bluuebunny/crossref_metadata_2025 huggingface dataset:
Ticlopidine Plus Aspirin for Coronary Thrombosis in Kawasaki Disease
Authors: O'Brien Maureen , Parness Ira A. , Neufeld Ellis J. , Baker Annette L. , Sundel Robert P. , Newburger Jane W.
Published: August 2004

Selective inhibitors of the adenosine 5′-diphosphate pathway of platelet activation have been used rarely in children in the United States. We report the successful use of ticlopidine, together with aspirin, in a 7-month-old infant with Kawasaki disease complicated by a thrombus in a giant coronary aneurysm that failed to resolve with thrombolytic therapy. Kawasaki disease, coronary aneurysms, antithrombotic therapy, ticlopidine, children.
Undiluted Albuterol Aerosols in the Pediatric Emergency Department
Authors: Gutglass David J. , Hampers Louis , Roosevelt Genie , Teoh Doreen , Nimmagadda Sai R. , Krug Steven E.
Published: August 2004

Objective.

To evaluate the efficacy and efficiency of a short treatment method of administering albuterol aerosols.

Methods.

Fifty children 6 to 18 years of age with severe acute asthma (peak flow rates <60% of predicted) were enrolled in a single-blind, controlled trial in an urban pediatric emergency department. Patients were randomized to receive either the study short treatment (3.5 mL of undiluted albuterol nebulized for 20 inhalations) or the control treatment (albuterol diluted [.5 mL] and nebulized in normal saline [3 mL]) every 20 minutes for a total of 3 treatments. Peak flow and spirometric measurements were performed before and after each treatment.

Results.

There were 25 patients in the study group and 25 in the control group. There were no demographic differences between groups; both had comparable pulmonary function at presentation. The mean forced expiratory volume in 1 second percent predicted improvement between 0 and 60 minutes was 18.8% in the study group and 14.5% in the control group. The total time of treatment delivery for the study group was 6.4 minutes versus 32.7 minutes for the control group.

Conclusion.

Undiluted albuterol short treatments seem to be as effective as standard diluted albuterol in severe asthmatics, while offering the ease and efficiency of shorter treatment administration time.
Presentation of Low Anorectal Malformations Beyond the Neonatal Period
Authors: Kim H. L. Nancy , Gow Kenneth W. , Penner Janice G. , Blair Geoffrey K. , Murphy James J. , Webber Eric M.
Published: August 2004

Objective.

Anorectal malformations are usually diagnosed at birth, but some patients have presented to this institution beyond the early newborn period without recognition of their anorectal malformations. To quantify the extent of this problem, we undertook a review of all patients presenting to this hospital with anorectal malformations.

Methods.

We reviewed all new cases of anorectal malformations treated at British Columbia's Children's Hospital during the past 11 years. We looked specifically at the time of diagnosis, patient age, sex and mode of presentation, the type of anorectal malformations, and any associated anomalies.

Results.

One hundred twenty new cases of anorectal malformations were seen here, of whom, 15 patients (9 girls and 6 boys) presented beyond the early newborn period. Of these, 1 male infant was diagnosed at 2 weeks of age and another girl at 14 years of age. The remaining 13 presented between 3 and 11 months of age because of increasing constipation, usually associated with the introduction of solid foods. All had low anorectal malformations. Nine patients had at least 1 other feature of the VACTERL complex.

Conclusions.

Most anorectal malformations are identified at birth, but a significant number of the milder lesions may not be recognized until later. Therefore, this condition must be considered in older infants and children presenting with constipation, particularly if they also have cardiac or genitourinary anomalies. constipation, imperforate anus, VACTERL.
Familial Mediterranean Fever: Effects of Genotype and Ethnicity on Inflammatory Attacks and Amyloidosis
Authors: Mimouni Aviva , Magal Nurit , Stoffman Nava , Shohat Tamy , Minasian Ara , Krasnov Michael , Halpern Gabrielle J. , Rotter Jerome I. , Fischel-Ghodsian Nathan , Danon Yehuda L. , Shohat Mordechai
Published: August 2004

Objective.

