bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Body Weight and Height of Israeli Schoolchildren With the Tanner and Centers for Disease Control and Prevention Growth Charts
Authors: Goldstein Abraham , Haelyon Uri , Krolik Evgenia , Sack Joseph
Published: August 2004

Objective. To examine the suitability of the growth charts that are currently used in Israel and consider their replacement with a recent standard. In a sample of schoolchildren, the current Tanner and Whitehouse standards were compared with the new growth charts from the Centers for Disease Control and Prevention (CDC).

Method. A total of 746 Israeli healthy children (368 boys and 378 girls) aged 6 to 14 years were sampled from 2 super-regional schools (from the Jewish population). Height was measured using the Leicester height measure, and weight was measured using scales calibrated by the researchers.

Results. In height, 75% of the boys and 81% of the girls fell in the 10th to 90th percentile range of the Tanner standards. In weight, 71% of the boys and 81% of the girls were in the 10th to 90th percentile range. Israeli boys were taller (χ2(1) = 30.53) and heavier (χ2(1) = 29.39), and girls were taller (χ2(1) = 13.81) than predicted by the Tanner standards. The CDC 10th to 90th percentile range included 81% of the boys and 83% of the girls for height and 78% of the boys and 81% of the girls for weight. The girls in our sample were slightly shorter (χ2(1) = 11.87) and lighter (χ2(1) = 9.52) than predicted from the CDC charts. Nevertheless, neither boys’ nor girls’ body mass index measures (kg/h2) differed from the CDC charts.

Conclusions. Our data suggest that the CDC growth charts are adequate for assessing Israeli children and slightly better than the current standard. Thus, in the absence of local standards, we recommend the use of the revised CDC growth charts, which include the additional body mass index measure.
Eosinophilic Cystitis in a 4-Year-Old Boy: Successful Long-Term Treatment With Cyclosporin A
Authors: Pomeranz Avishalom , Eliakim Alon , Uziel Yosef , Gottesman Giora , Rathaus Valeria , Zehavi Tanya , Wolach Baruch
Published: August 2004

A 4-year-old Jewish boy presented with dysuria, urinary dribbling, increased urinary frequency, and new onset of diurnal enuresis. An infiltrating solid mass involving the entire bladder wall was found. Biopsy revealed “tumor-forming” eosinophilic cystitis, a rare bladder lesion of unclear cause. Antitoxocariasis treatment was unsuccessful. High-dose corticosteroids failed. The child’s clinical condition and bladder sonographic findings continued to deteriorate. Treatment with cyclosporin A was given for 8 months, with a complete clinical, radiologic, and histopathologic cure and no side effects. Two years of follow-up showed a complete recovery.
Neonatal Aortic Arch Thrombosis as a Result of Congenital Cytomegalovirus Infection
Authors: Lanari Marcello , Lazzarotto Tiziana , Papa Irene , Venturi Valentina , Bronzetti Gabriele , Guerra Brunella , Faldella Giacomo , Corvaglia Luigi , Picchio Fernando Maria , Landini Maria Paola , Salvioli Gian Paolo
Published: August 2004

Thrombotic disease is rare in neonates. The main risk factors at this age are perinatal asphyxia, maternal diabetes, sepsis, polycythemia, dehydration, a low cardiac output, and in primis the catheterization of central lines. Another important risk factor is inherited thrombophilia. Arterial thrombosis is even more rare than venous thrombosis and less related to most of the risk factors listed above; it occurs more frequently in the iliac, femoral, and cerebral arteries but very rarely in the aorta. Most of the described cases of aortic thrombosis are associated with the catheterization of an umbilical artery and involve the descending tract and the renal arteries; very few relate to the ascending tract and the aortic arch. The possible role of virus-induced primary vascular endothelium damage in the etiopathogenesis of neonatal arterial thrombosis has been previously hypothesized. Herpesviruses, particularly human cytomegalovirus (HCMV), can infect endothelial cells and directly damage intact vascular endothelium, altering its thromboresistant surface as a result of procoagulant activity mediated by specific viral surface phospholipids, necessary for the coagulation enzyme complex assembly that leads to thrombin generation. We describe a case of congenital aortic arch thrombosis. The clinical, laboratory, and virologic pictures; the anatomopathologic findings (fully compatible with viral infection); the detection of HCMV in various tissues (including the aorta); and the absence of other causes of aortic thrombosis make it possible to attribute the case to a severe congenital HCMV infection with multiple organ involvement, after the primary infection of the mother. The hemostatic system disorders and hemodynamic disturbances related to viral cardiac damage explain the clinical features of the case and indicate that congenital HCMV infection should be included among the causes of neonatal aortic thrombosis.
Immunologic and Epidemiologic Experience of Vaccination With a Monocomponent Pertussis Toxoid Vaccine
Authors: Taranger John , Trollfors Birger , Bergfors Elisabet , Knutsson Nina , Lagergård Teresa , Schneerson Rachel , Robbins John B.
Published: August 2004

Pertussis re-emerged in Sweden with a cumulative incidence of about 60% during the first 10 years of life, when the locally produced cellular vaccine lost its efficacy around 1970 and general vaccination was discontinued in 1979. The epidemiology, clinical features, and immunology of pertussis and a monocomponent pertussis toxoid vaccine were studied in Göteborg, Sweden.

