bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute and Sustained Effects of Lucinactant Versus Poractant-α on Pulmonary Gas Exchange and Mechanics in Premature Lambs With Respiratory Distress Syndrome
Authors: Gastiasoro-Cuesta Elena , Alvarez-Diaz Francisco J. , Rey-Santano Carmen , Arnaiz-Renedo Arantxa , Loureiro-Gonzalez Begoña , Valls-i-Soler Adolf
Published: February 2006

BACKGROUND. Animal-derived, protein-containing surfactants seem to be superior to protein-free surfactants. Lucinactant, a synthetic surfactant containing a surfactant protein-B peptide analog, has been shown to be effective in animal models and phase II clinical trials. To date, lucinactant has not been compared with an animal-derived surfactant in a premature animal model.

OBJECTIVE. The objective was to compare the acute and sustained effects of lucinactant among premature lambs with respiratory distress syndrome (RDS) with the effects of a natural porcine surfactant (poractant-α).

METHODS. After 5 minutes of mechanical ventilation twin premature lambs were assigned randomly to the lucinactant group (30 mg/mL, 5.8 mL/kg) or the poractant-α group (80 mg/mL, 2.2 mL/kg). Heart rate, systemic arterial pressure, arterial pH, blood gas values, and lung mechanics were recorded for 12 hours.

RESULTS. Baseline fetal pH values were similar for the 2 groups (pH 7.27). After 5 minutes of mechanical ventilation, severe RDS developed (pH: <7.08; Paco2: >80 mm Hg; Pao2: <40 mm Hg; dynamic compliance: <0.08 mL/cm H2O per kg). After surfactant instillation, similar improvements in gas exchange and lung mechanics were observed for the lucinactant and poractant-α groups at 1 hour (pH: 7.3 ± 0.1 vs 7.4 ± 0.1; Paco2: 8 ± 18 mm Hg vs 40 ± 8 mm Hg; Pao2: 167 ± 52 mm Hg vs 259 ± 51 mm Hg; dynamic compliance: 0.3 ± 0.1 mL/cm H2O per kg vs 0.3 ± 0.1 mL/cm H2O per kg). The improvements in lung function were sustained, with no differences between groups. Cardiovascular profiles remained stable in both groups.

CONCLUSIONS. Among preterm lambs with severe RDS, lucinactant produced improvements in gas exchange and lung mechanics similar to those observed with a porcine-derived surfactant.
Toward Understanding Kernicterus: A Challenge to Improve the Management of Jaundiced Newborns
Authors: Wennberg Richard P. , Ahlfors Charles E. , Bhutani Vinod K. , Johnson Lois H. , Shapiro Steven M.
Published: February 2006

PURPOSE. We sought to evaluate the sensitivity and specificity of total serum bilirubin concentration (TSB) and free (unbound) bilirubin concentration (Bf) as predictors of risk for bilirubin toxicity and kernicterus and to examine consistency between these findings and proposed mechanisms of bilirubin transport and brain uptake.

METHODS. A review of literature was undertaken to define basic principles of bilirubin transport and brain uptake leading to neurotoxicity. We then reviewed experimental and clinical evidence that relate TSB or Bf to risk for bilirubin toxicity and kernicterus.

RESULTS. There are insufficient published data to precisely define sensitivity and specificity of either TSB or Bf in determining risk for acute bilirubin neurotoxicity or chronic sequelae (kernicterus). However, available laboratory and clinical evidence indicate that Bf is better than TSB in discriminating risk for bilirubin toxicity in patients with severe hyperbilirubinemia. These findings are consistent with basic pharmacokinetic principles involved in bilirubin transport and tissue uptake.

CONCLUSIONS. Experimental and clinical data strongly suggest that measurement of Bf in newborns with hyperbilirubinemia will improve risk assessment for neurotoxicity, which emphasizes the need for additional clinical evaluation relating Bf and TSB to acute bilirubin toxicity and long-term outcome. We speculate that establishing risk thresholds for neurotoxicity by using newer methods for measuring Bf in minimally diluted serum samples will improve the sensitivity and specificity of serum indicators for treating hyperbilirubinemia, thus reducing unnecessary aggressive intervention and associated cost and morbidity.
Parental Expectations, Physical Punishment, and Violence Among Adolescents Who Score Positive on a Psychosocial Screening Test in Primary Care
Authors: Ohene Sally-Ann , Ireland Marjorie , McNeely Clea , Borowsky Iris Wagman
Published: February 2006

OBJECTIVE. We sought to examine the relationship between perceived and stated parental expectations regarding adolescents' use of violence, parental use of physical punishment as discipline, and young adolescents' violence-related attitudes and involvement.

METHODS. Surveys were completed by 134 youth and their parents attending 8 pediatric practices. All youth were 10 to 15 years of age and had scored positive on a psychosocial screening test.

RESULTS. Multivariate analyses revealed that perceived parental disapproval of the use of violence was associated with a more prosocial attitude toward interpersonal peer violence and a decreased likelihood of physical fighting by the youth. Parental report of whether they would advise their child to use violence in a conflict situation (stated parental expectations) was not associated with the adolescents' attitudes toward interpersonal peer violence, intentions to fight, physical fighting, bullying, or violence victimization. Parental use of corporal punishment as a disciplining method was inversely associated with a prosocial attitude toward interpersonal peer violence among the youth and positively correlated with youths' intentions to fight and fighting, bullying, and violence victimization.