The gene causing familial Mediterranean fever (FMF)—an autosomal recessive disease characterized by recurrent short episodes of fever associated most commonly with peritonitis, pleuritis, and arthritis—has recently been found and several mutations identified. The most severe complication of the disease is amyloidosis, which can lead to renal failure. The aim of this study was to investigate the role of genetic versus nongenetic factors on the phenotype as well as on the development of amyloidosis in FMF in a large and heterogeneous group of patients.

Methodology.

We studied 382 patients from 4 ethnic origins living in different environments: North African Jews, other Jews, Turks, Armenians living in the United States, and Armenians from Yerevan, Armenia. Information regarding amyloidosis was available for 371 patients. We examined the association between the mutation M694V and the development of amyloidosis, and we also compared the clinical characteristics of the inflammatory attacks in patients from different ethnic origins, while controlling for the type of mutation.

Results.

A significant association was found between amyloidosis and the most common mutation in exon 10 of the FMF gene (MEFV), M694V (for M694V homozygotes, relative risk = 1.77; 95% CI = 1.16–2.71). Amyloidosis was present in 44 of 171 homozygous FMF patients (25.7%), in 22 of 143 compound heterozygous FMF patients (15.4%), and in 7 of 57 patients carrying other mutations (12.3%). In homozygotes for M694V who had not been treated with colchicine before 20 years of age, the risk of amyloidosis developing before this age was 61.0%. In our series, there were no cases of amyloidosis in 16 patients carrying the common mutation E148Q. We found that the type and severity of the FMF inflammatory symptoms were associated with both the genotype and the country of residence of the patient.

Conclusions.

In the light of the high frequency of amyloidosis in homozygotes for the mutation M694V, colchicine treatment should be given to this group irrespective of the severity of the inflammatory attacks to prevent the development of amyloidosis. Our findings also suggest that factors other than genotype, such as environment or genes other than MEFV, play a role in the determination of the severity of the inflammatory attacks in FMF. amyloidosis, specific mutation, phenotype-genotype correlation, ethnicity.
The Danger of Premature Graduation to Seat Belts for Young Children
Authors: Winston Flaura K. , Durbin Dennis R. , Kallan Michael J. , Moll Elisa K.
Published: August 2004

Objective.

To determine the risk of significant injury associated with premature graduation of young (2- to 5-year-old) children to seat belts from child restraint systems (CRS).

Background.

Advocates recommend use of child safety seats for children younger than age 4 and booster seats for children age 4 and older. Despite these recommendations, many children are prematurely taken out of these child restraints and placed in seat belts. Although data exist to support the use of child restraints over nonrestraint, no real-world data exist to evaluate the risk of significant injury associated with premature use of seat belts.

Design/Methods.

Partners for Child Passenger Safety includes a child-focused crash surveillance system based on a representative sample of children ages 0 to 15 years in crashes involving 1990 and newer vehicles reported to State Farm Insurance Companies in 15 states and the District of Columbia. Driver reports of crash circumstances and parent reports of child occupant injury were collected via telephone interview using validated surveys. Results were weighted based on sampling frequencies to represent the entire population.

Results.

Between December 1, 1998, and November 30, 1999, 2077 children aged 2 to 5 years were included and were weighted to represent 13 853 children. Among these young children, 98% were restrained, but nearly 40% of these children were restrained in seat belts.

Compared with children in CRS, children in seat belts were more likely to suffer a significant injury (relative risk: 3.5; 95% confidence interval: [2.4, 5.2]). Children in seat belts were at particular risk of significant head injuries (relative risk: 4.2; 95% confidence interval: [2.6, 6.7]) when compared with children in CRS.

Conclusions.

Premature graduation of young children from CRS to seat belts puts them at greatly increased risk of injury in crashes. A major benefit of CRS is a reduction in head injuries, potentially attributable to a reduction in the amount of head excursion in a crash.
First Intention High-Frequency Oscillation With Early Lung Volume Optimization Improves Pulmonary Outcome in Very Low Birth Weight Infants With Respiratory Distress Syndrome
Authors: Rimensberger Peter C. , Beghetti Maurice , Hanquinet Silviane , Berner Michel
Published: August 2004

Objectives.