After phase 1 and 2 studies, a randomized, double-blind, placebo-controlled trial of pertussis toxoid (PTox), compounded with diphtheria and tetanus toxoids, was administered to 3450 children according to the Swedish schedule at 3, 5, and 12 months of age. After a mean follow-up of 18 months, the efficacy was 71% overall and 75% in household contacts, respectively. A statistically significant correlation was found between the level of PTox-induced antibodies and protection against pertussis. As observed with cellular and with multicomponent acellular vaccines, PTox reduced the severity of disease and the percent of children with positive cultures. Furthermore, vaccination reduced the transmission of Bordetella pertussis to household contacts in the vaccinees compared with the controls who received only diphtheria and tetanus toxoids. Patients with culture-verified Bordetella parapertussis infection reacted with antibodies to pertactin and to filamentous hemagglutinin but not to pertussis toxin, and some subsequently developed pertussis. The antibody responses of patients with pertussis to the surface polysaccharides of B pertussis and to B parapertussis were cross-reactive serologically. Serosurveys showed that only antibodies to pertussis toxin were related to the occurrence of pertussis in the general population: antibodies to filamentous hemagglutinin and pertactin were probably stimulated by antigens of other bacteria as well as Bordetellae.

Mass vaccination of Göteborg children born in the 1990s was started in 1995. In February 1999, about 55% had been vaccinated and both B pertussis and pertussis decreased significantly in individuals of all ages (herd immunity). Similar to diphtheria, PTox-induced immunity to pertussis occurs both on an individual and community basis.

The apparent greater efficacy of multicomponent acellular pertussis vaccines compared with monocomponent PTox was proposed to be an artifact created when the diagnosis of pertussis was made by the serologic criteria of the World Health Organization only. Our conclusion is that PTox is both an essential and alone sufficient antigen in acellular pertussis vaccines.
Medical Staff Appointment and Delineation of Pediatric Privileges in Hospitals
Authors: O’Connor Mary E. ,   Committee on Hospital Care
Published: August 2004

The review and verification of credentials and the granting of clinical privileges are required of every hospital to ensure that members of the medical staff are competent and qualified to provide specified levels of patient care. The credentialing process involves the following: 1) assessment of the professional and personal background of each practitioner seeking privileges; 2) assignment of privileges appropriate for the clinician’s training and experience; 3) ongoing monitoring of the professional activities of each staff member; and 4) periodic reappointment to the medical staff on the basis of objectively measured performance.

This statement examines the essential elements of a credentials review for initial and renewed medical staff appointments along with suggested criteria for the delineation of clinical privileges. Sample forms for the delineation of privileges can be found on the American Academy of Pediatrics Web site (http://www.aap.org/visit/cmte19.htm). Because of the differences in individual hospitals, no one method for credentialing is universally applicable. The medical staff of each hospital must, therefore, establish its own process based on the general principles reviewed in this statement. The issues of medical staff membership and credentialing have become very complex, and institutions and medical staffs are vulnerable to legal action. Consequently, it is advisable for hospitals and medical staffs to obtain expert legal advice when medical staff bylaws are constructed or revised.
Health Supervision for Children With Turner Syndrome
Authors: Frías Jaime L. , Davenport Marsha L. ,   Committee on Genetics,   Section on Endocrinology
Published: August 2004

This Clinical Report was retired October 2008.

This report is designed to assist the pediatrician in caring for the child in whom the diagnosis of Turner syndrome has been confirmed by karyotyping. The report is meant to serve as a supplement to the American Academy of Pediatrics’ “Recommendations for Preventive Pediatric Care” and emphasizes the importance of continuity of care and the need to avoid its fragmentation by ensuring a medical home for every girl with Turner syndrome. The pediatrician’s first contact with a child with Turner syndrome may occur during infancy or childhood. This report also discusses interactions with expectant parents who have been given the prenatal diagnosis of Turner syndrome and have been referred for advice.
Prevention and Treatment of Type 2 Diabetes Mellitus in Children, With Special Emphasis on American Indian and Alaska Native Children
Authors: Gahagan Sheila , Silverstein Janet ,   Committee on Native American Child Health,   Section on Endocrinology
Published: August 2004

The emergence of type 2 diabetes mellitus in the American Indian/Alaska Native pediatric population presents a new challenge for pediatricians and other health care professionals. This chronic disease requires preventive efforts, early diagnosis, and collaborative care of the patient and family within the context of a medical home.
Maternal Depression, Changing Public Assistance, Food Security, and Child Health Status
Authors: Casey Patrick , Goolsby Susan , Berkowitz Carol , Frank Deborah , Cook John , Cutts Diana , Black Maureen M. , Zaldivar Nieves , Levenson Suzette , Heeren Tim , Meyers Alan ,   the Children’s Sentinel Nutritional Assessment Program Study Group
Published: August 2004

Objective. To examine the association of positive report on a maternal depression screen (PDS) with loss or reduction of welfare support and foods stamps, household food insecurity, and child health measures among children aged ≤36 months at 6 urban hospitals and clinics.

