published: June 2007

Premature delivery is common in pregnancies complicated by maternal diabetes. However, the outcome of very-low-birth-weight infants (VLBWI) born to mothers with diabetes is not known. Employing a matched double-cohort design, we investigated the influence of maternal diabetes on the outcome of VLBWI born in Winnipeg from 1988 to 1994. We compared mortality rates and early and late morbidity rates in VLBWI born to mothers with diabetes mellitus (DM) (cases, n=43, 23 with gestational DM and 20 with pregestational DM) and without DM (controls, n=539). Controls were matched for gestational age (GA), sex, and the year of birth. All subjects were enrolled in the Newborn Follow-Up Program. Relative risks and 95% confidence limits were calculated for each variable and Chi2 analysis, Student t-test, and Mann-Whitney test were used as appropriate for analysis. Diabetes mellitus control was assessed by conventional criteria. There were no differences between cases and controls in mode of delivery, birth weight (mean SD, 1,160±25 g vs 1,110±26 g), GA (29±2.8 wk vs 29±2.4 wk), smallness for gestational age (35% vs 30%), head circumference (26.5±1.9 vs 26.2±2.2 cm), length (38.8±2.8 vs 37.5±3.7 cm), Apgar score <4 at 1 min (42% vs 40%) and <7 at 5 min (37% vs 42%). Incidence of hyaline membrane disease (60% vs 71%), bronchopulmonary dysplasia (33% vs 31%), patent ductus arteriosus (30% vs 43%), necrotizing enterocolitis (12% vs 12%), sepsis (23% vs 25%), acute renal failure (9% vs 10%), intraventricular hemorrhage-all grades (74% vs 64%), retinopathy of prematurity-all stages (30% vs 26%), median days on ventilator (4 vs 4 days), and median days on supplemental oxygen (46 vs 42 days) were similar in both groups (p=NS, 95% confidence limits included 1 for all of these variables). There was no significant difference in mortality (21% vs 15%) or the incidence of major congenital anomalies. Weight, head circumference, and length at 6,12, and 18 months were similar in both groups. There were no group differences in developmental quotients, prevalence of neurodevelopmental impairments, respiratory morbidity, or number of hospitalizations up to the last follow-up (18 months). Our data suggest that with contemporary perinatal care there is no significant increase in mortality rates or early and late morbidity rates between VLBWI born to mothers with DM and VLBWI of nondiabetic mothers. It seems that with reasonable diabetic control, prematurity rather than the diabetic state determines the neonatal outcome, and this knowledge can be useful in parental counselling.
Dysfunctional Eating Patterns and Symptoms of Pica in Children and Adolescents with Sickle Cell Disease
Authors: Lemanek Kathleen L. , Brown Ronald T. , Armstrong F. Daniel , Hood Catherine , Pegelow Charles , Woods Gerald
Published: June 2007

The objective of this study was to examine the incidence and relationship of pica symptoms and dysfunctional eating patterns in children and adolescents with sickle cell disease (SCD). Children and caregivers (n = 146) completed questionnaires assessing eating difficulties and symptoms of pica. Information also was collected from medical records and analyzed for relationships with dysfunctional eating patterns. Incidence of problems and their association with disease parameters of SCD were examined. Dysfunctional eating patterns were found in those with no symptoms of pica and those with severe symptoms of pica. Caregiver-reported dysfunctional eating patterns were associated with caregiver-and child-reported frequency of painful episodes.
Body Mass Index and Age at Menarche in an Adolescent Clinic Population
Authors: Lin-Su Karen , Vogiatzi Maria G. , New Maria I.
Published: June 2007

Body fatness as a determinant of menarche has been studied extensively, but limited to underweight females. Adolescent female patients were measured and interviewed. Subjects were divided into three groups based on body mass index (BMI) standard deviation score (SDS). Average age at menarche was 11.87 + 1.1 years in the obese group, 12.14 ± 0.9 years in the overweight group, and 12.20 ± 1.3 years in the normal weight group. Pearson correlation factor between BMI SDS and age at menarche was -0.24 (p<0.01). These findings suggest an important role of increased body fatness on menarche that extends beyond underweight girls.
Physician Weight Counseling for Adolescents
Authors: Saelens Brian E. , Jelalian Elissa , Kukene Danielle M.
Published: June 2007

