bluuebunny/crossref_metadata_2025 huggingface dataset:
Infant Immunization With Acellular Pertussis Vaccines in the United States: Assessment of the First Two Years' Data From the Vaccine Adverse Event Reporting System (VAERS)
Authors: Braun M. Miles , Mootrey Gina T. , Salive Marcel E. , Chen Robert T. , Ellenberg Susan S. ,   the VAERS Working Group
Published: August 2004

Objective.

To evaluate the safety of infant immunization with acellular pertussis vaccines in the United States.

Background.

The US Food and Drug Administration approved the first acellular pertussis vaccine for use in infants in the United States on July 31, 1996.

Outcome Measures.

Adverse events in the United States after infant immunization with pertussis-containing vaccines, representing temporal (but not necessarily causal) associations between vaccinations and adverse events.

Data Source.

Reports to the Vaccine Adverse Event Reporting System (VAERS), a passive national surveillance system.

Design.

Reports concerning infant immunization against pertussis between January 1, 1995 (when whole-cell vaccine was in exclusive use) and June 30, 1998 (when acellular vaccine was in predominant use) were analyzed, if the reports were entered into the VAERS database by November 30, 1998.

Results.

During the study, there were 285 reports involving death, 971 nonfatal serious reports, and 4514 less serious reports after immunization with any pertussis-containing vaccine. For 1995 there were 2071 reports; in 1996 there were 1894 reports; in 1997 there were 1314 reports, and in the first half of 1998 there were 491 reports. Diphtheria-tetanus-pertussis vaccine (DTP) was cited in 1939 reports, diphtheria–tetanus–whole-cell pertussis–Haemophilus influenzae type b vaccine (DTPH) in 2918 reports, and diphtheria-tetanus-acellular pertussis vaccine (DTaP) in 913 reports. The annual number of deaths during the study was 85 in 1995, 82 in 1996, 77 in 1997, and 41 in the first half of 1998. The annual number of reported events categorized as nonfatal serious (defined as events involving initial hospitalization, prolongation of hospitalization, life-threatening illness, or permanent disability) to VAERS for all pertussis-containing vaccines declined: 334 in 1995, 311 in 1996, 233 in 1997, and 93 in the first half of 1998. Similarly, the annual number of less serious reports to VAERS for pertussis-containing vaccines declined: 1652 in 1995, 1501 in 1996, 1004 in 1997, and 357 in the first half of 1998. A comparison of the adverse event profiles (proportional distributions) for DTaP, DTP, and DTPH, as well as an analysis of specific adverse events considered in a 1991 Institute of Medicine report on the safety of diphtheria-tetanus-pertussis vaccine, did not identify any new, clear safety concerns.

Conclusions.

These findings reflect the administration of millions of doses of acellular pertussis vaccine and are reassuring with regard to the safety of marketed acellular pertussis vaccines. VAERS data, although subject to the limitations of passive surveillance, support the prelicensure data with regard to the safety of the US-licensed acellular pertussis vaccines that we evaluated.
Sources of Infection Among Persons With Acute Hepatitis A and No Identified Risk Factors During a Sustained Community-Wide Outbreak
Authors: Staes Catherine Janes , Schlenker Thomas L. , Risk Ilene , Cannon Kyle G. , Harris Heath , Pavia Andrew T. , Shapiro Craig N. , Bell Beth P.
Published: August 2004

Context.

Hepatitis A is a common vaccine-preventable disease in the United States. Most cases occur during community-wide outbreaks, which can be difficult to control. Many case-patients have no identified source.

Objective.

To identify foodborne and household sources of hepatitis A during a community-wide outbreak.

Design.

Serologic and descriptive survey.

Setting.

Salt Lake County, Utah.

Participants.

A total of 355 household contacts of 170 persons reported with hepatitis A during May 1996 to December 1996, who had no identified source of infection; and 730 food handlers working in establishments where case-patients had eaten.

Main Outcome Measure.

Prevalence of immunoglobulin M antibodies to hepatitis A virus (IgM anti-HAV) among household and food service contacts.

Results.

Overall, 70 household contacts (20%) were IgM anti-HAV-positive, including 52% of children 3 to 5 years old and 30% of children <3 years old. In multivariate analysis, the presence of a child <3 years old (odds ratio [OR]: 8.8; 95% confidence limit [CL]: 2.1,36) and a delay of ≥14 days between illness onset and reporting (OR: 7.9; 95% CL: 1.7,38) were associated with household transmission. Of 18 clusters of infections linked by transmission between households, 13 (72%) involved unrecognized infection among children <6 years old. No food handlers were IgM anti-HAV-positive.

Conclusion.

During a community-wide outbreak, HAV infection among children was common, was frequently unrecognized, and may have been an important source of transmission within and between households. Transmission from commercial food establishments was uncommon. Ongoing vaccination of children may prevent future outbreaks.
Late-Onset Neutropenia in Very Low Birth Weight Infants
Authors: Omar Said A. , Salhadar Alaa , Wooliever Diane E. , Alsgaard Patricia K.
Published: August 2004

Background.

Neutropenia, defined as absolute neutrophil count (ANC) <1500/mm3, affects 6% to 58% of premature infants in the first week of life. This early-onset neutropenia in premature infants has previously been correlated with sepsis, maternal hypertension, severe asphyxia, and periventricular hemorrhage. Late-onset neutropenia, defined as ANC <1500/mm3 at a postnatal age of ≥3 weeks, has not been previously reported.

Objectives.