Methods. A convenience sample of 5306 mothers, whose children <36 months old were being seen in hospital general clinics or emergency departments (EDs) at medical centers in 5 states and Washington, District of Columbia, were interviewed from January 1, 2000 until December 31, 2001. Questions included items on sociodemographic characteristics, federal program participation and changes in federal benefits, child health status rating, child’s history of hospitalizations since birth, household food security status, and a 3-question PDS. For a subsample interviewed in the ED, whether the child was admitted to the hospital that day was recorded.

Results. PDS status was associated with loss or reduction of welfare support and food stamps, household food insecurity, fair/poor child health rating, and history of child hospitalization since birth but not low child growth status measures or admission to the hospital at the time of ED visit. After controlling for study site, maternal race, education, and insurance type as well as child low birth weight status, mothers with PDS were more likely to report fair/poor child health (adjusted odds ratio [AOR]: 1.58; 95% confidence interval [CI]: 1.33–1.88) and hospitalizations during the child’s lifetime (AOR: 1.20; 95% CI: 1.03–1.39), compared with mothers without PDS. Controlling for the same variables, mothers with PDS were more likely to report decreased welfare support (AOR: 1.52; 95% CI: 1.03–2.25), to have lost food stamps (AOR: 1.56; 95% CI: 1.06–2.30), and reported more household food insecurity (AOR: 2.69; 95% CI: 2.33–3.11) than mothers without PDS.

Conclusion. Positive maternal depression screen status noted in pediatric clinical samples of infants and toddlers is associated with poorer reported child health status, household food insecurity, and loss of federal financial support and food stamps. Although the direction of effects cannot be determined in this cross-sectional survey, child health providers and policy makers should be aware of the potential impact of maternal depression on child health in the context of welfare reform.
Evaluation of Neonatal Intensive Care for Extremely Low Birth Weight Infants in Victoria Over Two Decades: I. Effectiveness
Authors: Doyle Lex W. ,   the Victorian Infant Collaborative Study Group
Published: August 2004

Context. Although individual components of neonatal intensive care have proven efficacy, doubts remain about its overall effectiveness.

Objective. To determine the changes in effectiveness of neonatal intensive care for extremely low birth weight (ELBW) infants over 2 decades.

Design. Population-based cohort study of consecutive ELBW infants born during 4 distinct eras: 1979–1980, 1985–1987, 1991–1992, and 1997, all followed to at least 2 years of age.

Setting. The state of Victoria, Australia.

Patients. All ELBW live births of birth weight 500 to 999 g in the state in the calendar years indicated (1979–1980 [n = 351]; 1985–1987 [n = 560]; 1991–1992 [n = 429]; 1997 [n = 233]). Survivors were assessed at 2 years of age by pediatricians and psychologists blinded to perinatal details. The follow-up rates were high for each ELBW cohort (1979–1980: 100% [89 of 89]; 1985–1987: 100% [212 of 212]; 1991–1992: 98% [237 of 241]; 1997: 99% [168 of 170]).

Main Outcome Measures. Survival and quality-adjusted survival rates at 2 years of age.

Results. The survival rate to 2 years of age improved significantly between successive eras (absolute increase and 95% confidence interval: 1985–1987 vs 1979–1980, 12.5% and 6.3%–18.4%; 1991–1992 vs 1985–1987, 18.3% and 12.1%–24.4%; 1997 vs 1991–1992, 16.8% and 9.2%–23.9%), as did the quality-adjusted survival rate (absolute increase: 1985–1987 vs 1979–1980, 12.4%; 1991–1992 vs 1985–1987, 13.8%; 1997 vs 1991–1992, 13.2%). Overall, the survival rate increased from ∼1 in 4 (25%) in 1979–1980 to 3 in 4 (73%) in 1997, and the quality-adjusted survival rate also increased threefold, from 19% in 1979–1980 to 59% in 1997. The biggest gains in survival and quality-adjusted survival in the most recent era were in infants in lighter birth-weight subgroups.

Conclusion. The effectiveness of neonatal intensive care for ELBW infants in Victoria improved progressively from the late 1970s to the late 1990s.
Participation in Boxing by Children, Adolescents, and Young Adults
Authors:   Committee on Sports Medicine and Fitness
Published: August 2004

Because boxing may result in serious brain and eye injuries, the American Academy of Pediatrics opposes this sport. This policy statement summarizes the reasons.
Varicella and Zoster in Children After Kidney Transplantation: Long-term Results of Vaccination
Authors: Broyer Michel , Tete Marie José , Guest Genevieve , Gagnadoux Marie France , Rouzioux Christine
Published: August 2004

Objective. To determine the long-term prevalence of varicella infection and herpes zoster after kidney transplantation and to assess the effectiveness of varicella immunization with the Oka attenuated strain.

Methods. This study involved 704 children and adolescents who received a kidney graft in our institution from 1973 to 1994 and had routinely been given varicella vaccine beginning in 1980 in preparation for transplantation.