Adolescent obesity prevalence is increasing, with minimal study of physician weight counseling with youth. This study examines adolescents' (n=110) perceptions of physicians weight counseling. Overweight adolescents (>85th percentile for body mass index, BMI) report receiving counseling more than nonoverweight adolescents. Physicians more often have counseled obese (>95th BMI percentile) than overweight but not obese adolescents (85th-94th BMI percentile). Prior counseling and adolescents' ethnicity were related to greater perceived physician concern and adolescent receptivity to future counseling. Overweight adolescents report attempting weight loss strategies at rates similar to recommendations, but recommendations for specific weight control behaviors do not increase the likelihood of adolescent attempts.
Comparison of High-Dose and Low-Dose Aspirin Plus Intravenous Immunoglobulin in the Treatment of Kawasaki Syndrome
Authors: Saulsbury Frank T.
Published: June 2007

The efficacy of intravenous immunoglobulin (IVIG) in the treatment of Kawasaki syndrome (KS) has been unequivocally established, but questions remain concerning the proper dose of adjunctive aspirin therapy in the treatment of KS. The medical records of 72 children with KS were reviewed. All patients were treated with IVIG; 21 received 400 mg/kg/dose on 4 consecutive days and 51 received 2 g/kg as a single infusion. Seventy patients also received aspirin. Twenty-four of the 70 patients were started on high-dose aspirin (80-100 mg/kg/day) at the time of diagnosis. High-dose aspirin was given for a mean (± SE) duration of 6.1 ± 0.9 days, then switched to low-dose aspirin (3-5 mg/kg/day). Forty-six of the 70 patients were started on low-dose aspirin at the time of diagnosis and remained on low-dose aspirin for the duration of treatment. Coronary artery abnormalities were present at the time of diagnosis in 12 of 72 patients (17%), including 6 of 6 of patients (100%) with atypical KS and 6 of 66 patients (9%) with typical KS. None of the remaining 60 patients developed coronary artery abnormalities after treatment with IVIG and aspirin. The mean duration of fever after initiation of therapy was 44 ± 6 hours in patients treated with IVIG 400 mg/kg/dose on 4 consecutive days and 35 ± 5 hours in patients treated with 2 g/kg as a single infusion (p=0.3). The mean duration of fever after the initiation of therapy was 47 ± 8 hours in patients treated with high-dose aspirin compared to 34 ± 5 hours in patients treated with low-dose aspirin (p=0.13). These preliminary results indicate there is no benefit to high-dose aspirin compared to low-dose aspirin in the treatment of children with KS.
Reasons Hospitals Give for Not Offering Hepatitis B Vaccine to Low-Risk Newborns
Authors: Aiken Kimberly D. , Clark Sarah J. , Cabana Michael D.
Published: June 2007

After a temporary suspension of hepatitis B vaccination (HBV) for low-risk newborns in July 1999, some hospitals still do not offer HBV to these infants. A semi-structured telephone survey of medical directors from a national random sample of 296 hospital nurseries was completed from August 2000 to April 2001 and analyzed using qualitative techniques. Directors of 201 of 290 eligible nurseries (71%) participated. Twenty-eight nurseries have never offered HBV to low-risk newborns (“Never Offered HBV”) and 37 nurseries had offered HBV to low-risk newborns before July 1999, but discontinued this practice after the temporary suspension (“Discontinued HBV”). Common reasons for not offering HBV to low-risk newborns were difficulty with reimbursement and convenience of outpatient administration. In addition, directors of “Never Offered HBV” nurseries cited low disease incidence in their patient population, whereas directors of “Discontinued HBV” cited preference for the combination hepatitis B-Haemophilus influenza type b vaccine as important factors. Multi-faceted interventions may be necessary to increase HBV use in the nursery.
Solid Tumors in the Neonatal Period
Authors: Büyükpamukçu Münevver , Varan Ali , Tanyel Cahit , Şenocak Mehmet Emin , Göšgüş Safiye , Akyüz Canan , Kutluk Tezer , Büyükpamukçu Nebil
Published: June 2007

From 1972 to 2000, 123 patients with solid tumors whose complaints had started in the first 28 days of life were retrospectively evaluated. Fifty-five patients were diagnosed in the first 28 days and 68 patients were diagnosed after 28 days. In the former group, 85.5% of patients had symptoms in the first day of life. In the latter group, 77.9% had the onset of symptoms in the first day. Tumor subgroups in the neonatal period included teratoma (34), neuroblastoma (11), rhabdomyosarcoma (3), Wilms tumor (1), and retinoblastoma (3), and the others (3). Three patients had other, less common tumors. In the second group the numbers were the following: for teratoma (32), neuroblastoma (15), germ cell tumors other than teratomas (8), rhabdomyosarcomas (4), the other soft tissue sarcomas (3), Wilms tumor (1), retinoblastoma (1), and other, rare tumors (4). There were 22 malignant tumors in the first group, and 44 in the second group. Fourteen patients in the first group died in the early postoperative period or with progressive disease. Nineteen of 44 patients died in the second group. Overall survival rates were 24.9% and 51.6% in first and second groups, respectively (p=0.015). Event-free survival rates were 14.7% and 47.7% in these groups, respectively (p=0.0063). This is the first report comparing clinical features and prognosis of tumors diagnosed in the first 28 days of the life with those diagnosed after 28 days. The prognosis was worse in infants diagnosed in the first 28 days of life.
Voiding Dysfunction in Pediatric Patients
Authors: Hellerstein Stanley , Linebarger Jennifer S.
Published: June 2007