The purposes of this study were to determine the prevalence of late-onset neutropenia in very low birth weight (VLBW) infants and to examine the factors that may be associated with this phenomenon.

Methods.

A weekly complete blood cell count (CBC) was performed routinely in all premature infants with birth weight ≤1500 g (n = 225) admitted to the neonatal intensive care in a 3-year period who survived until discharge. CBC and differentials were recorded at day 1, day 3, and then weekly until discharge. The clinical data of the study infants were collected by reviewing the medical records retrospectively.

Results.

Late-onset neutropenia was detected in 51 infants (22%). In both neutropenic (n = 51) and nonneutropenic infants (n = 174), ANC increased postnatally, remained above 5000/mm3 for the first 3 weeks of life, and had a marked decrease at ∼4 weeks of age. Thereafter, ANC decreased to a level of ∼1400/mm3 in the neutropenic infants and 4000/mm3 in the nonneutropenic infants. The neutropenic infants had a significantly lower nadir ANC, lower hemoglobin, and higher reticulocyte count than did the nonneutropenic infants with similar platelet counts. None of the study infants received erythropoietin during their hospitalization. This late-onset neutropenia occurred at postnatal age of 6 ± 2 weeks (range: 3–10 weeks). The duration of neutropenia was 1.7 ± .7 weeks (range: 1–3 weeks). All of the neutropenic infants had anemia of prematurity with high reticulocyte count and normal platelet count. The neutropenic infants were stable, growing on full oral feedings, and had no signs or symptoms of sepsis. No adverse effects of late-onset neutropenia were apparent in these infants.

Conclusion.

Late-onset neutropenia is a common incidental finding in stable, growing VLBW infants that has not been previously reported. Late-onset neutropenia is a phenomenon that occurs in anemic premature infants who have marked reticulocytosis. Normal regulation of hematopoiesis is accompanied by a balance between colony-stimulating factors, such as erythropoietin and granulocyte colony-stimulating factor, which regulate erythropoiesis and granulopoiesis. We speculate that imbalance of these factors with increased reticulocytopoiesis in response to anemia of prematurity may explain this phenomenon. We recommend avoiding institution of aggressive, potentially harmful therapy for this phenomenon in healthy, growing VLBW infants.
Hemophagocytic Syndrome: A Misleading Complication of Visceral Leishmaniasis in Children—A Series of 12 Cases
Authors: Gagnaire Marie-Helene , Galambrun Claire , Stéphan Jean Louis
Published: August 2004

Objective.

To describe the difficulties in diagnosing visceral leishmaniasis (VL) when revealed by hemophagocytic syndrome (HS) in young children.

Design.

Retrospective study of patients identified over a 17-year period in French pediatric units.

Results.

This series comprises 12 cases of VL that were either revealed (n = 11) or complicated (on starting treatment with antimony salts [n = 1]) by HS. Clinical manifestations were those of severe VL with sustained high fever and hepatosplenomegaly in children in very poor condition. Biological manifestations always included pancytopenia, marked hypofibrinogenemia and hypertriglyceridemia, hepatic cytolysis, and prominent hemophagocytosis on the bone marrow smear. These features led to transfer to a hematology unit. Ten children were very young (<38 months) at onset (and consequently at infection). Signs of autoimmunity (Coombs' test-positive erythrocytes, antinuclear factors, and various autoantibodies) were found in 4 cases and were probably secondary to polyclonal B cell activation. Serologic tests forLeishmania were negative at onset in 6 children, and no amastigotes were found on the first marrow smear in 8 of 12 cases despite extensive search. Seven patients had not visited foreign countries. All these factors explain the initial diagnostic confusion. Three cases were initially misdiagnosed as familial erythrophagocytic lymphohistiocytosis or infection-associated HS, and these patients were treated with etoposide (once for 5 months) to control the HS after failure of steroids. The diagnostic delay in these cases was 50, 74, and 134 days. When VL was finally diagnosed, amphotericin B monotherapy was effective in 4 cases. Eight patients were treated with antimony salts; 4 were cured, 3 required adjunctive treatment, and 1 worsened (HS) and was cured with steroids and liposomal amphotericin. Regardless of the type of therapy, all 12 children are presumed cured with a mean follow-up of 7 years (range: 6 months–16 years).

Conclusions.

A diagnosis of VL should, therefore, be seriously considered in all young patients with HS exposed to visceralizing Leishmania sp in Southern Europe. Clinicians and cytopathologists must be aware of the association. Early diagnosis of VL will minimize unnecessary hospitalization and potentially harmful investigations and treatments.
School Disconnectedness: Identifying Adolescents at Risk
Authors: Bonny Andrea E. , Britto Maria T. , Klostermann Brenda K. , Hornung Richard W. , Slap Gail B.
Published: August 2004

Objective.

School connectedness, or the feeling of closeness to school personnel and the school environment, decreases the likelihood of health risk behaviors during adolescence. The objective of this study was to identify factors differentiating youth who do and do not feel connected to their schools in an effort to target school-based interventions to those at highest health risk.

Methods.

The study population consisted of all students attending the 7th through 12th grades of 8 public schools. The students were asked to complete a modified version of the in-school survey designed for the National Longitudinal Study of Adolescent Health (Add Health). The school connectedness score (SCS) was the summation of 5 survey items. Bivariate analyses were used to evaluate the association between SCS and 13 self-reported variables. Stepwise linear regression was conducted to identify the set of factors best predicting connectedness, and logistic regression analysis was performed to identify students with SCS >1 standard deviation below the mean.