Results. After vaccination 62% of these patients still had varicella/zoster (VZ) antibodies at 1 year and 42% after 10 years. After transplantation the incidence of varicella was significantly lower, 26/212 (12%), in patients who received immunization than in those who did not and had no history of varicella, 22/49 (45%). The disease was also significantly less severe in the vaccinated patients (three deaths among naive patients vs none among vaccinees). In the vaccinees, varicella infection was observed only in those who did not develop or lost VZ antibodies; in addition, 21 patients of this subgroup had an asymptomatic seroconversion. Four of the 415 patients with a history of varicella had another episode of benign varicella after grafting. Herpes zoster was observed in 76 of the 704 patients included in the study. The prevalence differed according to VZ status at the time of grafting: 13% in patients with a history of varicella, 7% in the vaccinees, and 38% in the naive patients at grafting who developed varicella. Three rejection episodes occurred in association with a varicella episode and four with a zoster episode, but graft function was only transiently impaired, and as a whole varicella or zoster did not significantly affect graft function or survival.

Conclusion. Naive VZ patients with a kidney graft are at risk to develop severe varicella and this may be effectively prevented by available immunization.
β2-Agonist Metered Dose Inhaler Overuse: Psychological and Demographic Profiles
Authors: Beausoleil Janet L. , Weldon Daniel P. , McGeady Stephen J.
Published: August 2004

Objective. To identify psychological and demographic correlates of children and adolescents known to overuse β2-agonist metered dose inhalers (β-MDIs).

Design. During residential care for severe asthma, demographic and psychological characteristics of 17 children and adolescents known to be β-MDI overusers were compared with 38 asthmatic subjects of similar age without such history.

Results. β-MDI overuse occurred among all groups; however, males, minorities, and those from lower socioeconomic groups were overrepresented. Overusers scored significantly lower on standardized IQ tests. Subtests of arithmetic for numeric reasoning, comprehension for understanding of social values, and picture completion for visual attention to detail were also significantly lower in β-MDI overusers, as were reading achievement tests. Testing also revealed tendencies toward dominant, shrewd, and undisciplined personality traits in the overusers.

Conclusion. Recognition of these characteristics of children prone to β-MDI overuse will raise the clinician's awareness of this potential. Greater efforts and alternative approaches toward education and treatment of the at-risk patient and family are indicated.
Behavioral Characteristics of Children With Stool Toileting Refusal
Authors: Blum Nathan J. , Taubman Bruce , Osborne Mary L.
Published: August 2004

Objective. To determine if children with stool toileting refusal have more behavior problems than matched children who are toilet trained.

Design. Case-control study.

Setting. Suburban private pediatric practice.

Participants. Children 30 to 48 months old who had achieved bladder control but refused to defecate on the toilet were identified as cases. Controls were sex- and age-matched children who were fully toilet trained.

Measures. Total behavior problems were assessed using a semi-structured behavior screening interview with the child's parents. The parents also completed the Child Behavior Checklist for ages 2 to 4 and either the Toddler Temperament Scale (30 to 36 months old) or the Behavioral Style Questionnaire (36 to 48 months old). Child compliance with adult instructions was measured during a room clean-up task.

Results. Children with stool toileting refusal were not found to have more behavior problems than the matched children who were toilet trained. There were no differences between the two groups in compliance during the room clean-up task. There was a trend toward children with stool toileting refusal having a more difficult temperament, and these children were reported to have more problems with constipation and painful bowel movements than the controls.

Conclusions. Children with stool toileting refusal do not have more behavior problems than controls who are toilet trained. Parents do report higher rates of constipation and painful defecation, but it is not clear whether this is a cause or effect of stool toileting refusal.
Toilet Training and Toileting Refusal for Stool Only: A Prospective Study
Authors: Taubman Bruce
Published: August 2004

Objective. To determine the incidence of toileting refusal for bowel movements and its outcome when toilet training children using a child-oriented approach.

Design. Prospective study.

Setting. Private suburban pediatric setting consisting of middle and upper middle class families.

Methods. Healthy children between 18 and 30 months with no signs of developmental delay were enrolled in the study. Parents were given questions regarding their child's toilet training and behavior. Families were followed every 6 months during an office visit or by phone call until the child was successfully day time toilet trained.

Results. A total of 482 children (255 males) completed the study. There were 106 children (54 males) (22%) who experienced at least 1 month of stool toileting refusal. There was an association between the presence of younger siblings (P = .023) and parental inability to set limits for the child (P= .017) and stool toileting refusal. Stool toileting refusers trained at a later age than the rest of the group (P < .0001). Fifty percent (22/44) of the children who trained between 42 and 48 months and 73% (8/11) of the children who trained after 48 months experienced stool toileting refusal. Sixty-one of the study children developed stool withholding during toilet training. Forty-nine (80%) of these children were stool toileting refusers (P < .00001). In 77 (73%) of the children no intervention was undertaken. Of these, the behavior lasted more than 6 months in 20. Intervention was undertaken with 29 children, either because of severe stool withholding (23) or the age of the child (6). Interupting toilet training and having the child return to diapers resulted in the child spontaneously using the toilet for bowel movements within 3 months in 24 of 27 children.