CONCLUSIONS. Perceived parental disapproval of the use of violence may be an important protective factor against youth involvement in violence, and parental use of physical punishment is associated with both violence perpetration and victimization among youth. Parents should be encouraged to clearly communicate to their children how to resolve conflicts without resorting to violence and to model these skills themselves by avoiding the use of physical punishment.
Personality in Young Adults Who Are Born Preterm
Authors: Allin Matthew , Rooney Maeve , Cuddy Marion , Wyatt John , Walshe Muriel , Rifkin Larry , Murray Robin
Published: February 2006

INTRODUCTION. Very preterm birth (VPT; <33 weeks' gestation) is associated with later neuromotor and cognitive impairment, reduced school performance, and psychiatric morbidity. Several follow-up studies have demonstrated increased anxiety and social rejection and reduced self-esteem in preterm children and adolescents, but few studies have examined the effects of preterm birth on adult personality.

METHODS. We assessed 108 VPT individuals and 67 term-born controls at ages 18 to 19 years with the Eysenck Personality Questionnaire-Revised, short form (EPQ-RS). This questionnaire rates 3 dimensions of personality: extraversion (sociability, liveliness, sensation seeking); neuroticism (anxiety, low mood, low self-esteem); and psychoticism (coldness, aggression, predisposition to antisocial behavior). A fourth scale, “lie,” which measures dissimulation, is also derived.

RESULTS. VPT individuals had significantly lower extraversion scores, higher neuroticism scores, and higher lie scores than term-born controls, after controlling for age at assessment and socioeconomic status. P scores were not significantly different between the 2 groups. There was a gender difference in that the increased neuroticism and decreased extraversion scores were accounted for mainly by VPT females. Associations between EPQ-RS scores and neonatal status, adolescent behavioral ratings, and body size at 18 to 19 years were assessed by using Kendall partial correlations, correcting for age at assessment and socioeconomic status. Gestational age, indices of neonatal hypoxia, and neonatal ultrasound ratings were not correlated with EPQ-RS scores. Birth weight was weakly associated with increased lie scores. Rutter Parents' Scale score, a measure of adolescent psychopathology, was associated with an increased neuroticism score. Poor social adjustment in adolescence was associated with an increased lie score. Height and weight at 18 to 19 years were not associated with EPQ-RS, but reduced occipitofrontal circumference was associated with both decreased extraversion and increased lie scores.

CONCLUSIONS. Young adults who are born VPT have different personality styles from their term-born peers. This may be associated with an increased risk of psychiatric difficulties.
Panton-Valentine Leukocidin Genes Are Associated With Enhanced Inflammatory Response and Local Disease in Acute HematogenousStaphylococcus aureusOsteomyelitis in Children
Authors: Bocchini Claire E. , Hulten Kristina G. , Mason Edward O. , Gonzalez Blanca E. , Hammerman Wendy A. , Kaplan Sheldon L.
Published: February 2006

BACKGROUND. Staphylococcus aureus strains carrying the genes encoding Panton-Valentine leukocidin (pvl-positive [pvl+]) are associated with more febrile days and higher complication rates of osteomyelitis in children than are pvl-negative (pvl−) strains.

OBJECTIVES. Selected clinical, laboratory, and radiographic findings in children with osteomyelitis caused by pvl+ and pvl− S aureus strains were compared.

METHODS. The demographics, selected clinical features, laboratory values, and radiographic findings of children with community-acquired S aureus osteomyelitis prospectively identified at Texas Children's Hospital between August 2001 and July 2004 were reviewed. Polymerase chain reaction was performed to detect the genes for pvl (luk-S-PV and luk-F-PV) and fibronectin-binding protein (fnbB) in S aureus isolates. χ2, 2-sample t test, and multiple logistic regression were used for statistical analysis.

RESULTS. Methicillin-susceptible and methicillin-resistant S aureus (MSSA and MRSA, respectively) caused osteomyelitis in 33 and 56 children, respectively. Twenty-six isolates were pvl− (26 MSSA), 59 were pvl+ (3 MSSA, 56 MRSA), and 4 were not available for analysis (4 MSSA). On univariate analysis, patients with pvl+ S aureus isolates had significantly higher erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level both at presentation and as a maximum value during hospitalization and were more likely to have a blood culture positive for S aureus during their admission. Patients with pvl+ S aureus isolates were significantly more likely to have concomitant myositis or pyomyositis compared with patients with pvl− S aureus isolates on MRI. In a multivariate analysis pvl remained significantly associated with ESR and CRP levels at presentation and blood culture positive for S aureus. pvl+ status and younger age were associated with myositis on MRI.

CONCLUSIONS. Osteomyelitis caused by pvl+ S aureus strains were associated with more severe local disease and a greater systemic inflammatory response compared with osteomyelitis caused by pvl− S aureus.
Household Food Insecurity and Overweight Status in Young School Children: Results From the Early Childhood Longitudinal Study
Authors: Rose Donald , Bodor J. Nicholas
Published: February 2006

OBJECTIVE. Recent work on the determinants of obesity has shown a positive association between household food insecurity and overweight status in adult women, yet research exploring this issue in children has been inconclusive. In this study we examine the association between food insecurity and overweight status in young school children by using a large, nationally representative sample.