Results.

Of the 3491 students receiving surveys, 1959 (56%) submitted usable surveys. The sample was 47% white and 38% black. Median age was 15. Median grade was 9th. The SCS was normally distributed with a mean of 15.7 and a possible range of 5 to 25. Of the 12 variables associated with connectedness, 7 (gender, race, extracurricular involvement, cigarette use, health status, school nurse visits, and school area) entered the linear regression model. All but gender were significant in the logistic model predicting students with SCS >1 standard deviation below the mean.

Conclusions.

In our sample, decreasing school connectedness was associated with 4 potentially modifiable factors: declining health status, increasing school nurse visits, cigarette use, and lack of extracurricular involvement. Black race, female gender, and urban schools were also associated with lower SCS. Further work is needed to better understand the link between these variables and school connectedness. If these associations are found in other populations, school health providers could use these markers to target youth in need of assistance.
Primitive Neuroectodermal Tumors of the Brainstem: Investigation of Seven Cases
Authors: Zagzag David , Miller Douglas C. , Knopp Edmond , Farmer Jean-Pierre , Lee Mark , Biria Shahriar , Pellicer Angel , Epstein Fred J. , Allen Jeffrey C.
Published: August 2004

Objective.

We discuss the clinical aspects, pathology, and molecular genetics of 7 patients with primitive neuroectodermal tumors (PNETs) arising in the brainstem that were treated at our institution from 1986 through 1995. Most neuro-oncologists avoid performing biopsies in children with pontine tumors. This article raises the question as to whether biopsies should be performed, because treatment recommendations might differ if a PNET was diagnosed rather than a pontine glioma.

Patients and Methods.

We reviewed the clinical neuro-oncology database and the files of the Division of Neuropathology at New York University Medical Center from 1986 through 1995 and identified 7 histologically confirmed PNETs arising in the brainstem among 146 pediatric brainstem tumors. The clinical, neuroradiological, and neuropathological data were reviewed. Postmortem examinations were performed in 2 cases. Formalin-fixed, paraffin-embedded tumor tissues were also available in 6 of 7 patients that were tested for p53 gene mutations using single-strand conformation polymorphism analysis. We also tested 9 cerebellar PNETs, 9 brainstem gliomas, and 3 normal brains for p53 gene mutations as controls.

Results.

All 7 patients presented with focal cranial nerve deficits, and 2 were also hemiparetic. The median age at diagnosis was 2.7 (1–8 years). Magnetic resonance imaging (MRI) characteristics included a focal intrinsic exophytic nonenhancing brainstem lesion that had low T1-weighted and high T2-weighted signals. Hydrocephalus was present in 5 patients at diagnosis, 3 of whom had leptomeningeal dissemination. Meningeal dissemination occurred later in the course of the disease in 3 other patients. Five children required shunts at diagnosis and another 2 at recurrence. Despite therapy, all 7 PNET patients died within 17 months of diagnosis with a mean survival of 8 (4–17) months. No mutation in the p53 gene was detected.

Conclusions.

Brainstem PNETs tend to arise at a younger age than brainstem gliomas and medulloblastomas. The MRI pattern suggests a localized rather than a diffuse intrinsic nonenhancing brainstem tumor. Like other PNETs, brainstem PNETs have a high predilection to disseminate within the central nervous system. The absence of p53 mutations is similar to other PNETs. Despite their origin close to the cerebellum, brainstem PNETs exhibit a more aggressive behavior and result in worse clinical outcomes than do cerebellar PNETs.
Daily Physical Activity Program Increases Bone Mineralization and Growth in Preterm Very Low Birth Weight Infants
Authors: Moyer-Mileur Laurie J. , Brunstetter Vickie , McNaught Teresa P. , Gill Gurmail , Chan Gary M.
Published: August 2004

Objective.

A study of daily physical activity was performed with 32 preterm infants to evaluate changes in body weight and bone mineralization.

Study Design.

Subjects were matched by birth weight and gestational age and randomly assigned to the physical activity (PA;n = 16) or to the control (C; n= 16) program. PA consisted of range of motion against passive resistance to all extremities for 5 to 10 minutes daily. Peripheral dual-energy x-ray of the right forearm (ulna and radius); biomarkers of bone formation (serum type I collagen C-terminal propeptide [PICP]) and resorption (urine pyridinoline cross-links of collagen [Pyd]); serum calcium, phosphate, alkaline phosphatase, parathyroid hormone (PTH), and 1,25-(OH)2 vitamin D; and urine levels of calcium, phosphate, and creatinine were obtained. All measurements were made at study entry and at 2.0 kg of body weight.

Results.

Despite a similar nutrient intake at advised levels for preterm infants, gains in body weight (g) and forearm bone length (cm), bone area (BA; cm2), bone mineral content (BMC; mg), and fat-free mass (g) were greater in PA infants. Forearm bone mineral density and fat mass gains did not differ between groups. Serum PICP levels remained constant in PA infants but decreased in C infants suggesting a slower rate of bone formation. Urine Pyd or bone resorption activity was similar between groups. A higher level of serum PTH was observed in PA infants at 2.0 kg of body weight; however, the change from study entry to completion did not differ between groups. All other serum and urine values were similar and within normal limits.

Conclusion.