The goals of this study were to describe the pattern of voiding disorders in children in our community, to describe clinical criteria for making the specific diagnoses, and to comment on management. The medical records of 226 children referred because of voiding dysfunction or urinary tract infections (UTI) were evaluated. Children with normal voiding patterns when uninfected, with monosymptomatic nocturnal enuresis, and with known neurologic or anatomic abnormalities were excluded. Detrusor instability, an abnormal voiding pattern characterized by urgency with or without frequency, was the diagnosis in 175 of the 226 children. Children with detrusor instability who used various posturing maneuvers to avoid urinary incontinence had a significantly higher incidence of UTIs than those who did not attempt to obstruct urine outflow. Detrusor instability appeared to be secondary to constipation in 19 of the children. The other diagnoses were extraordinary daytime urinary frequency, infrequent voiding, monosymptomatic daytime wetting, transient voiding dysfunction, giggle incontinence, dysfunctional voiding, and unexplained dysuria. It is concluded that children with detrusor instability who use posturing maneuvers to avoid incontinence are at high risk for recurrent UTIs. Constipation is 1 cause of detrusor instability. Dysfunctional voiding, the form of voiding dysfunction most likely to result in renal damage, was present in only 2 of 226 children seen for voiding disorders.
White Blood Cell Count Can Aid Judicious Antibiotic Prescribing in Acute Upper Respiratory Infections in Children
Authors: Casey Janet R. , Marsocci Steven M. , Murphy Marie Lynd , Francis Anne B. , Pichichero Michael E.
Published: June 2007

Fifty percent or more of children with upper respiratory infections (URIs) and nonspecific febrile illnesses (e.g., children febrile, anorexic, decreased activity, irritable) receive unnecessary antibiotics from community-based physicians. This study was undertaken to show that white blood cell (WBC) count testing can aid physicians in avoiding antibiotic prescribing when managing children with URIs, and nonspecific febrile illnesses. A prospective, 3-year study was conducted in a community-based pediatric practice. A weekly convenience sample (Tuesdays) of acute URI and febrile patients ages 3 months to 21 years was studied. Data collected on enrollment included: age, gender, duration of illness, recent/current antibiotic use, temperature, symptoms, signs, laboratory testing (WBC count, cultures), diagnosis and treatment. Similar data on any illness visits in the previous 2 weeks and the subsequent 2 weeks after enrollment were collected. Viral culture specimens were obtained on a subset. The use of the WBC count was assessed, including obviating antibiotic prescription, frequency of related follow-up visits, and the occurrence of subsequent bacterial infections. Of 1,956 patients with respiratory or febrile illness enrolled, 1,219 (62%) had a diagnosis established by history and examination (e.g., acute otitis media) and 737 (38%) did not. Of the 737 patients without an established diagnosis, 386 (52%) did not receive an antibiotic because they did not appear particularly ill, their temperature was less than 101 °F, and parents were not demanding antibiotics, leaving 351 (48%) patients who appeared ill, had a temperature greater than 101 °F, and parents were demanding an antibiotic or physicians were inclined to give an antibiotic. A WBC count was performed on these 351 children; 337 children (96%) had a WBC count less than 15,000/mm3, and 14 (4%) had a W1BC 15,000/mm3 or greater. An antibiotic was prescribed for 13 of the 14 children with a WBC count greater than 15,000/mm3. With this approach, return office visits in the following 2 weeks were infrequent (13% of 737 patients), and no child had significant bacterial illness that was missed. With selective use of WBC count testing near-complete avoidance of unnecessary antibiotic use can be achieved in caring for children with URI and nonspecific febrile illness without adverse outcomes.
Pediatric Methylphenidate Exposures: 7-Year Experience of Poison Centers in the United States
Authors: Klein-Schwartz Wendy
Published: June 2007