The lack of decline in chronic lung disease of prematurity despite the generalized use of surfactant and alternative modes of ventilation such as high-frequency oscillation (HFO) has been attributed to some misunderstanding of how HFO has to be used. We used a new ventilatory strategy in very low birth weight (VLBW) infants, by initiating HFO immediately after intubation and attempting early lung volume optimization before surfactant was administered.

Study Design.

The outcome of 32 VLBW infants, managed with first intention HFO over a period of 24 months (September 1, 1996 and August 31, 1998) was compared by chart review with 39 historical controls, consecutively managed with conventional mechanical ventilation (CMV) over a period of 24 months (January 1, 1994 and December 31, 1995).

Setting.

An 11-bed tertiary care pediatric and neonatal intensive care unit of a university teaching hospital.

Results.

The 2 groups of patients were similar in demographic distribution of birth weight, gestational age, race, and gender. Patients on first intention HFO were ventilator-dependent (median [95% confidence interval]: 5 [3–6] vs 14 [6–23] days) and oxygen-dependent (12 [4–17] vs 51 [20–60] days) for a shorter time than patients on CMV. The incidence of chronic lung disease at 36 weeks of gestational age was significantly lower in the HFO group compared with the CMV group (0% vs 34%).

Conclusions.

First intention HFO with early lung volume optimization shortened the need for respiratory support and improved pulmonary outcome of VLBW infants with respiratory distress syndrome significantly.
Pulmonary Outcome in Extremely Low Birth Weight Infants
Authors: Fitzgerald Dominic A. , Mesiano Giulia , Brosseau Lyne , Davis G. Michael
Published: August 2004

Objective.

To determine whether infants with hyaline membrane disease (HMD) superimposed on immature lung disease (ILD) have more abnormal lung function and respiratory drive during the evolution of chronic neonatal lung disease (CNLD) in extremely low birth weight infants (ELBW; <1000 g).

Methods.

We measured lung mechanics (respiratory frequency, tidal volume, minute ventilation, lung resistance, lung compliance, lung impedance, and work of breathing per minute) and respiratory drive (airway opening pressure 100 milliseconds after initiation of breath [P0.1] and maximal inspiratory pressure generated during airway occlusion) on 3 occasions before term in 24 ELBW infants.

Results.

Ten infants with ILD (mean [95% CI] gestation: 24.3 weeks [23.1,25.4]; birth weight: 675 g [553,798]) were studied at 27, 31, and 35 weeks of postconceptional age and 14 infants with HMD superimposed on ILD (gestation: 25.1 weeks [24.4,25.9]; birth weight: 687 g [601,773]) were studied at 28, 32, and 35 weeks of postconceptional age. There were no statistically significant differences between the groups for respiratory frequency, tidal volume, minute ventilation, lung resistance, lung compliance, lung impedance, work of breathing per minute, P0.1, and maximal inspiratory pressure generated during airway occlusion. With increasing age, both groups demonstrated increased respiratory drive as measured by P0.1 without significant changes in respiratory frequency or CO2. Work of breathing per minute increased in the HMD group with age and was higher in extubated subjects. A similar trend with age was demonstrated in ILD infants. Regardless of whether the initial lung disease was ILD alone or HMD + ILD, ELBW infants developed a mildly reduced lung compliance/kg (.8–1.1 mL/cm·H2O/kg) and high lung resistance (75–125 cm·H2O/L/second) pattern of CNLD, which changed little after 3 weeks of age. Survival to 6 months was 23/24 (96%). Oxygen dependency was 16/24 (67%) at 35 weeks, yet only 5/23 (22%) survivors required oxygen at discharge from the neonatal unit (43 weeks).

Conclusions.

The visco-elastic and flow-resistive properties of the lungs in ELBW infants with CNLD remain only mildly abnormal, suggesting a more favorable prognosis for lung function in later years than previously reported.
Neurodevelopmental and Functional Outcomes of Extremely Low Birth Weight Infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993–1994
Authors: Vohr Betty R. , Wright Linda L. , Dusick Anna M. , Mele Lisa , Verter Joel , Steichen Jean J. , Simon Neal P. , Wilson Dee C. , Broyles Sue , Bauer Charles R. , Delaney-Black Virginia , Yolton Kimberly A. , Fleisher Barry E. , Papile Lu-Ann , Kaplan Michael D.
Published: August 2004

Objectives.