A daily PA program promotes greater gains in body weight, forearm length, BA, BMC, and fat-free mass in premature infants.
Chronic Urticaria in Children: Expanding the “Autoimmune Kaleidoscope”
Authors: Dalal Ilan , Levine Arie , Somekh Eli , Mizrahi Avraham , Hanukoglu Aaron
Published: August 2004

Most cases of chronic urticaria (CU) are considered idiopathic. It has recently been accepted that autoimmunity plays a critical role in the pathogenesis of CU in some of these patients. Although urticaria is common in the pediatric population, the knowledge regarding CU-associated autoimmunity is very limited.

We describe the association of CU with a wide spectrum of clinical and laboratory autoimmune disorders in 2 children and emphasize the concept that CU is another manifestation of the “autoimmune kaleidoscope.”
Child Life Services
Authors:   Committee on Hospital Care
Published: August 2004

Child life programs have become the standard in large pediatric settings to address the psychosocial concerns that accompany hospitalization and other health care experiences. Child life programs facilitate coping and the adjustment of children and families in 3 primary service areas: 1) providing play experiences; 2) presenting developmentally appropriate information about events and procedures; and 3) establishing therapeutic relationships with children and parents to support family involvement in each child's care. Although other members of the health care team share these responsibilities for the psychosocial concerns of the child and the family, for the child life specialist, this is the primary role. The child life specialist focuses on the strengths and sense of well-being of children while promoting their optimal development and minimizing the adverse effects of children's experiences in a hospital setting.
Surfactant Treatment of Neonates With Respiratory Failure and Group B Streptococcal Infection
Authors: Herting Egbert , Gefeller Olaf , Land Matthias , van Sonderen Loekie , Harms Karsten , Robertson Bengt ,   Members of the Collaborative European Multicenter Study Group
Published: August 2004

Objective.

Connatal pneumonia caused by group B streptococcal (GBS) infection may be associated with surfactant dysfunction. We investigated the effects of surfactant treatment in term and preterm neonates with GBS infection and respiratory failure, in comparison with corresponding data from a control population of noninfected infants treated with surfactant for respiratory distress syndrome (RDS).

Design/Methods.

The study comprised 118 infants with respiratory failure, clinical and/or laboratory signs of acute inflammatory disease, and GBS infection proven by culture results. They were recruited retrospectively from a database of patients treated with surfactant at 28 neonatology units participating in European multicenter trials (1987–1993) and prospectively from the same units in the following years. A nonrandomized control group of 236 noninfected infants was selected from the same database. The primary parameters evaluated were oxygen requirement, ventilator settings, and incidence of complications.

Results.

Median birth weight in the GBS study group was 1468 g (25th–75th percentiles: 1015–2170), and median gestational age was 30 (27–33) weeks. Thirty-one percent of the infants weighed >2000 g. Median age at surfactant treatment was 6 hours. The mean initial surfactant dose was 142 mg/kg (standard deviation: 53). Ninety of the infants were treated with Curosurf (Chiesi Farmaceutici, Parma, Italy), 13 with Survanta (Abboth GmbH, Wiesbaden, Germany), 12 with Alveofact (Dr Karl Thomae GmbH, Biberach, Germany), and 3 with Exosurf (Wellcome GmbH, Burgwedel, Germany). Within 1 hour of surfactant treatment, median fraction of inspiratory oxygen was reduced from .84 (25th–75th percentiles: .63–1.0) to .50 (.35–.80). The incidence of complications in the study group (mortality: 30%; pneumothorax: 16%; intracranial hemorrhage: 42%) was high, compared with infants with RDS.

Conclusions.

Surfactant therapy improves gas exchange in the majority of patients with GBS pneumonia. The response to surfactant is slower than in infants with RDS, and repeated surfactant doses are often needed. The mortality and morbidity are substantial, considering the relatively high mean birth weight of the treated infants.
Safety and Immunogenicity of Heptavalent Pneumococcal Vaccine Conjugated to CRM197 Among Infants With Sickle Cell Disease
Authors: O'Brien Katherine L. , Swift Andrea J. , Winkelstein Jerry A. , Santosham Mathuram , Stover Beth , Luddy Ruth , Gootenberg Joseph E. , Nold Jeffrey T. , Eskenazi Allen , Snader Sally J. , Lederman Howard M. ,   for the Pneumococcal Conjugate Vaccine Study Group
Published: August 2004

Objectives.

To determine the immunogenicity and safety of heptavalent pneumococcal polysaccharide vaccine (serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F) conjugated to CRM197 (7-valent conjugate pneumococcal vaccine [7VPnC]) among infants with sickle cell disease (SCD) and a comparison group of infants without SCD (non-SCD).

Design.

Two cohorts of infants were enrolled and received open-label doses of 7VPnC vaccine; infants enrolled before 2 months of age received 7VPnC vaccine at 2, 4, and 6 months of age followed by 23-valent pneumococcal polysaccharide vaccine (PS-23) at 24 months of age for those infants with SCD (schedule A), and infants enrolled between 2 and 12 months of age received 7VPnC at 12 months of age followed by PS-23 at 24 months of age for infants with SCD (schedule B). Safety data were collected for 3 days after each dose of vaccine. Antibody concentrations were measured to each of the 7VPnC serotypes by enzyme-linked immunosorbent assay before each vaccine dose and 1 month after the last 7VPnC dose and the PS-23 vaccine dose.

Results.