This study was undertaken to evaluate trends and toxicity of pediatric methylphenidate exposures; 1993 to 1999 national poison center data were analyzed. There were 12,917 exposures, increasing from 927 in 1993 to 2,445 in 1999. The majority of children during the entire study period experienced no effect (60.3%) or minor effects (28.7%), with no fatalities. Most common reasons were unintentional general or therapeutic errors in children under 13 years and suicide attempt in adolescents. Adolescents were more likely to experience clinical toxicity, hospitalizations and more serious outcomes. The trend of increasing frequency of methylphenidate exposures reported to poison centers exactly parallels increasing therapeutic use.
Effect of Oral Supplementation on Catch-Up Growth in Picky Eaters
Authors: Alarcon Pedro A. , Lin Lung-Huang , Noche Miguel , Hernandez Virginia C. , Cimafranca Leonard , Lam Wayne , Comer Gail M.
Published: June 2007

Ninety-two subjects ages 36 to 60 months who had picky-eater behavior and evidence of growth faltering were randomized to receive either nutrition counseling alone, or nutrition counseling plus a nutritional supplement (Study) for 90 days. The Study group had significantly greater increases in weight and height. There were no significant differences between groups in changes in appetite or activity levels, or in gastrointestinal symptom scores. The percent of subjects who developed upper respiratory tract infections was significantly lower in the Study group. These data suggest that a nutritional supplement in addition to nutrition counseling promote catch-up growth and may contribute to lower rates of infectious disease in children with picky eater behavior.
Accelerated Intravenous Rehydration
Authors: Kanaan Usama , Dell Katherine Macrae , Hoagland Jason , O'Riordan Mary Ann , Furman Lydia
Published: June 2007

This study was undertaken to determine whether accelerated intravenous (IV) rehydration using a new Isotonic Dehydration Worksheet results in: (1) complications in serum sodium or volume status; and (2) decreased duration of IV fluid therapy or length of hospital stay. A retrospective cohort study utilizing chart review method was used. An intervention group of 98 children ages 1 month to 12 years treated with the Isotonic Dehydration Worksheet from December 2000 to March 2001 was compared to a control group of 61 children treated from December 1999 to March 2000 before introduction of the worksheet. Complication rates were low and did not differ between the 2 groups. Mean unadjusted lengths of IV therapy (35.3 vs. 33.7 hours) and of hospital stay (47.0 vs. 49.3 hours) were not significantly different between the 2 groups. Introduction of an accelerated rehydration protocol was well tolerated by patients, but did not result in a significant decrease in the outcome variables examined. Other factors may have a greater impact on the outcome variables, and a prospective study to address these questions is planned.
A Pilot Study of the Use of Guided Imagery for the Treatment of Recurrent Abdominal Pain in Children
Authors: Ball Thomas M. , Shapiro Daniel E. , Monheim Cynthia J. , Weydert Joy A.
Published: June 2007

Few effective therapies are available for children with recurrent abdominal pain (RAP). Relaxation and guided imagery have been shown to impact the autonomic nervous system, which is altered in patients with functional gastrointestinal disorders. Ten children with RAP were enrolled in the study after evaluation by a pediatric gastroenterologist. They were trained in relaxation and guided imagery during 4 weekly 50-minute sessions. Pain diaries were completed at 0, 1, and 2 months. Children and parents also completed psychological questionnaires at enrollment. Although refractory to conventional treatment by their physician and pediatric gastroenterologist, the children experienced a 67% decrease in pain during the therapy (chi-square for trend, p<0.001). No baseline psychological characteristics impacted the response to therapy. The use of relaxation along with guided imagery is an effective and safe treatment for childhood RAP.
High School Student Athletes: Associations Between Intensity of Participation and Health Factors
Authors: Pyle Renee P. , Mc Quivey Ross W. , Brassington Glenn S. , Steiner Hans
Published: June 2007

This paper addresses and compares the impact of organized, more intensive sports participation with lower intensity participation among high school student-athletes. Subjects included 770 high school students who reported being active in organized school sports. Mental health, physical health, and coping skills were assessed as indicated by factor scores derived from the Juvenile Wellness and Health Survey (JWHS-76). Results indicate that compared to students who were less active, competitive sports participation was associated with fewer mental health problems, fewer total risks, and fewer eating and dietary problems for both girls and boys. These results provide initial support for the association between youth participation in competitive sports and mental health.
A Comparison of Breastfed Children with Nutritional Rickets Who Present During and After the First Year of Life
Authors: Peng Lynn F , Serwint Janet R.
Published: June 2007