METHODS. Data from the Early Childhood Longitudinal Study-Kindergarten Cohort (ECLS-K) were analyzed. Replicate heights and weights were measured on kindergarten children (N = 16889) in the spring of 1999. Children with a body mass index ≥95th percentile of their gender-specific BMI-for-age chart were considered overweight. Food-insecurity status was assessed by using the full 18-question US Department of Agriculture Household Food Security Scale. Multivariate logistic regression was used to assess the relationship between overweight and food-insecurity status while controlling for potential demographic, socioeconomic, and behavioral confounders.

RESULTS. Overall, 11.2% of the girls and 11.8% of the boys were overweight. Children from food-insecure households were 20% less likely to be overweight than their food-secure counterparts. Similar results on the food-insecurity/overweight link were found across a range of different models and expressions for key variables. Positive predictors of overweight status included low physical activity, television watching for >2 hours/day, high birth weight, black or Latino ethnicity, and low income.

CONCLUSIONS. There are strong arguments for reducing food insecurity among households with young children. This research suggests that these arguments would be based on reasons other than a potential link to obesity. Low activity levels and excessive television watching, however, were strongly related to overweight status, a finding that supports continued efforts to intervene in these areas.
Wide Geographic Variation Between Pennsylvania Counties in the Population Rates of Hospital Admissions for Pneumonia Among Children With and Without Comorbid Chronic Conditions
Authors: Gorton Christopher P. , Jones Jayne L.
Published: February 2006

OBJECTIVES. To compare county rates of hospital admissions for pediatric pneumonia and to assess the contribution of comorbid chronic conditions to county and state pediatric pneumonia admission rates.

METHODS. We performed retrospective analyses of data for all Pennsylvania-resident children 2 months through 17 years of age who were admitted to acute care hospitals with a principal diagnosis of pneumonia in 2003 or 2004. We divided the admissions into 2 groups (all pneumonia and pneumonia excluding coded comorbid chronic conditions) and calculated admission rates for each Pennsylvania county.

RESULTS. There were 5429 pediatric pneumonia admissions during the 12-month study period, of which 4948 (91.1%) were included in the study. The Pennsylvania state admission rate for all pneumonia was 156.3 admissions per 100000 children. County admission rates for all pneumonia ranged from 77.0 admissions per 100000 children to 457.6 admissions per 100000 children. Similar geographic patterns were seen among the 2851 admissions that remained in the second group after the exclusion of 2097 records (42.4%) coded for comorbid chronic conditions. The Pennsylvania state admission rate for pneumonia without chronic conditions was 90.0 admissions per 100000 children. County admission rates for pneumonia without comorbid chronic conditions ranged from 18.3 admissions per 100000 children to 350.3 admissions per 100000 children. Sixty-two (93%) of 67 counties remained in the same or an adjacent admission rate quintile after children with comorbid chronic conditions were excluded. On average, the county admission rates for pneumonia without comorbid chronic conditions were 58.1% of their admission rates for all pneumonia.

Conclusions. County pediatric pneumonia admission rates vary widely, even among geographically contiguous and demographically similar counties. Excluding children with comorbid chronic conditions, to control for varying community disease burdens, did not alter substantially the county rank order or the pattern or degree of variations in admission rates in our study.
Axial and Radial Diffusivity in Preterm Infants Who Have Diffuse White Matter Changes on Magnetic Resonance Imaging at Term-Equivalent Age
Authors: Counsell Serena J. , Shen Yuji , Boardman James P. , Larkman David J. , Kapellou Olga , Ward Philip , Allsop Joanna M. , Cowan Frances M. , Hajnal Joseph V. , Edwards A. David , Rutherford Mary A.
Published: February 2006

Objective. Diffuse excessive high signal intensity (DEHSI) is observed in the majority of preterm infants at term-equivalent age on conventional MRI, and diffusion-weighted imaging has shown that apparent diffusion coefficient values are elevated in the white matter (WM) in DEHSI. Our aim was to obtain diffusion tensor imaging on preterm infants at term-equivalent age and term control infants to test the hypothesis that radial diffusivity was significantly different in the WM in preterm infants with DEHSI compared with both preterm infants with normal-appearing WM on conventional MRI and term control infants.

Methods. Diffusion tensor imaging was obtained on 38 preterm infants at term-equivalent age and 8 term control infants. Values for axial (λ1) and radial [(λ2 + λ3)/2] diffusivity were calculated in regions of interest positioned in the central WM at the level of the centrum semiovale, frontal WM, posterior periventricular WM, occipital WM, anterior and posterior portions of the posterior limb of the internal capsule, and the genu and splenium of the corpus callosum.

Results. Radial diffusivity was elevated significantly in the posterior portion of the posterior limb of the internal capsule and the splenium of the corpus callosum, and both axial and radial diffusivity were elevated significantly in the WM at the level of the centrum semiovale, the frontal WM, the periventricular WM, and the occipital WM in preterm infants with DEHSI compared with preterm infants with normal-appearing WM and term control infants. There was no significant difference between term control infants and preterm infants with normal-appearing WM in any region studied.