Forty-five infants (34 SCD and 11 non-SCD) were vaccinated according to schedule A and 16 infants (13 SCD and 3 non-SCD) according to schedule B. The 7VPnC vaccine was highly immunogenic for all serotypes among infants with and without SCD who received 3 doses of vaccine according to schedule A: depending on serotype, 89% to 100% achieved antibody concentrations above .15 μg/mL and 56% to 100% achieved antibody concentrations above 1.0 μg/mL. Among infants immunized according to schedule B, a single dose of 7VPnC vaccine resulted in antibody concentrations above .15 μg/mL in 53% to 92% by serotype and above 1.0 μg/mL in 31% to 71% by serotype. A single dose of PS-23 resulted in dramatic increases in the antibody concentrations to all serotypes regardless of 1- or 3-dose priming. There was no difference in the reactogenicity of the 7VPnC vaccine between those with and without SCD. There were no serious reactions to the 7VPnC or PS-23 vaccines, even among those with high antibody concentrations before immunization.

Conclusions.

Infants with SCD respond to 7VPnC vaccine with antibody concentrations that are at least as high as infants without SCD. Infants immunized with 7VPnC vaccine at 2, 4, and 6 months of age developed antibody concentrations in the same range as those achieved among infants without SCD enrolled in a large trial that demonstrated vaccine efficacy against invasive disease. Significant rises were seen in antibody concentrations to all 7VPnC serotypes after the PS-23 booster in children receiving schedule A or B.
Economic Impact of Influenza Vaccination in Preschool Children
Authors: Cohen Gail M. , Nettleman Mary D.
Published: August 2004

Objective.

The economic impact of routine vaccination of preschool children with inactivated influenza vaccine was investigated.

Design.

A decision analysis was performed using data from the literature. Direct and indirect costs of each vaccination strategy were calculated and compared with a strategy of not vaccinating.

Setting.

Two settings were evaluated: a setting in which vaccination was available during flexible hours and a setting in which vaccination was available only during usual work hours (8:00 am–5:00 pm).

Results.

Vaccination resulted in a net cost savings in both settings. The net savings per vaccine recipient were $21.28 in the flexible setting and $1.20 in the restricted setting. Although the analysis was performed for the inactivated vaccine, sensitivity analysis showed that the nasal vaccine could also result in a net cost savings depending on the price of the cold-adapted vaccine when it is licensed.

Conclusion.

Vaccinating preschool children is economically advantageous. Serious consideration should be given to recommending vaccination in this age group.
Can Urine Clarity Exclude the Diagnosis of Urinary Tract Infection?
Authors: Bulloch Blake , Bausher Judith C. , Pomerantz Wendy J. , Connors J. Michael , Mahabee-Gittens Melinda , Dowd M. Denise
Published: August 2004

Objectives.

To determine the association of clear urine by visual inspection with the absence of significant bacteruria, and to compare it with standard urinalysis.

Methods.

The study was performed in the emergency department of Children's Hospital Medical Center, Cincinnati, Ohio. It was a prospective, convenience sample of children <21 years of age who had catheterized or midstream clean-catch urine specimen collected for culture. Clinical findings including the presence or absence of fever, abdominal pain, dysuria, frequency, and urgency were collected for each patient. Urine was visually assessed for clarity by 2 independent observers using a standardized technique. Standard laboratory urinalysis and microscopy were also performed on all specimens. A positive urine culture was defined as ≥104 colony-forming unit (CFU)/mL of a urinary pathogen if obtained by catheterization and ≥105 CFU/mL if obtained by midstream.

Results.

Samples were obtained from 159 patients ranging in age from 4 weeks to 19 years. Females comprised 77% of the patients. One hundred ten of the samples (69%) were clear to visual inspection. There were a total of 29 positive cultures; however, 3 were in children with clear urine. The finding of clear urine on visual inspection had a negative predictive value of 97.3%. These results were similar to those obtained with standard urinalysis.

Conclusion.

Clear urine on visual inspection cannot completely eliminate the possibility that a child has a urinary tract infection. However, it is a reproducible test that offers the advantages of being simple, fast, and inexpensive. The finding of clear urine should be considered a reasonable and relatively effective bedside screen for the presence of a urinary tract infection.
Pneumococcal Facial Cellulitis in Children
Authors: Givner Laurence B. , Mason Edward O. , Barson William J. , Tan Tina Q. , Wald Ellen R. , Schutze Gordon E. , Kim Kwang Sik , Bradley John S. , Yogev Ram , Kaplan Sheldon L.
Published: August 2004

Objective.

To review the epidemiology and clinical course of facial cellulitis attributable toStreptococcus pneumoniae in children.

Design.

Cases were reviewed retrospectively at 8 children's hospitals in the United States for the period of September 1993 through December 1998.

Results.

We identified 52 cases of pneumococcal facial cellulitis (45 periorbital and 7 buccal). Ninety-two percent of patients were <36 months old. Most were previously healthy; among the 6 with underlying disease were the only 2 patients with bilateral facial cellulitis. Fever (temperature: ≥100.5°F) and leukocytosis (white blood cell count: >15 000/mm3) were noted at presentation in 78% and 82%, respectively. Two of 15 patients who underwent lumbar puncture had cerebrospinal fluid with mild pleocytosis, which was culture-negative. All patients had blood cultures positive for S pneumoniae. Serotypes 14 and 6B accounted for 53% and 27% of isolates, respectively. Overall, 16% and 4% were nonsusceptible to penicillin and ceftriaxone, respectively. Such isolates did not seem to cause disease that was either more severe or more refractory to therapy than that attributable to penicillin-susceptible isolates. Overall, the patients did well; one third were treated as outpatients.

Conclusions.