This study compares the patient characteristics of breastfed children in Baltimore, Maryland from 1990 to 2000 diagnosed with nutritional rickets at 12 months or younger to those older than 12 months to gain a better understanding of nutritional and environmental factors. All 30 of the patients were African American. Patients 12 months or younger (n=15) compared to those older than 12 months (n=15) were more likely to be born during the summer and to present with seizures and hypocalcemia. We recommend vitamin D supplementation of all breastfed infants at an early age and that supplementation continue throughout the duration of breastfeeding.
Clinical and Parental Assessment of Sleep in Children with Attention-Deficit/Hyperactivity Disorder Referred to a Pediatric Sleep Medicine Center
Authors: Crabtree Valerie Mclaughlin , Ivanenko Anna , Gozal David
Published: June 2007

Frequently reported sleep problems in children with attention deficit-hyperactivity disorder (ADHD) referred to a pediatric sleep medicine center were assessed and compared with objective sleep assessments. A retrospective review of 97 children with ADHD (mean age of 8.3 ± 3.0 years) was conducted. Polysomnography in 69 children revealed periodic limb movement disorder (PLMD) in 36% and sleep-disordered breathing in 7%, while actigraphy uncovered substantial variability in sleep schedules of 16 patients. Although parental subjective sleep complaints were verified by objective sleep assessments in a small proportion of cases, PLMD and night-to-night variability in sleep patterns were common.
Clinical Spectrum of Gross Hematuria in Pediatric Patients
Authors: Youn Trisha , Trachtman Howard , Gauthier Bernard
Published: June 2007

Although isolated gross hematuria is a disturbing symptom, there have been few studies of this finding in pediatric patients. Therefore, this study was performed to examine the associated symptoms and causes of gross hematuria in children and adolescents who presented with this problem as their major clinical manifestation. It also determined the long-term outcome of patients in whom no etiology was found. A retrospective review was performed on the medical records of 100 consecutive patients referred for evaluation of gross hematuria between 1992 and1999. The etiology was determined based on standard urinalysis methods, clinical laboratory tests, and imaging studies. Patients with gross hematuria in whom an etiology was not found were followed up through 2001. Of the 100 patient records reviewed, 18 were excluded because the clinical evaluation was incomplete. The remaining 82 patients (59 M: 23 F) had a mean age of 9.2 ± 5.0 years. Glomerular gross hematuria was found in 24 patients. A cause was found in all of these patients, most commonly immunoglobulin A (IgA) nephropathy (n=13) and Alport syndrome (n=6). Nonglomerular gross hematuria was found in 56 patients, and the most common etiologies were hypercalciuria (n=9), urethrorrhagia (n=8), and hemorrhagic cystitis (n=7). No etiology was found in 26 patients with nonglomerular gross hematuria. No diagnosis was made in the case of 2 patients whose hematuria could not be defined as glomerular or nonglomerular. Telephone follow-up was performed in 18 of these children 4.0 ± 3.2 years (range: 1–9 years) after the initial evaluation and showed that only 3 of these patients had had recurrences of gross hematuria. They and all of the other patients remained otherwise well. The urinalysis, including microscopic examination, was the most important diagnostic test in a patient with isolated gross hematuria. Nonglomerular problems were more than twice as common as glomerular diseases as a cause of isolated gross hematuria in pediatric patients The distribution of the etiologies of gross hematuria was consistent with previous studies. Although nearly half of the patients with nonglomerular gross hematuria could not be given a diagnosis, their long-term prognosis appeared to be good.
Treatment of Encopresis and Chronic Constipation in Young Children: Clinical Results from Interactive Parent-Child Guidance
Authors: Reid Helen , Bahar Ron J.
Published: June 2007

To describe the source of and treatment for encopresis in a series of 40 children under age 9 years. Referral for psychological based treatment followed upon limited success of standard gastroenterologic intervention. The treatment provided is defined as interactive parent-child family guidance. This includes a variety of specific psychologically based recommendations offered to parents, and, when indicated, direct interventions with the symptomatic child. These are different from various forms of behavioral corrective reward-punishment interventions frequently recommended for young children with encopresis. The pediatric and the psychological literature offer few reports of successful treatment of young children with this syndrome. Also, there are few specific descriptions of psychologically based interventions. The results reported here are of the successful treatment of 38 of 40 cases referred specifically for psychologically based intervention following the prior limited success of standard gastroenterologic treatment. The interactive parent-child family guidance intervention described in this report, differentiated from typical behavior therapies, is a notably successful mode of psychologically based therapy for these children. It offers an important alternative to standard pediatric gastroenterological treatment for encopresis, as well as to reward-punishment oriented behavioral therapies.
Hematuria in Children Due to Schistosomiasis in a Nonendemic Setting
Authors: Summer Andrea P. , Stauffer William , Maroushek Stacene R. , Nevins Thomas E.
Published: June 2007