Conclusion. Stool toileting refusal occurred in one in five children in this study population. Two behaviors associated with stool toileting refusal may require the intervention of the pediatrician. The first is stool withholding causing constipation which can result in rectal impaction and primary encopresis. The second is lack of successful toilet training by 42 months of age. A child who is still untrained at this late age can be a source of family conflict and stress requiring the advice and support of the pediatrician.
Pediatric Mortality Probability Estimated From Pre-ICU Severity of Illness
Authors: Kanter Robert K. , Edge Walter E. , Caldwell Cecelia R. , Nocera Mary Alice , Orr Richard A.
Published: August 2004

Objective. The Pediatric Risk of Mortality (PRISM) score is a measure of illness severity based on abnormalities observed in the bedside examination and laboratory assessment. PRISM scores obtained after pediatric intensive care unit (PICU) admission predict mortality probability, but no previous efforts to evaluate mortality risk before PICU admission have been reported. Our study was performed on patients admitted to PICUs at four pediatric tertiary care centers to derive a quantitative estimate of hospital mortality probability as a function of PRISM scores obtained at referring hospitals before PICU transfer. Performance of the model was tested by evaluating accuracy of mortality predictions obtained from pre-ICU PRISM scores in a separate validation set of patients.

Methods. Patients were randomized to the derivation or validation sets. Data were recorded prospectively from observations made at hospitals referring to the study PICUs. Patients included 780 infants and children with medical and surgical emergencies and trauma. Electively admitted patients were excluded from analysis.

Results. The relationship between mortality probability (P) and the pre-ICU PRISM score is expressed by the equation: P =er/(1 + er). In this equation, r is an empirical function of the pre-ICU PRISM score: r = .197 × PRISM − 4.705. The mortality probability rises from near 0 at low scores, approaching 1 (certainty) above a PRISM score of 40. Mortality probability exceeds 10% at a score of 13 and exceeds 50% at a score of 24. Performance of predictions in the validation set of patients was evaluated for five categories of mortality probability. The observed number of deaths corresponded to predicted mortality across the range of illness severity. When compared for each tertiary institution, observed mortality rates were similar to predictions for three of four institutions. For data obtained at institution D, the observed mortality of 17% significantly exceeded the 7% predicted rate. In infants younger than 1 year, as well as children 1 year and older, observed mortality rates were similar to predicted.

Conclusions. The pre-ICU PRISM score as a measure of illness severity provides an estimate of hospital mortality probability. Further investigation is required to determine the use of pre-ICU mortality estimates in making clinical decisions.
Improving the Vitamin K Status of Breastfeeding Infants With Maternal Vitamin K Supplements
Authors: Greer Frank R. , Marshall Sharon P. , Foley Andrea L. , Suttie John W.
Published: August 2004

Objective. To increase the phylloquinone (vitamin K1) concentration of human milk with maternal oral phylloquinone supplements such that both the phylloquinone intake of breastfed infants and their serum concentrations of phylloquinone would approach those of formula-fed infants who are known to be at much less risk for hemorrhagic disease of the newborn.

Design. Two stages: stage I, longitudinal, randomized study of 6 weeks' duration; and stage II, longitudinal, randomized, double-blind, placebo-controlled study of 12 weeks' duration.

Setting. Patients from a private pediatric practice in Madison, WI.

Patients. Stage I: sequential sampling of 20 lactating mothers to determine the level of maternal supplementation needed in stage II. Ten mothers received 2.5 mg/d oral phylloquinone, and 10 mothers received 5.0 mg/d oral phylloquinone. Stage II: sequential sampling of 22 human milk-fed infants and lactating mothers. All infants received 1 mg of phylloquinone at birth. Eleven mothers received a placebo; 11 mothers received 5 mg/d phylloquinone.

Measurements and Results. In stage I, both 2.5 and 5.0 mg/d phylloquinone significantly increased the phylloquinone content of human milk at both 2 and 6 weeks. As expected, 5.0 mg had a greater effect (mean ± SD, 58.96 ± 25.39 vs 27.12 ± 12.18 ng/mL at 2 weeks). In stage II, the vitamin K-supplemented group had significantly higher maternal serum phylloquinone concentrations, higher phylloquinone milk concentrations, and higher infant plasma phylloquinone concentrations at 2, 6, and 12 weeks compared with the placebo group. At 12 weeks infant phylloquinone intakes were significantly higher for the vitamin K group than the placebo group (9.37 ± 4.55 vs 0.15 ± 0.07 μg/kg per day). This corresponded to a plasma phylloquinone concentration in the vitamin K group of 2.84 ± 3.09 vs 0.34 ± 0.57 ng/mL in the placebo group. At 12 weeks, the prothrombin times did not differ between the groups, but the des-γ-carboxy-prothrombin (partially carboxylated prothrombin thought to be a measure of vitamin K deficiency) was significantly elevated in the placebo group compared with the vitamin K group (1.48 ± 1.19 vs 0.42 ± 0.55 ng/mL).