Pneumococcal facial cellulitis occurs primarily in young children (<36 months of age) who are at risk for pneumococcal bacteremia. They present with fever and leukocytosis. Response to therapy is generally good in those with disease attributable to penicillin-susceptible or -nonsusceptible S pneumoniae. Ninety-six percent of the serotypes causing facial cellulitis in this series are included in the heptavalent-conjugated pneumococcal vaccine recently licensed in the United States.
Should Central Venous Catheters Be Removed as Soon as Candidemia Is Detected in Neonates?
Authors: Karlowicz M. Gary , Hashimoto Laura Nickles , Kelly Robert E. , Buescher E. Stephen
Published: August 2004

Background.

Controversy exists regarding the most appropriate acute management of central venous catheters (CVCs) in neonates with candidemia, with up to two thirds of neonatologists preferring to attempt antifungal therapy without removing CVCs.

Objective.

To determine whether CVCs should be removed as soon as candidemia is detected in neonates.

Methods.

A cohort study of candidemia and CVC was conducted in infants in a neonatal intensive care unit (NICU) over a 5-year period (1994–1998).

Results.

Fifty infants had early-removal CVC (ER-CVC) within 3 days and 54 infants had late-removal CVC (LR-CVC) >3 days after the first positive blood culture for Candidaspecies. All infants were treated with amphotericin B. There was no significant difference between infants in the ER-CVC and LR-CVC groups in terms of gender, ethnicity, birth weight, gestational age, age at candidemia, severity-of-illness scores, distribution of types of CVC, or in the distribution of Candida species causing candidemia. The ER-CVC group had significantly shorter duration of candidemia (median: 3 days; range: 1–14 days), compared with the LR-CVC group (median: 6 days; range: 1–24 days). The case fatality rate of Candida albicans candidemia was significantly affected by the timing of CVC removal: 0 of 21 (95% confidence interval [CI]: 0–14) infants died in the ER-CVC group in contrast to 9 of 23 (39%; 95% CI: 19–59) in the LR-CVC group.

Conclusion.

Failure to remove CVC as soon as candidemia was detected in neonates was associated with significantly increased mortality in C albicans candidemia and prolonged duration of candidemia regardless of Candidaspecies.
Snoring in Portuguese Primary School Children
Authors: Ferreira Ana Maria , Clemente Vanda , Gozal David , Gomes Ana , Pissarra Celsa , César Helena , Coelho Isabel , Silva Carlos F. , Azevedo Maria Helena P.
Published: August 2004

Objective.

To determine the prevalence of snoring and its potential associations with sleep problems, such as daytime symptoms, medical conditions, school performance, and behavioral disturbances in Portuguese children attending primary school.

Methods.

A previously validated questionnaire was sent to the parents of 1381 children attending primary schools in a parish of Coimbra, Portugal. To assess behavioral disturbances, the Portuguese version of Rutter's Children's Behavior Questionnaire for completion by teachers was used.

Results.

Of the 988 questionnaires returned (71.5%), complete information concerning snoring was obtained for 976 children (496 girls and 480 boys; mean age: 8.1 ± 1.5 years). Loud snoring during sleep was reported as frequent or constantly present (LSn) in 84 children (8.6%), as occasionally present in 299 children (30.6%), and as never present (NSn) by 593 children (60.8%). The LSn and NSn groups did not differ with respect to age, gender, sleep duration, time to fall asleep, frequency of night wakings, bedwetting, daytime tiredness, and school achievement. However, LSn was significantly associated with increased bedtime problems (fears and struggles), increased need for comforting activities to fall asleep, behaviors suggestive of parasomnias (sleep talking, teeth grinding, and night terrors), increased daytime sleepiness and irritability, and behavioral disturbances. Children in the LSn group were also more likely to report recurrent medical problems particularly those involving infections of the respiratory tract.

Conclusions.

Snoring is a common symptom in Portuguese children that is associated with behavioral daytime and sleep time disturbances. Children with loud snoring may benefit from early evaluation and intervention.
The Pediatrician's Role in Reducing Tobacco Exposure in Children
Authors: Stein Risa Jean , Haddock Christopher Keith , O'Byrne Kristin Koetting , Hymowitz Norman , Schwab Joseph
Published: August 2004

Objective.

Pediatricians have a unique and important role to play in the prevention and treatment of childhood and adolescent tobacco use, the protection of patients from the harmful effects of environmental tobacco smoke, and the encouragement of smoking cessation among parents. However, because recent research indicates that physician training in tobacco dependence is woefully weak and lacks a model for training, this article constructs a useful approach to this problem.

Methodology.

A comprehensive review of the literature served as the basis for the development of a new model for pediatrician training in tobacco dependence.

Results.

A comprehensive model is presented for training pediatricians in the areas of reducing infant and child exposure to environmental tobacco smoke, preventing youth smoking initiation, and providing smoking cessation assistance for adolescents and parents.

Conclusions.

Pediatricians have been called on to play an active role in the antitobacco arena. Because of their unique opportunity to interact with children, adolescents, and parents, pediatricians can and should be antitobacco interventionists. For this to occur, however, additional guidance should be provided to pediatricians during their training to better prepare them to carry out effective assessment and intervention practices. smoking initiation, smoking prevention, smoking cessation, environmental tobacco smoke, pediatricians.
Distribution of Accidents, Injuries, and Illnesses by Family Type
Authors: O'Connor Thomas G. , Davies Lisa , Dunn Judy , Golding Jean ,   the ALSPAC Study Team
Published: August 2004

Objective.

To investigate whether family type and psychosocial risks indexed by family type were systematically associated with differences in health outcomes in children.