Infection with Schistosoma hematobium is common in immigrants from tropical Africa and commonly presents with painless hematuria. Since chronic, heavy infection can lead to significant morbidity, it is imperative for clinicians who serve the immigrant and refugee population to become familiar with this traditionally exotic disease. Increased awareness will allow earlier diagnosis and treatment of infection, avoiding complications and minimizing expensive and invasive diagnostic procedures.
Severe Hypernatremic Dehydration Secondary to Undetected Lactation Failure: Usefulness of Sodium Levels in Breast Milk
Authors: Alsina-Manrique L. , Esteban M. , Salvià D. , Miracle X. , Rodríguez-Miguélez J. , Figueras J. , Carbonell X.
Published: June 2007

There is a concern that lactation failure and neonatal morbidity might be more common than previously thought. Maybe the early discharge, the lack of timely follow-up, or poor information during pregnancy or after delivery play important roles. A case of severe hypernatremic dehydration secondary to lactation failure is reported and we analyze recent recommendations.
Adherence Issues Related to the Selection of Antistaphylococcal or Antifungal Antibiotic Suspensions for Children
Authors: Steele Russell W. , Russo Troy M. , Thomas Mathew P.
Published: June 2007

To evaluate the palatability and cost as variables in the selection of antimicrobial suspensions to treat staphylococcal infections and oral thrush, 31 physicians and health care personnel randomly sampled 7 antistaphylococcal antibiotics and 2 antifungal agents, evaluating them in categories of appearance, smell, texture, taste, and aftertaste. Final scoring was then adjusted for cost. Overall taste (palatability) ranking of antistaphylococcal antibiotics, highest to lowest, was as follows: rifampin, cephalexin, EES, TMP/SMX, clindamycin with FLAVORx, linezolid, and clindamycin without FLAVORx. Fluconazole was superior to nystatin. Cost was considered a major factor if the medication was more than $60.00 for treatment of a hypothetical 2-year-old, 13-kg child.
Extreme Hyperbilirubinemia in Newborn Infants
Authors: Tiker Filiz , Gulcan Hande , Kilicdag Hasan , Tarcan Aylin , Gurakan Berkan
Published: June 2007

This study was undertaken to determine the frequency and investigate the etiology of extreme hyperbilirubinemia (total serum bilirubin [TSB] ≥25 mg/dL [428 μmol/L]) in newborns admitted to a neonatal intensive care unit in southern Turkey. The charts of 93 term and near-term infants admitted with TSB levels of 25 mg/dL (428 μmol/L) or greater in the first 30 days after birth were retrospectively reviewed. During the 4.5-year study period, 774 infants were admitted to our unit with neonatal jaundice. Ninety-three (12%) of these infants had TSB levels of 25 mg/dL (428 μmol/L) or greater. The mean TSB level in the 93 cases was 30.1 ± 5.7 mg/dL (514.7 ± 97.5 μmol/L), and the peak levels ranged from 25.0 to 57.4 mg/dL (428-981.5 μmol/L). Thirty-three (35.5%) of the 93 babies had TSB levels of 30 mg/dL (513 μmol/L) or greater. Eighty-nine of 93 infants were being exclusively breast-fed. Nineteen babies were isoimmunized, 7 were bacteremic, 2 of the 39 babies tested for glucose-6-phosphate dehydrogenase had this enzyme deficiency, and 1 of the 71 infants tested for thyroid function had hypothyroidism. No cause for extreme hyperbilirubinemia was found in 61 (65.6%) cases.
Preschool Vision Screening in Pediatric Practices
Authors: Kemper Alex R. , Clark Sarah J.
Published: June 2007

A national sample of pediatricians was surveyed to evaluate preschool vision screening practices (response rate 55%, 377 of 690 eligible respondents). The rate of acuity screening for 3- year-old children was low (35%), but increased for 4- (73%) and 5-year-old children (66%). Few used photoscreening or autorefraction (8%). Common barriers were that screening is too time-consuming and children are uncooperative. Half reported that there should be separate reimbursement for vision screening. Financial incentives may be important for ensuring the delivery of preschool vision screening, as well as adoption of emerging screening technologies if such devices are shown to be effective.
Turner Syndrome: An Update and Review for the Primary Pediatrician
Authors: Doswell Brandy H. , Visootsak Jeannie , Brady April N. , Graham John M.
Published: June 2007