Conclusion. In exclusively breastfed infants who receive intramuscular phylloquinone at birth, the vitamin K status as measured by plasma phylloquinone and des-γ-carboxy-prothrombin concentrations is improved by maternal oral supplements of 5 mg/d phylloquinone through the first 12 weeks of life.
Interactive Communication in High-technology Home Care: Videophones for Pediatric Ventilatory Care
Authors: Miyasaka Katsuyuki , Suzuki Yasuyuki , Sakai Hirokazu , Kondo Yoichi
Published: August 2004

Objective. To develop and to assess the clinical impact of a near-television quality home digital videophone system (Integrated Services Digital Network [ISDN] 64, 320 × 200 resolutions, 10 to 12 frames per second), which would provide respiratory care specialists’ resources to primary care physicians and their pediatric patients receiving home respiratory care.

Method. A prospective study comparing the preceding 6 months and following 6 months of implementation of a videophone system on seven pediatric home respiratory care patients (group I) and a prospective analytical study of three patients (group II) being introduced to home ventilatory care were carried out. Clinical effectiveness and time-saving benefits were studied.

Results. There were large reductions in the number of house calls by the physicians (from 5 to 0), unscheduled hospital visits by patients (from 24 to 5), and hospital admission days (from 22 to 10), with a fivefold increase in phone calls (from 11 to 58) in group I. This reduced the net number of hours spent by both patients and physicians in unscheduled medical care by 95 hours for the patients and 51.2 hours for the physicians. A total of 45 videophone calls, of which 27 were related to mechanical concerns and 18 to medical concerns, were made in group II. There were 7 mechanical and 10 medical problems of clinical significance, but all were directly handled by physicians by videophone. The majority (35 of 45) of videophone calls were made in the first 3-month period, indicating a decrease in nonspecific concerns after this period. The specifications of the system we used were found acceptable by both patients and health care professionals. The system seemed to be useful in effectively using the time of specialists and in relieving the anxieties of families. No deleterious effects were noted. The current initial cost is substantial but rapidly falling. The running cost is similar to a regular telephone bill when one ISDN 64 line is used.

Conclusions. The videophone system using ISDN 64 can now be considered a practical and effective tool to recruit specialist resources into home care and to improve the quality of pediatric home ventilatory care. This study encourages the use of videophones to help establish designated home care support systems that may extend beyond national borders and time zones. home care, videophone, telemedicine, Integrated Services Digital Network.
Partial Liquid Ventilation in Critically Ill Infants Receiving Extracorporeal Life Support
Authors: Greenspan Jay S. , Fox William W. , Rubenstein S. David , Wolfson Marla R. , Spinner Susan S. , Shaffer Thomas H. ,   Philadelphia Liquid Ventilation Consortium
Published: August 2004

Objectives. To demonstrate that a period of partial liquid ventilation (PLV) with perflubron improves pulmonary function, without adverse events, in a select group of critically ill infants receiving extracorporeal life support (ECLS) with a high likelihood of mortality.

Methods. This was an open-label, noncontrolled, phase I and II trial of PLV in two infants with congenital diaphragmatic hernia and four infants with acute respiratory distress syndrome (ARDS) who were failing to improve while receiving ECLS. PLV was performed by instilling and maintaining a functional residual capacity of sterile perflubron for 4 to 96 hours.

Results. Four infants were successfully weaned off ECLS for at least 3 days, and two infants (both with ARDS) are long-term survivors after PLV. All infants demonstrated lung recruitment and improved lung compliance, and there were no adverse events related to PLV.

Conclusions. The study suggests that perflubron PLV is safe, improves lung function, and recruits lung volume in critically ill infants receiving ECLS. PLV therapy for infants with ARDS seems to have a great deal of promise. Based on this and other phase I and II trials, studies of PLV on selected full-term infants before ECLS have been initiated. congenital diaphragmatic hernia, acute respiratory distress syndrome, partial liquid ventilation, extracorporeal life support.
Environmental Risk Factors Associated With Pediatric Idiopathic Pulmonary Hemorrhage and Hemosiderosis in a Cleveland Community
Authors: Montaña Eduardo , Etzel Ruth A. , Allan Terrance , Horgan Timothy E. , Dearborn Dorr G.
Published: August 2004

Background. Unexplained pulmonary hemorrhage and hemosiderosis are rarely seen in infancy. A geographic cluster of 10 infants with this illness was identified in a large pediatric referral hospital in Cleveland, Ohio, during the period of January 1993 through December 1994. One infant died of severe respiratory failure.

Methods. A case-control study was conducted. Three control infants were matched by age with each case infant. All study infants’ guardians were interviewed. Questions were asked about child care practices and home conditions for the period before case infants’ illnesses. All infants’ records were reviewed, their homes were visited, and a structural and environmental survey was conducted.

Results. All 10 case infants were black, and 9 were male, whereas 50.0% of control infants were male, and 83.3% were black. The case infants’ mean age was 10.2 weeks (range, 6 weeks to 6 months). Matched analysis demonstrated that case infants’ homes were more likely to have had water damage preceding the pulmonary hemorrhage event (odds ratio, 16.25; 95% confidence interval, 2.55 to ∞). Case infants were also more likely to have had close relatives with pulmonary hemorrhage (odds ratio, 33.14; 95% confidence interval, 5.10 to ∞). In addition, 50.0% of case infants experienced recurrent pulmonary hemorrhaging after returning to their homes.