Design and Subjects.

The study is based on a longitudinal, prospective study of a large (n = ∼10 000) community sample of families, the Avon Longitudinal Study of Pregnancy and Childhood.

Main Outcome Measures.

Frequency of accidents, illnesses, and medical interventions.

Results.

At 2 years of age, children in single-parent and stepfamilies were disproportionately likely to experience accidents and receive medical treatment for physical illnesses. In addition, children in single-parent families and stepfamilies were more likely to be hospitalized or receive attention from a hospital doctor for an injury or illness. Exposure to psychosocial risks also were elevated in single-parent families and stepfamilies, compared with intact or nonstepfamilies, and these factors primarily accounted for the connection between family type and children's physical health.

Conclusions.

The consequences of family transitions on children's health extend beyond traditional mental health and behavioral outcomes and include accident proneness, illness, and receipt of medical attention. The mediating processes are not entirely attributable to social class differences connected to family type and may instead be associated with a range of psychosocial risks that are more frequently found in single-parent families and stepfamilies, compared with intact or nonstepfamilies. Prevention and intervention efforts directed toward children at risk for poor behavioral and mental health adjustment secondary to family disruption should consider children's physical health and health-related behaviors.
Chest Compressions in an Infant With Osteogenesis Imperfecta Type II: No New Rib Fractures
Authors: Sewell Robert D. , Steinberg Mary A.
Published: August 2004

The case report of a newborn female with osteogenesis imperfecta type II who underwent cardiopulmonary resuscitation (CPR) with manual chest compressions for several minutes is presented. Chest radiographs taken before and after the chest compressions were administered were reviewed by several radiologists from 3 different hospitals and demonstrated no new radiographically visible rib fractures. Collagen analysis, the patient's clinical appearance, and clinical course, as well as a consultant's opinion aided in confirmation of the diagnosis of osteogenesis imperfecta type II. A review of 4 previous studies concerning rib fractures and CPR is included. This unique case supports previous articles that have concluded that rib fractures rarely, if ever, result from CPR in pediatrics, even in children with a lethal underlying bone disease, such as osteogenesis imperfecta type II. cardiopulmonary resuscitation, chest compressions, osteogenesis imperfecta, rib fractures, bone disease.
Growth Pattern of Breastfed and Nonbreastfed Infants With Atopic Dermatitis in the First Year of Life
Authors: Agostoni Carlo , Grandi Francesca , Scaglioni Silvia , Giannı̀ Maria L. , Torcoletti Marta , Radaelli Giovanni , Fiocchi Alessandro , Riva Enrica
Published: August 2004

Objective.

The growth of infants with atopic dermatitis (AD) has been poorly investigated based on the early type of feeding. The aim of this study was to assess the growth pattern of AD infants during the first 12 months of life in comparison to healthy infants, according to the early type of feeding (breastfed or nonbreastfed).

Methods.

Fifty-five term AD infants (36 breastfed and 19 nonbreastfed) and 114 term healthy infants (58 breastfed and 56 nonbreastfed) were evaluated by standardized growth indices (z scores; National Center for Health Statistics-World Health Organization data) through the first 12 months of life.

Results.

No difference was found between AD and healthy groups at birth. In AD infants, weight (WA) and length (LA)z scores decreased with age and were significantly lower, compared with healthy infants from the second month of age onward. The difference of mean z scores between AD and healthy infants at 12 months of age was −.69 (95% confidence interval [CI]: −1.00 to −.38) for WA and −.67 (95% CI: −.98 to −.36) for LA. The growth pattern of AD infants was not influenced by the early type of feeding, whereas in the 6- to 12-month period, the delay in growth was more pronounced in patients with more severe dermatitis.

Conclusions.

In the first year of life, AD infants show a progressive impairment in growth irrespective of the early type of feeding. The severity of disease may be an independent factor negatively influencing growth.
Decreased Use of Neonatal Extracorporeal Membrane Oxygenation (ECMO): How New Treatment Modalities Have Affected ECMO Utilization
Authors: Hintz Susan R. , Suttner Denise M. , Sheehan Arlene M. , Rhine William D. , Van Meurs Krisa P.
Published: August 2004

Objective:

Over the last decade, several new therapies, including high-frequency oscillatory ventilation (HFOV), exogenous surfactant therapy, and inhaled nitric oxide (iNO), have become available for the treatment of neonatal hypoxemic respiratory failure. The purpose of this retrospective study was to ascertain to what extent these modalities have impacted the use of neonatal extracorporeal membrane oxygenation (ECMO) at our institution.

Methods.

Patients from 2 time periods were evaluated: May 1, 1993 to November 1, 1994 (group 1) and May 1, 1996 to November 1, 1997 (group 2). During the first time period (group 1), HFOV was not consistently used; beractant (Survanta) use for meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn (PPHN), and pneumonia was under investigation; and iNO was not yet available. During the second time period (group 2), HFOV and beractant treatment were considered to be standard therapies, and iNO was available to patients with oxygenation index (OI) ≥25 × 2 at least 30 minutes apart, or on compassionate use basis. Patients were included in the data collection if they met the following entry criteria: 1) OI >15 × 1 within the first 72 hours of admission; 2) EGA ≥35 weeks; 3) diagnosis of MAS, PPHN or sepsis/pneumonia; 4) <5 days of age on admission; and 5) no congenital heart disease, diaphragmatic hernia, or lethal congenital anomaly.

Results.