Turner syndrome (TS) is among the most common of the sex chromosomal aneuploidies. It results from the absence of one sex chromosome (or part of an X chromosome) in a female, leaving only one X chromosome present in the cell. Primary care physicians should be able to recognize the presenting signs and symptoms of TS, and once the diagnosis is confirmed by a chromosome analysis, they should be able to serve as a valuable source of support for the patient and her family and understand the most current treatments available.
What Providers from General Emergency Departments Say about Implementing a Pediatric Asthma Pathway
Authors: Butterfoss Frances Dunn , Major Debra A. , Clarke Suzanne M. , Cardenas Rebekah A. , Isaacman Daniel J. , Mason Jon D. , Clements Daryl L.
Published: June 2007

The goal of this study was to assess institutional climate and providers’ readiness to adopt pediatric pathways for asthma treatment and management. Twelve focus groups were held with 24 physicians/physicians’ assistants, 20 nurses, and 17 emergency medical technicians from emergency departments in 4 general hospitals from July to October 2002. Positive experience with previous pathways, open communication and buy-in from clinicians and administrators, comprehensive training on pathways, and adapting standards to fit specific emergency department environments were identified as necessary elements for pathway adoption. Providers were optimistic about successfully implementing an asthma pathway (95%) and supportive of pathway implementation (87%).
Parent Reasons for Nonreturn to a Pediatric Weight Management Program
Authors: Barlow Sarah E. , Ohlemeyer Chris L.
Published: June 2007

To identify parent reasons for lack of return to a weight management program, a questionnaire was sent to 85 families who attended two or fewer visits; 43 families completed the questionnaire. A total of 37% reported that the program was not what they were looking for. Specifically, they were dissatisfied with the staff or treatment focus. Other reasons for nonreturn were distance to program (23%), scheduling conflicts (21%), and lack of insurance for weight management (21%). High body mass index z score was associated with return, but age, gender, race, and medical condition were not. Matching program structure, location, and time to parent preference might improve retention.
Narcolepsy with Cataplexy in Early Childhood
Authors: Hayes Don
Published: June 2007

Narcolepsy is a rare neurologic sleep disorder with morbidity associated with functional impairment and frequent delay in diagnosis. Symptoms typically manifest in adolescence or early adulthood, but diagnosis of narcolepsy has been reported in early childhood. Diagnosis rates are as low as 50% of the total population of patients with narcolepsy and are delayed as much as 10 years after disease onset due to inadequate patient-physician communication and/or misdiagnosis. I present the complexity of diagnosing narcolepsy in early childhood in a patient with cataplexy that started soon after independent ambulation at age 10 months.
Success of Short-Course Parenteral AntibioticTherapy for Acute Osteomyelitis of Childhood
Authors: Bachur Richard , Pagon Zrinka
Published: June 2007

The outcome of acute osteomyelitis treated with sequential therapy consisting of a short course of parenteral antibiotics, followed by oral antibiotics, was studied. To be considered acute osteomyelitis, related symptoms must have been present for less than 2 weeks before diagnosis. Short-course parenteral antibiotics (therapy for 7 days or less) and then oral antibiotics were used to treat 29 patients (median age, 6.3 years). Pathogens were identified from blood cultures and bone aspirates. Staphylococcus aureus was isolated in 59%. Median duration of parenteral antibiotics and oral antibiotics was 4 days (range, 0-7 days) and 28 days (range, 14-42 days), respectively. Median duration of combined (parenteral and oral) therapy was 32 days (range, 20-49 days). No failures or complications were noted at the 6-month follow-up, which was available for 27 patients. Short-course parenteral antibiotic therapy followed by oral therapy appears to be effective for treatment of acute, uncomplicated osteomyelitis.
Clindamycin Versus Unasyn in the Treatment of Facial Cellulitis of Odontogenic Origin in Children
Authors: Rush Demetris E. , Abdel-Haq Nahed , Zhu Jian-Fu , Aamar Basim , Malian Monica
Published: June 2007

The study was undertaken to characterize the microbiology of dental abscesses in children and to compare clindamycin and ampicillin/sulbactam in the treatment of facial cellulitis of odontogenic origin. Sixty children with acute facial cellulitis of dental origin underwent surgery (extraction or root canal procedure) within 24 hours of presentation. Pus samples were cultured aerobically and anaerobically. Patients were randomized (1:1) to receive intravenous ampicillin/sulbactam or clindamycin for 48 hours followed by oral amoxicillin/clavulanate or clindamycin for 7 days. A total of 211 bacterial isolates were recovered from 54 samples. The most common aerobic and facultative organisms were viridans streptococci, Neisseria, and Eikenella species. Among anaerobes, Prevotella and Peptostreptococcus species were the most frequent. No treatment failure occurred in either group. Dental abscesses in children are polymicrobial aerobic/anaerobic infections. Treatment of complicated dental infections with ampicillin plus a β-lactamase inhibitor or clindamycin in combination with surgical drainage is very effective.
Probiotics in Primary Care Pediatrics
Authors: Cabana Michael D. , Shane Andi L. , Chao Cewin , Oliva-Hemker Maria
Published: June 2007