Conclusion. The results of this investigation of a cluster of infants with massive, acute pulmonary hemorrhage and hemosiderosis suggest that the affected infants may have been exposed to contaminants in their homes. Epidemiologic clues, such as water damage in the case infants’ homes, suggest that environmental risk factors may contribute to pulmonary hemorrhage. pulmonary hemorrhage, hemosiderosis, infancy, indoor air pollution, pesticides, volatile organic compounds, cholinesterase.
Primary Care Pediatrics in Italy: Eighteen Years of Clinical Care, Research, and Teaching Under a National Health Service System
Authors: del Torso Stefano , Bussi Roberto , DeWitt Thomas G.
Published: August 2004

This article reviews how Italian National Health Service (NHS) pediatricians have tried to fulfill the obligations of modern primary care providers in a managed care environment, with special reference to the experience of the Veneto region in Italy and compares this situation with the present changes of the health system in the United States.

Italian NHS primary care pediatricians work independently in their offices, providing acute and chronic patients to all children 0 to 14 years old: NHS primary care physicians, including 7000 pediatricians, contract directly with the government for the care of patients through a capitated reimbursement system.

Twenty-nine independent associations of community pediatricians have been formed with the primary goal to pursue research and education in primary care pediatrics, in addition to traditional care. Several multicenter collaborative research studies at the national level have been organized and four university residency programs are training their residents in community-based pediatricians’ offices also, giving priority to activities specific to ambulatory practice and follow the suggestion of an Italian work group on ambulatory pediatric training.

The NHS has allowed the Italian pediatrician to focus on patient care and education rather than business. Computerization has been applied to the practice of medicine through the development of electronic medical records, particularly in the Veneto region. This technology allows combining effective clinical care with outcome researches and facilitates continuing medical education and residents’ training programs.

Italian primary care NHS pediatricians have tried to identify and address patient’s needs as well as the needs of a primary care provider in a managed care system. Recent and possible future modifications in the health system in the United States and in Italy need to be examined to learn from similarities and differences. primary care, network research, managed care, national health care, education.
Children and Adult Perceptions of Childhood Asthma
Authors: Guyatt Gordon H. , Juniper Elizabeth F. , Griffith Lauren E. , Feeny David H. , Ferrie Penelope J.
Published: August 2004

Objective. To explore children's and parents' assessment of children's asthma.

Design. Prospective 2-month cohort study in which children and parents were reviewed at baseline and 1-month intervals.

Setting. Mid-sized, English-speaking, industrial community serving an urban and regional rural population.

Patients or Participants. Fifty-two children, 7 to 17 years old, with a wide range of asthma severity, and their parents.

Interventions. We offered patients with inadequately controlled asthma additional inhaled steroid.

Main Outcome Measures. Children and parents provided global ratings of change in childhood symptoms and children completed spirometry and the Paediatric Asthma Quality of Life Questionnaire at clinic visits. Patients recorded peak flow rates, symptoms, and medication use in a daily diary. The diary symptom report, medication use, and spirometry were combined to form an asthma control score.

Results. In children younger than 11, children's global rating of change in symptoms correlated strongly with changes in quality of life (0.54 to .67) but not with measures of airway caliber or asthma control, while parents' global ratings did not correlate with children's quality of life but showed moderate correlations with airway caliber (0.29 to .48) and asthma control (0.50). In children over the age of 11, correlations with all clinical variables were higher for their own than their parents' global ratings.

Conclusions. In children under 11, clinicians can gain complementary information from questioning children and parents. For children over 11, parents can provide little if any information beyond that obtained through questioning the child.
Prevention of Pediatric Drowning and Near-drowning: A Survey of Members of the American Academy of Pediatrics
Authors: O'Flaherty Jennifer E. , Pirie Phyllis L.
Published: August 2004

Objective. To assess pediatricians' knowledge about the epidemiology of childhood drowning, their opinions and current practices regarding its prevention, and their interest in taking on more responsibility for its prevention.

Design. A self-administered questionnaire was mailed to 800 pediatricians in the United States, randomly selected from the American Academy of Pediatrics' approximately 18 000 full fellows.

Results. A total of 560 completed surveys were returned, a response rate of 70.1%. Although 85% of respondents believe it is the responsibility of pediatricians to become involved in community and/or legislative efforts to prevent childhood drowning, only 4.1% were involved in such efforts. Only a minority of respondents provided written materials and anticipatory guidance on drowning prevention to their patients. Women were more likely than men to discuss drowning prevention with their patients. Younger physicians were more likely than older physicians to discuss drowning prevention with their patients. Physicians who received formal education on drowning prevention during their pediatric residency training were more likely to provide written materials and anticipatory guidance on drowning prevention to their patients. However, only 17.9% of respondents received formal education on drowning prevention during their pediatric residency training. Seventy-four percent of all respondents felt that further education on the prevention of childhood drowning and near-drowning would be useful to them.