Of the 49 patient in group 1, 21 (42.8%) required ECMO therapy. Of these ECMO patients, 14 (66.6%) had received diagnoses of MAS or PPHN. Only 3 of the patients that went on to ECMO received beractant before the initiation of bypass (14.3%). All ECMO patients in group 1 would have met criteria for iNO had it been available. Of all patients in group 1, 18 (36.7%) were treated with HFOV, and 13 (26.5%) received beractant. Of the 47 patients in group 2, only 13 (27.7%) required ECMO therapy (compared with group 1). Of these ECMO patients, only 5 (38.5%) had diagnoses of MAS or PPHN, with the majority of patients (61.5%) requiring ECMO for sepsis/pneumonia, with significant cardiovascular compromise. Only 5 of these ECMO patients, all outborn, did not receive iNO before cannulation because of the severity of their clinical status on admission. Of all patients in group 2, 41 (87.2%) were treated with HFOV (compared with group 1), 42 (89.3%) received beractant (compared with group 1), and 18 (44.7%) received iNO.

Conclusions.

The results indicate that ECMO was used less frequently when HFOV, beractant and iNO was more commonly used. The differences in treatment modalities used and subsequent use of ECMO were statistically significant. We speculate that, in this patient population, the diagnostic composition of neonatal ECMO patients has changed over time.
Teething and Tooth Eruption in Infants: A Cohort Study
Authors: Wake Melissa , Hesketh Kylie , Lucas James
Published: August 2004

Objective.

Many symptoms are attributed to teething in infants. There is little evidence to support these beliefs, despite their implications for clinical management. We investigated relationships between tooth eruption, fever, and teething symptoms.

Methods.

Prospective cohort study.

Participants.

Twenty-one children 6 to 24 months old attending 3 suburban long-day care centers ≥3 days/week.

Measures.

1) Daily temperature recording and examination of alveolar ridges for tooth eruption (dental therapist). 2) Daily questionnaires—symptoms over preceding 24 hours (staff and parents independently). 3) Final questionnaire—beliefs/experiences related to teething (parents).

Definitions.

Eruption day—the first day a tooth could be seen or felt. Non-toothdays–more than 28 days clear of any eruption day. Toothdays–the 5 days preceding eruption days.

Results.

Data were collected for 236 toothdays and 895 non-toothdays pertaining to 90 teeth. Child temperatures were similar on toothdays and non-toothdays (36.21 vs 36.18, paired ttest). Logistic regression adjusted for age did not show an association between toothdays and temperature (odds ratio [OR] = 1.35, 95% confidence interval [CI] = 0.80, 2.27 for high fever; OR = 1.34, 95% CI = 0.48, 3.77 for low fever). Logistic regression models allowing for within-child cluster effects and age were fitted to daily staff and parent reports of mood, wellness/illness, drooling/dribbling, sleep, diarrhea, strong diapers, red cheeks, and rashes/flushing. Only parent-reported (but not staff-reported) loose stools were significantly associated with tooth eruption (OR = 1.86, 95% CI = 1.26, 2.73). When the toothday definition was varied to 10 days preceding or 5 days surrounding tooth eruption, this single significant association was no longer apparent (OR = 1.42, 95% CI = 0.98, 2.05 and OR = 1.47, 95% CI = 0.97, 2.21, respectively). All parents retrospectively reported that their own children had suffered a range of teething symptoms.

Conclusions.

This study did not confirm the expected strong associations between tooth eruption and a range of teething symptoms in children 6 to 30 months old, although we cannot rule out the possibility that weak associations may exist (Type II error). These findings contrast with strong parent and professional beliefs to the contrary. Such beliefs may preclude optimal management of common patterns of illness and behavior in young children.teething, infants, symptoms, tooth eruption, illness.
Maternal Perceptions of Overweight Preschool Children
Authors: Baughcum Amy E. , Chamberlin Leigh A. , Deeks Cindy M. , Powers Scott W. , Whitaker Robert C.
Published: August 2004

Context.

Childhood obesity is a major public health problem, and prevention efforts should begin early in life and involve parents.

Objective.

To determine what factors are associated with mothers' failure to perceive when their preschool children are overweight.

Design.

Cross-sectional survey.

Settings.

Offices of private pediatricians and clinics of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Participants.

Six hundred twenty-two mothers with children 23 to 60 months of age.

Main Outcome Measures.

Maternal demographic variables, maternal self-reported height and weight, and children's measured height and weight. Mothers were asked whether they considered themselves or their children overweight.

Results.

Forty-five percent of mothers had low education (high school degree or less) and 55% had high education (some college or more). Obesity (body mass index: ≥30 kg/m2) was more common in the low education group of mothers (30% vs 17%), and their children tended to be more overweight (weight-for-height percentile: ≥90th; 19% vs 14%). Ninety-five percent of obese mothers believed that they were overweight, with no difference between education groups. However, 79% of mothers failed to perceive their overweight child as overweight. Among the 99 mothers with overweight children, low maternal education was associated with a failure to perceive their children as overweight after adjusting for low family income (≤185% of poverty), maternal obesity, age, and smoking plus the child's age, race, and gender (adjusted odds ratio: 6.2; 95% confidence interval: 1.7–22.5).

Conclusions.

Obesity was more common in mothers with less education as well as in their children. Nearly all of the obese mothers regarded themselves as overweight. However, the majority of mothers did not view their overweight children as overweight, and this misperception was more common in mothers with less education. Childhood obesity prevention efforts are unlikely to be successful without a better understanding of how mothers perceive the problem of overweight in their preschool children.