Conclusions. These findings suggest that DEHSI represents an oligodendrocyte and/or axonal abnormality that is widespread throughout the cerebral WM.
A Double-Blind, Randomized, Controlled Study of a “Stress Dose” of Hydrocortisone for Rescue Treatment of Refractory Hypotension in Preterm Infants
Authors: Ng Pak C. , Lee Cheuk H. , Bnur Flora Liu , Chan Iris H.S. , Lee Anthony W.Y. , Wong Eric , Chan Hin B. , Lam Christopher W.K. , Lee Benjamin S.C. , Fok Tai F.
Published: February 2006

Objective. To assess the effectiveness of a “stress dose” of hydrocortisone for rescue treatment of refractory hypotension and adrenocortical insufficiency of prematurity in very low birth weight (VLBW) infants. We hypothesized that significantly more VLBW infants who were receiving dopamine ≥10 μg/kg per min could wean off vasopressor support 72 hours after treatment with hydrocortisone.

Methods. A double-blind, randomized, controlled study was conducted in a university neonatal center. Forty-eight VLBW infants who had refractory hypotension and required dopamine ≥10 μg/kg per min were randomly assigned to receive a stress dose of hydrocortisone (1 mg/kg every 8 hours for 5 days; n = 24) or an equivalent volume of the placebo solution (isotonic saline; n = 24).

Results. The baseline clinical characteristics were similar between the groups. Serum cortisol concentrations were very low immediately before randomization in both groups of infants. Significantly more VLBW infants who were treated with hydrocortisone weaned off vasopressor support 72 hours after starting treatment. The use of volume expander, cumulative dose of dopamine, and dobutamine were significantly less in hydrocortisone-treated infants compared with control infants. In addition, the median duration of vasopressor treatment was halved in hydrocortisone-treated patients. Two versus 11 infants in the hydrocortisone and control groups required a second vasopressor for treatment of refractory hypotension. The trend (linear and quadratic) of the mean arterial blood pressure was also significantly and consistently higher in hydrocortisone-treated infants.

Conclusions. A stress dose of hydrocortisone was effective in treating refractory hypotension in VLBW infants. Although routine and prophylactic use of systemic corticosteroids could not be recommended because of their potential adverse effects, this relatively low dose of hydrocortisone would probably be preferable to high-dose dexamethasone for treatment of refractory hypotension in emergency and life-threatening situations.
A Survey of Delivery Room Resuscitation Practices in the United States
Authors: Leone Tina A. , Rich Wade , Finer Neil N.
Published: February 2006

Objective. To determine current resuscitation practices of neonatologists in the United States.

METHODS. A 15-question survey was developed and mailed to neonatal directors in May 2004.

ELRESULTS. Of the total of 797 surveys mailed, 84 were returned undeliverable or unanswered and 450 were returned completed (63% response rate). Respondents were mainly (70%) from level III NICUs. Most programs resuscitate newborns in the delivery room (83%), rather than in a separate room. The number and background of individuals attending deliveries vary greatly, with 31% of programs having <3 individuals attending deliveries. Flow-inflating bags are most commonly used (51%), followed by self-inflating bags (40%) and T-piece resuscitators (14%). Pulse oximeters are used during resuscitation by 52% of programs, and 23% of respondents indicated that there was a useful signal within 1 minute after application. Blenders are available for 42% of programs, of which 77% use pure oxygen for the initial resuscitation and 68% use oximeters to alter the fraction of inspired oxygen. Thirty-two percent of programs use carbon dioxide detectors to confirm intubation, 48% routinely and 43% when there is difficulty confirming intubation. Preterm infants are wrapped with plastic wrap to prevent heat loss in 29% of programs, of which 77% dry the infant before wrap application. A majority of programs (76%) attempt to provide continuous positive airway pressure or positive end expiratory pressure (PEEP) during resuscitation, most commonly with a flow-inflating bag (58%), followed by a self-inflating bag with PEEP valve (19%) and T-piece resuscitator (16%). A level of 5 cm H2O is used by 55% of programs.

CONCLUSIONS. Substantial variations exist in neonatal resuscitation practices, some of which are not addressed in standard guidelines. Future guidelines should include recommendations regarding the use of blenders, oximeters, continuous positive airway pressure/PEEP, and plastic wrap during resuscitation.
Child Outcomes and Family Characteristics 1 Year After Severe Inflicted or Noninflicted Traumatic Brain Injury
Authors: Keenan Heather T. , Runyan Desmond K. , Nocera Maryalice
Published: February 2006

Objective. To assess outcomes 1 year after severe traumatic brain injury (TBI) among young children and to compare outcomes between children with inflicted versus noninflicted injuries.

Study Design. Prospective cohort study.

Methods. All North Carolina-resident children who were hospitalized between January 2000 and December 2001 in any of the state's 9 PICUs and who survived a severe TBI that occurred on or before their second birthday were eligible to participate. Child health status, child use of ancillary medical resources, and family characteristics were determined through maternal caregiver interviews ∼1 year after injury. Comparisons were made between family characteristics and child outcomes according to injury type.