Conclusion. Although drowning is the second leading cause of death by unintentional injury in the pediatric population (aged 0 to 19 years), most pediatricians do not routinely provide information to their patients, or to their patients' parents, on drowning prevention.

Implication. Pediatricians have been effective child advocates in many areas of injury prevention. If the prevention of drowning is made a priority in pediatric practice, many more children's lives will be saved.
Long-term Appearance of Lacerations Repaired Using a Tissue Adhesive
Authors: Simon Harold K. , McLario David J. , Bruns Thomas B. , Zempsky William T. , Wood Robert J. , Sullivan Kevin M.
Published: August 2004

Background. Histoacryl Blue (HAB), a tissue adhesive, has been shown to decrease laceration repair time, cause less pain to the child, eliminate the need for suture removal, and result in a similar short-term cosmetic outcome compared with conventional suturing. Reports suggest that poor correlation can exist between the short-term and long-term cosmetic outcomes for lacerations repaired by conventional suturing. Therefore, this study compares the long-term cosmetic outcome of HAB to conventional suturing for laceration repair in children.

Design. Prospective, randomized clinical trial.

Participants. Children presenting an urban pediatric emergency department for laceration repair between October 1994 and February 1995 were eligible. Patients less than 1 or more than 18 years old, those with lacerations more than 5 cm in length, or in areas of high tension or mobility were excluded.

Interventions. After routine wound management, including subcutaneous closure when deemed necessary, patients were randomized to receive skin sutures or HAB for cutaneous closure. Photographs taken at the 2-month and 1-year follow-up visits were evaluated for cosmetic appearance by two plastic surgeons blinded to the method of repair.

Results. Sixty-one children were enrolled: HAB (N = 30), suture (N = 31). Thirty HAB and 25 sutured patients were assessed at 2 months, while 17 HAB and 15 sutured patients were reevaluated at 1 year. Patients that followed-up at 2 months and 1 year were comparable to those with no follow-up in: treatment group (HAB vs suture), demographics, wound characteristics, and initial parental satisfaction. The two plastic surgeons graded the cosmetic appearance of the wounds repaired by HAB to be comparable to those repaired by conventional suturing at both the 2-month and 1-year follow-up.

Conclusions. The use of HAB is an ideal alternative to conventional suturing for the cutaneous closure of low tension lacerations in children with a long-term cosmetic outcome comparable to conventional suturing.
Religious Objections to Medical Care
Authors:   Committee on Bioethics
Published: August 2004

Parents sometimes deny their children the benefits of medical care because of religious beliefs. In some jurisdictions, exemptions to child abuse and neglect laws restrict government action to protect children or seek legal redress when the alleged abuse or neglect has occurred in the name of religion. The American Academy of Pediatrics (AAP) believes that all children deserve effective medical treatment that is likely to prevent substantial harm or suffering or death. In addition, the AAP advocates that all legal interventions apply equally whenever children are endangered or harmed, without exemptions based on parental religious beliefs. To these ends, the AAP calls for the repeal of religious exemption laws and supports additional efforts to educate the public about the medical needs of children.
Acellular Pertussis Vaccine: Recommendations for Use as the Initial Series in Infants and Children
Authors:   Committee on Infectious Diseases
Published: August 2004

In 1991 and 1992, the US Food and Drug Administration approved two acellular pertussis vaccines combined with diphtheria and tetanus toxoids for use as the fourth and fifth doses after the initial three-dose primary series with the standard whole-cell pertussis vaccine administered at 2, 4, and 6 months of age. Recently completed trials of acellular pertussis vaccines conducted in Europe have documented the efficacy of these vaccines when administered as a primary series in infancy. Based on these studies, two acellular pertussis vaccines, Tripedia (Connaught Laboratories, Swiftwater, PA) and ACEL-IMUNE (Wyeth-Lederle Laboratories, Pearl River, NY), were licensed by the Food and Drug Administration for the initial three-dose series. Additional acellular pertussis vaccines are likely to be licensed for use in infants in the future. The recommendations in this statement supplement previous American Academy of Pediatrics guidelines for the use of acellular pertussis vaccines.1-4
Therapy for Children With Invasive Pneumococcal Infections
Authors:   Committee on Infectious Diseases
Published: August 2004

This Policy Statement was retired May 2009.

This statement provides guidelines for therapy of children with serious infections possibly caused by Streptococcus pneumoniae. Resistance of invasive pneumococcal strains to penicillin, cefotaxime, and ceftriaxone has increased over the past few years. Reports of failures of cefotaxime or ceftriaxone in the treatment of children with meningitis caused by resistant S pneumoniae necessitates a revision of Academy recommendations. For nonmeningeal infections, modifications of the initial therapy need to be considered only for patients who are critically ill and those who have a severe underlying or potentially immunocompromising condition or patients from whom a highly resistant strain is isolated. Because vancomycin is the only antibiotic to which all S pneumoniaestrains are susceptible, its use should be restricted to minimize the emergence of vancomycin-resistant organisms. Patients with probable aseptic (viral) meningitis should not be treated with vancomycin. These recommendations are subject to change as new information becomes available.