Probiotics are live microorganisms that help stabilize and balance intestinal microflora. Although these organisms are ubiquitous and have been used in the production of foods, probiotics have been used more frequently for therapeutic purposes, including the treatment and prevention of pediatric diseases. This article reviews the proposed mechanisms of the beneficial effects of probiotics, potential uses of these organisms in pediatric care, and promising future directions for their application.
Toileting Concerns, Parenting Stress, and Behavior Problems in Children with Special Health Care Needs
Authors: Macias Michelle M. , Roberts Kathryn M. , Saylor Conway F. , Fussell Jill J.
Published: June 2007

This study examined the relationship between toileting concerns, behavior problems, and parenting stress in parents of children with special health care needs (CSHCN). Participants included parents of 99 males and 71 females aged 4 to 12 years with neural tube defects (NTD), developmental-behavioral disabilities (DBD), or history of perinatal intraventricular hemorrhage (IVH). Parents completed the Achenbach Child Behavior Checklist (CBCL) and the Parenting Stress Index-Short Form (PSI-SF). Parents expressing toileting concerns on the CBCL reported significantly more personal distress and more externalizing problems versus those with continent children. Variation within subsamples suggested that expectations based on nature of disability may be a factor in parent adjustment. Direct assessment and intervention of toileting issues should be a high priority in secondary stress prevention with CSHCN and their families.
Targeted Child Psychiatric Services: A New Model of Pediatric Primary Clinician—Child Psychiatry Collaborative Care
Authors: Connor Daniel F. , McLaughlin Thomas J. , Jeffers-Terry Mary , O’Brien William H. , Stille Christopher J. , Young Lynda M. , Antonelli Richard C.
Published: June 2007

Between 15% and 25% of children and adolescents seen in pediatric primary care have a behavioral health disorder with significant psychopathology, high functional impairment, and frequent psychiatric diagnostic comorbidity. Because child psychiatry services are frequently unavailable, primary care clinicians are frequently left managing these children without access to child psychiatry consultation. We describe Targeted Child Psychiatric Services (TCPS), a new model of pediatric primary clinician-child psychiatry collaborative care, and describe program utilization and characteristics of children referred over the first 18 months of the program using a retrospective chart review. The TCPS model can serve a large number of pediatric primary care practices and provide collaborative help with the evaluation and treatment of complex attention deficit hyperactivity disorder, depression, anxiety disorders, and pediatric psychopharmacology.
Improvement of Cardiac Auscultation Skills in Pediatric Residents With Training
Authors: Dhuper Sarita , Vashist Sudhir , Shah Nishant , Sokal Myron
Published: June 2007

Cardiac murmurs, most of which are harmless, are present in more than 50% of children. Good auscultation skills are required to prevent unnecessary referrals. The auscultation skills of a group of 21 pediatric residents were assessed. Based on their identification of key features such as S1, S2, timing, grade, location, quality of the murmur, and any extra sounds, residents were asked to make a clinical diagnosis. The overall diagnostic accuracy for all residents was 30% and improved with years of training. The average score for correctly identified key features was 46% with no significant improvement with year of training. Residents who had completed a cardiology rotation scored better than the others (41% vs 18% for correct diagnosis). Clinical auscultation skills of pediatric residents in our institution showed significant improvement with training, especially in the ability to recognize a harmless heart murmur.
Accuracy of Five Domestic Violence Screening Questions With Nongraphic Language
Authors: Zink Therese , Levin Linda , Putnam Frank , Beckstrom Andrew
Published: June 2007

To assess the accuracy of 5 domestic violence screening questions designed with less graphic language that they may be appropriate when children are present, mothers (n = 400) were recruited from primary care waiting rooms. Sensitivities, specificities, and predictive values were calculated using the revised Conflict Tactic Scale. “How do you and your partner work out arguments?” was the best individual question (area under the receiver operating characteristics curve 0.82, sensitivity 25%, specificity 97.7%). The 3-question combination with the domains of argument, safety, and manner of treating you and the children had the best results (area under the receiver operating characteristics curve 0.86, sensitivity 45.5%, and specificity 94.6%). The high specificity suggests a less graphic and potentially more acceptable group of questions for introductory discussions about domestic violence.