Results. Seventy-two interviews of maternal caregivers were completed among 112 survivors (64.3%). Children with inflicted injuries (n = 41) had worse outcomes than did children with noninflicted injuries (n = 31), as measured with the Pediatric Outcome Performance Category and Stein-Jessup Functional Status II (Revised) tools. However, ∼50% of children with inflicted injuries had only mild deficits or better. Children with inflicted injuries had a higher use of ancillary medical resources. Families caring for the children did not differ substantively, with a large proportion of single, working, minority mothers.

Conclusions. Children with inflicted TBIs had worse outcomes than did children with other TBIs 1 year after injury. However, outcomes for these children were better than those reported previously. Many families caring for children after severe TBI are socially disadvantaged. Interventions to improve child outcomes may include enhanced family support.
Cerebral Oxygenation and Electrical Activity After Birth Asphyxia: Their Relation to Outcome
Authors: Toet Mona C. , Lemmers Petra M.A. , van Schelven Leonard J. , van Bel Frank
Published: February 2006

OBJECTIVE. To determine the value of regional cerebral oxygen saturation (rSo2), fractional cerebral tissue oxygen extraction (FTOE) measured by near-infrared spectroscopy (NIRS), and amplitude integrated electroencephalogram (aEEG) after birth asphyxia in relation to neurodevelopmental outcome.

METHODS. NIRS measured rSo2, FTOE, and aEEG were monitored simultaneously, together with arterial oxygen saturation (Sao2) and blood pressure during the first 48 hours after severe birth asphyxia in 18 term infants. FTOE was calculated as [Sao2 − rSo2]/Sao2. Neurodevelopmental outcome was assessed at 3, 9, and 18 months and 3 and 5 years of age. At the time points 6, 12, 18, 24, 30, 36, 42, and 48 hours after birth, the mean values of Sao2, rSo2, FTOE, and mean arterial blood pressure were calculated over a 1-hour period. A stepwise-regression model was used to investigate the relative contribution of rSo2, FTOE, or aEEG to developmental outcome.

RESULTS. Nine Infants died during the neonatal period as a result of neurologic deterioration, and 8 infants had a normal outcome at 5 years of age. One child developed learning disabilities and a mild diplegia. The rSo2 and FTOE remained stable in infants with a normal outcome. The rSo2 increased and the FTOE decreased after 24 hours in the infants with an adverse outcome. (rSo2: 65% vs 84% at 12 and 48 hours, respectively; FTOE: 0.32 vs 0.12 at 12 and 48 hours, respectively). aEEG showed the closest relationship with outcome, but also rSo2 showed a significant correlation 24 hours after birth.

CONCLUSIONS. rSo2 and FTOE seem to reflect secondary energy failure. aEEG showed the closest relationship with outcome after severe birth asphyxia.
Increases in Overweight After Adenotonsillectomy in Overweight Children With Obstructive Sleep-Disordered Breathing Are Associated With Decreases in Motor Activity and Hyperactivity
Authors: Roemmich James N. , Barkley Jacob E. , D'Andrea Lynn , Nikova Margarita , Rogol Alan D. , Carskadon Mary A. , Suratt Paul M.
Published: February 2006

Objective. To examine the effect of adenotonsillectomy (T&A) in children with obstructive sleep-disordered breathing on growth, hyperactivity, and sleep and waking motor activity.

Methods. We studied 54 children who were aged 6 to 12 years and had adenotonsillar hypertrophy and an obstructive apnea-hypopnea index of ≥1 before and 12 months after they all received adenotonsillectomy (T&A). We measured their height, weight, percentage overweight (patient BMI − BMI at 50th percentile)/BMI at 50th percentile * 100) and obtained a hyperactivity score from parent report on a standardized behavior questionnaire scale. A subset of 21 of these children were also studied for motor activity by wrist actigraphy for 7 consecutive days and nights before and 12 months after T&A.

Results. After T&A, mean obstructive apnea-hypopnea index decreased from 7.6 to 0.6. Height percentile did not change, but weight percentile increased; as a consequence, percentage overweight increased from 32.0% to 36.3%. Hyperactivity scores and total daily motor activity were reduced after T&A. From linear regression, the reduction in hyperactivity scores predicted an increase in percentage overweight. Reduced motor activity was correlated with increased percentage overweight.

Conclusions. An increase in percentage overweight after T&A in children with obstructive sleep-disordered breathing is correlated to decreased child hyperactivity scores and to decreased measured motor activity in the subset studied. These associations suggest that the increase in overweight may be attributable to reductions in physical activity and fidgeting energy expenditure.
Influenza Vaccinations of Young Children Increased With Media Coverage in 2003
Authors: Ma K.K. , Schaffner W. , Colmenares C. , Howser J. , Jones J. , Poehling K.A.
Published: February 2006

OBJECTIVE. We sought to evaluate the impact of intense influenza media coverage during the 2003–2004 influenza season on the influenza vaccination status of children 6 to 59 months of age.

METHODS. Children 6 to 59 months of age who presented to a large, academic pediatric continuity clinic or affiliated acute care clinic in the summer of 2004 were enrolled. A parental survey ascertained the influenza vaccination status of the child and family members during the 2003–2004 influenza season and factors that influenced their vaccination status. For children vaccinated in the clinic or health department, influenza vaccination dates were confirmed in a computerized medical chart or state immunization registry.

RESULTS. Of 256 enrolled children, 98 (38%) parents reported that their child had received the 2003–2004 influenza vaccine, and 64 (65%) had confirmed influenza vaccination dates. Unlike the previous influenza season in which confirmed influenza vaccination dates from a similar study population were distributed more evenly from October through December, most children (75%) with confirmed vaccination dates received the vaccine after the media coverage in mid-November. Influenza vaccinations per week increased dramatically after the media coverage began (2.4 vs 8.6 per week; t test: P < .001). In late November and December 2003, the influenza-related media coverage, which focused primarily on an early, severe influenza season, increased dramatically and explained 85% of the variation in influenza vaccinations. Multivariate analysis showed that recalling a physician recommendation (odds ratio [OR]: 6.8; 95% confidence interval [CI]: 2.3–19.7), having a family member who had received the influenza vaccine (OR: 9.5; 95% CI: 4.3–21.3), having a continuity clinic visit between October and January (OR: 4.5; 95% CI: 2.0–10.1), and having a high-risk medical condition (OR: 2.9; 95% CI: 1.1–7.8) strongly predicted the influenza vaccination status in the children.

CONCLUSION. Media coverage in conjunction with explicit physician recommendation for children and their contacts are key factors that are associated with influenza vaccination rates in children.
Behavior Problems Among Inner-City Children With Asthma: Findings From a Community-Based Sample
Authors: Halterman Jill S. , Conn Kelly M. , Forbes-Jones Emma , Fagnano Maria , Hightower A. Dirk , Szilagyi Peter G.
Published: February 2006

OBJECTIVE. Previous studies have suggested a relationship between childhood asthma and behavior problems. However, few studies have used community-based samples to assess the prevalence of behavior problems among urban children with asthma symptoms. The objective of this study was to evaluate the relationship between asthma symptoms and behavior among a population-based sample of inner-city children and to determine the prevalence of behavioral comorbidity among children with asthma symptoms.

METHODS. In 2003, parents of children who were entering kindergarten in the city of Rochester completed a detailed survey regarding the child's background, medical history (with specific questions about asthma symptoms), and behavior. We compared children with no asthma symptoms, intermittent symptoms, and persistent symptoms with regard to positive peer social skills (eg, makes friends easily), negative peer social skills (eg, fights with other children), task orientation (eg, concentrates well), and shy/anxious behavior (eg, is withdrawn) (validated scales; range: 1–4). We used multivariate regression to determine the independent association between symptom severity and behavioral outcomes.

RESULTS. A total of 1619 children were included (response rate: 80%; mean age: 5.1 year), and 15% had asthma symptoms (8% persistent, 7% intermittent). Average negative peer scores were worse for children with persistent asthma symptoms compared with children with intermittent and no symptoms (mean scores: 1.88, 1.70, and 1.65). Children with persistent symptoms also scored worse than children with no symptoms on the assessment of task orientation (2.85 vs 3.03) and shy/anxious behavior (2.11 vs 1.89). Among children with persistent asthma symptoms, >20% scored >1 SD below average on 2 or more scales, compared with 16% of children with intermittent symptoms and 10% with no symptoms.

CONCLUSIONS. Urban children with persistent asthma symptoms demonstrate more behavior problems across several domains compared with children with no symptoms. These findings suggest a clear need for an early biopsychosocial approach to care for vulnerable children with asthma.
Body-Checking Rules and Childhood Injuries in Ice Hockey
Authors: Macpherson Alison , Rothman Linda , Howard Andrew
Published: February 2006

BACKGROUND. Body checking is the predominant mechanism of youth ice hockey injuries. The Canadian Hockey Association has allowed body checking from ages 12 to 13 (peewee level) and up. One Canadian province (Ontario) introduced body checking at ages 10 to 11 (atom level) in the competitive leagues, whereas in Quebec body checking has only been allowed at ages 14 to 15 (bantam Level). The purpose of this study was to compare body-checking injuries, fractures, and concussions in boys' minor hockey between jurisdictions in which checking is allowed and jurisdictions in which body checking is not allowed.

METHODS. Data from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) were used to characterize children's ice hockey injuries from September 1995 to the end of August 2002. Children treated at CHIRPP hospitals in areas in which checking was allowed were compared with children in areas in which checking was not allowed.

RESULTS. Of the 4736 hockey injuries, 3006 (63%) were in Ontario and 1730 (37%) were in Quebec. Most of the injuries occurred in areas in which checking was allowed (2824 [59.6%]). At ages 10 to 13, players had significantly greater odds of suffering a checking injury where checking was allowed (odds ratio [OR]: 1.86; 95% confidence interval [CI]: 1.6–2.11). Players in this age group were also more likely to suffer a concussion (OR: 1.42; 95% CI: 0.98–2.05) or fracture (OR: 1.25; 95% CI: 1.06–1.47) where checking was allowed. Among older players, when checking was allowed in both provinces, there were higher odds (OR: 1.90; 95% CI: 1.36–2.66) of receiving a checking injury in the province that had introduced checking at a younger age, suggesting that there is no protective effect from learning to check earlier.

CONCLUSIONS. Increased injuries attributable to checking were observed where checking was allowed. This study supports policies that disallow body checking to reduce ice hockey injuries in children.
Weight Teasing and Disordered Eating Behaviors in Adolescents: Longitudinal Findings From Project EAT (Eating Among Teens)
Authors: Haines Jess , Neumark-Sztainer Dianne , Eisenberg Marla E. , Hannan Peter J.
Published: February 2006

OBJECTIVE. To assess whether weight-related teasing predicts the development of binge eating, unhealthy weight control behaviors, and frequent dieting among male and female adolescents.

METHODS. A prospective study was conducted with an ethnically and socioeconomically diverse sample of 2516 adolescents who completed surveys at both time 1 (1998–1999) and time 2 (2003–2004) of the Project EAT (Eating Among Teens) study.

RESULTS. In 1998–1999, approximately one fourth of participants reported being teased about their weight at least a few times a year. After adjustment for age, race/ethnicity, socioeconomic status (SES), and BMI, boys who were teased about their weight were more likely than their peers to initiate binge eating with loss of control and unhealthy weight control behaviors 5 years later. The predicted prevalence for incident binge eating behaviors with loss of control among boys who were teased was 4.1% as compared with 1.4% for those who were not teased, after adjustment for age, race/ethnicity, SES, and BMI. For unhealthy weight control behaviors at time 2, the predicted prevalence was 27.5% among boys who were teased and 19.3% for boys who were not teased, after adjustment for age, race/ethnicity, SES, and BMI. Girls who were teased were more likely than their peers to become frequent dieters. The predicted prevalence for incident frequent dieting among girls who were teased was 18.2% as compared with 11.0% for those who were not teased, after adjustment for age, race/ethnicity, SES, and BMI.

CONCLUSIONS. Weight teasing in adolescence predicts disordered eating behaviors at 5-year follow-up. The patterns of these associations differ by gender. Reducing teasing through educational interventions and policies may reduce the level of disordered eating behaviors among youths.
Of Lobsters, Electronic Medical Records, and Neonatal Total Parenteral Nutrition
Authors: Costakos Dennis T.
Published: February 2006

At the Mayo Health System in LaCrosse, Wisconsin, there are >1000 infant total parenteral nutrition (TPN) orders placed per year. It is the most complicated order that the pharmacy fills, so a recent peer-review article in Pediatrics moved a group of us to action at our center to buy or develop a TPN calculator. We did this because no stand-alone commercial calculators were available to us, and expensive electronic medical records typically do not include TPN calculators for neonatal patients. The new software includes decision support, and the orders are consistently legible. The physician performs fewer calculations, and there are no mathematical errors. This article examines the broader significance of providers having to write their own TPN software.
Association Between Bone Density and Fractures in Children: A Systematic Review and Meta-analysis
Authors: Clark E.M. , Tobias J.H. , Ness A.R.
Published: February 2006

OBJECTIVE. The objective of this article was to systematically review all published studies that investigated the association between bone density and fractures in children.

DESIGN. Potentially relevant articles were identified by searching electronic databases. Duplicates were removed, abstracts were inspected, and relevant articles were obtained. Studies were included in the systematic review if participants were <16.0 years old, were healthy, had extractable data on bone mass, and had fractures as the outcome.

RESULTS. Ten case-control studies were identified. No prospective studies were found. There was no evidence of heterogeneity between studies or of funnel-plot asymmetry. Eight of the studies were included in the meta-analysis, because they presented results as means and standard deviations of bone density in cases and controls. The pooled standardized mean difference for bone mass in children with and without fractures, from a fixed-effects model, was −0.32 (95% confidence interval: −0.43 to −0.21).

CONCLUSIONS. Evidence for an association between bone density and fractures in children is limited. The results from this meta-analysis suggest that there is an association between low bone density and fractures in children. Although there was no evidence of heterogeneity or publication bias, this meta-analysis is based on case-control studies that are prone to bias. Large, well-conducted prospective cohort studies are required to confirm the association between bone density and fractures in children.
Physical Health Outcomes of Childhood Exposure to Intimate Partner Violence: A Systematic Review
Authors: Bair-Merritt Megan H. , Blackstone Mercedes , Feudtner Chris
Published: February 2006

BACKGROUND. Children exposed to intimate partner violence (IPV) are at increased risk for adverse mental and behavioral health sequelae, as has been documented by both systematic reviews and meta-analyses. Studies addressing the physical health impact of childhood IPV exposure, however, have not been summarized in a manner that might facilitate additional hypothesis-driven research and accelerate the development of targeted interventions.

METHODS. To identify a comprehensive set of articles examining the association between childhood IPV exposure and physical health, we searched online bibliographic databases including Medline, CINAHL, PsychInfo, and Sociological Abstracts using the keywords “domestic” or “intimate partner violence” and “infant,” “child,” or “pediatric.” From >2000 articles retrieved in the initial search, we used online abstract and bibliographic information to identify 94 articles potentially meeting the inclusion criteria of studies that (1) examined a postnatal physical health outcome related to IPV exposure and (2) had a contemporaneous control group. Thorough review of these 94 published studies yielded 22 that met these inclusion criteria. The data then were abstracted independently by 2 of the authors, and differences were settled with the assistance of a third author.

RESULTS. Childhood exposure to IPV increases the likelihood of risk-taking behaviors during adolescence and adulthood and is likely associated with underimmunization. Minimal data and study limitations preclude establishing a clear connection between IPV exposure and general health and use of health services, breastfeeding, or weight gain.

CONCLUSIONS. The impact on physical health from exposure to IPV during childhood is still uncertain. Future studies should be grounded in a theoretical model that specifies how IPV exposure can affect child health, should adjust for confounders adequately, should include a community-based sample, and should be of larger scale.
Evaluation of a School-Based Tuberculosis-Screening Program and Associate Investigation Targeting Recently Immigrated Children in a Low-Burden Country
Authors: Brassard Paul , Steensma Colin , Cadieux Louise , Lands Larry C.
Published: February 2006

CONTEXT. In countries with a low incidence of tuberculosis (TB), screening programs targeting recent immigrants from TB-endemic countries have been shown to be effective in further reducing TB incidence; however, evaluative data on some aspects of these programs remain sparse.

OBJECTIVE. We sought to retrospectively evaluate a school-based screening program targeting children at high risk for TB infection in Montreal, Canada, as well as subsequently investigate family and household associates of the schoolchildren with latent TB infection (LTBI), based on adherence to LTBI therapy and cost-benefit analysis.

DESIGN, SETTING, AND PARTICIPANTS. Newly arrived immigrant children (aged 4–18 years) in selected schools were screened for LTBI by using the tuberculin skin test (TST). The TST was defined as positive at an induration of ≥10 mm. Each child who tested positive on the TST was referred for medical evaluation. Family and household associates of the TST-positive child also were screened for LTBI. Classroom attendance sheets and medical charts were reviewed for 16 elementary and secondary schools that comprised the school-screening program of the Montreal Children's Hospital from 1998 to 2003. Medical charts of the child associates (<18 years old) who were screened were reviewed also.

MAIN OUTCOME MEASURES. The main outcome measures were TST-positivity rate, rate of adherence to LTBI therapy, estimation of factors associated with adherence, and net cost/benefit of the school-screening and associate-investigation programs, both respectively and as a combined program, compared with the cost of passive treatment of TB disease.

RESULTS. Of 2524 immigrant children screened, 542 (21%) were TST-positive. Of 342 children started on therapy, 316 (92%) demonstrated adequate adherence. The only predictor of adherence among the schoolchildren was having ≥2 family members brought in for TB screening (adjusted odds ratio: 2.0; 95% confidence interval: 1.3–3.3). There were 599 associates investigated from the 484 TST-positive schoolchildren seen at the TB clinic. Of 555 associates with TST results, 211 (38%) were found to be TST-positive. Of 136 TST-positive child associates, 131 were seen at the Montreal Children's Hospital TB clinic and had their chart reviewed. Of these, 108 (82%) were started on LTBI therapy, and 78 (79%) of 99 of those children with information complied adequately with their therapy. We found net benefits from both school-based screening and associate investigation, both as stand-alone programs and as 1 coordinated, targeted TB-screening program.

CONCLUSION. We demonstrated the effectiveness, including cost-effectiveness, of a targeted, school-based screening program in a low-burden country and the extra benefit given by adding associates to such a program.
Visceral Larva Migrans Associated With Earthworm Ingestion: Clinical Evolution in an Adolescent Patient
Authors: Cianferoni Antonella , Schneider Lynda , Schantz Peter M. , Brown Daniel , Fox LeAnne M.
Published: February 2006

A 16-year-old girl developed a cough, hypereosinophilia (absolute eosinophil count: 32000/mm3), hypergammaglobulinemia, and multiple noncavitary pulmonary nodules 1 month after having ingested an earthworm on a dare. Spirometry revealed moderate restriction and reduced gas diffusion. Parabronchial biopsy demonstrated eosinophilic organizing pneumonitis with multiple eosinophilic microabscesses, and Toxocara titers were elevated (>1:4096). Ophthalmologic examination ruled out ocular larva migrans. The patient received a 10-day course of albendazole (400 mg orally twice daily) and demonstrated significant clinical improvement with resolution of cough and pulmonary function abnormalities. Her white blood cell count and hypergammaglobulinemia normalized within 20 days, yet eosinophils (absolute eosinophil count: 1780/mm3) and Toxocara serologies (>1:4096) remained elevated 3 months after completing antihelminthic therapy. In this instance, the ingested earthworm served as the paratenic carrier of Toxocara larvae from the soil to the patient. This case highlights the clinical evolution of pulmonary visceral larva migrans infection caused by Toxocara spp. associated with a discrete ingestion in an adolescent patient. In addition, it provides a rare opportunity to define the incubation period of visceral larva migrans and emphasizes the importance of education regarding sources of Toxocara infection.
Toddlers at Risk for Paper Shredder Injury in the Home: Easy Access and Severe Injury
Authors: Warren Ramona C. , Foltin George L.
Published: February 2006

A 2-year-old girl sustained severe injury to 2 fingers from a home paper shredder. This case illustrates the risk of injury from paper shredders, which are increasingly common household items. Toddlers are at risk of finger injury and amputation. The US Consumer Product Safety Commission performed an investigation of reported injuries and the characteristics of paper shredders that might have contributed to the injuries, and we summarize their findings.