The purposes of this study were to report the neurodevelopmental, neurosensory, and functional outcomes of 1151 extremely low birth weight (401–1000 g) survivors cared for in the 12 participating centers of the National Institute of Child Health and Human Development Neonatal Research Network, and to identify medical, social, and environmental factors associated with these outcomes.

Study Design.

A multicenter cohort study in which surviving extremely low birth weight infants born in 1993 and 1994 underwent neurodevelopmental, neurosensory, and functional assessment at 18 to 22 months' corrected age. Data regarding pregnancy and neonatal outcome were collected prospectively. Socioeconomic status and a detailed interim medical history were obtained at the time of the assessment. Logistic regression models were used to identify maternal and neonatal risk factors for poor neurodevelopmental outcome.

Results.

Of the 1480 infants alive at 18 months of age, 1151 (78%) were evaluated. Study characteristics included a mean birth weight of 796 ± 135 g, mean gestation (best obstetric dates) 26 ± 2 weeks, and 47% male. Birth weight distributions of infants included 15 infants at 401 to 500 g; 94 at 501 to 600 g; 208 at 601 to 700 g; 237 at 701 to 800 g; 290 at 801 to 900 g; and 307 at 901 to 1000 g. Twenty-five percent of the children had an abnormal neurologic examination, 37% had a Bayley II Mental Developmental Index <70, 29% had a Psychomotor Developmental Index <70, 9% had vision impairment, and 11% had hearing impairment. Neurologic, developmental, neurosensory, and functional morbidities increased with decreasing birth weight. Factors significantly associated with increased neurodevelopmental morbidity included chronic lung disease, grades 3 to 4 intraventricular hemorrhage/periventricular leukomalacia, steroids for chronic lung disease, necrotizing enterocolitis, and male gender. Factors significantly associated with decreased morbidity included increased birth weight, female gender, higher maternal education, and white race.

Conclusion.

ELBW infants are at significant risk of neurologic abnormalities, developmental delays, and functional delays at 18 to 22 months' corrected age.
Birth Weight- and Gestational Age-Specific Sudden Infant Death Syndrome Mortality: United States, 1991 Versus 1995
Authors: Malloy Michael H. , Freeman Daniel H. , PhD Jr,
Published: August 2004

Objective.

To estimate the changes in birth weight- and gestational age-specific sudden infant death syndrome (SIDS) mortality rates since the publication of the sleep-positioning recommendations by the American Academy of Pediatrics Task Force on Infant Positioning and SIDS.

Methods.

This is a historical cohort study using US vital statistic linked birth and infant death certificate files for the years 1991 and 1995. SIDS deaths were identified as any death attributed toInternational Classification of Diseases, Ninth Revisioncode 7980, occurring between the 28th and 365th days of life.

Results.

There were 4871 deaths attributed to SIDS in 1991 for a postneonatal mortality rate of 1.2/1000 postneonatal survivors compared with 3114 deaths in 1995 for a rate of .8/1000. This represents a 33% drop in the postneonatal SIDS mortality from 1991 to 1995. Between 1991 and 1995, SIDS rates declined 38%, 38%, 35%, and 32% for birth weight groupings of 500 to 999 g, 1000 to 1499 g, 1500 to 2499 g, and ≥2500 g, respectively. There were no SIDS deaths attributed to infants weighing <500 g. The SIDS rates declined 27%, 21%, 40%, and 23% for gestational age groups of <29 weeks, 29 to 32 weeks, 33 to 36 weeks, and ≥37 weeks. The rate of decline did not differ significantly across birth weight- or gestational age-specific categories. There was a significant increase in the black:non-black postneonatal SIDS mortality ratio from 2.00 to 2.28, reflecting a smaller decline in birth weight- and gestational age-specific mortality for blacks than observed for the non-black population.

Conclusion.

Postneonatal SIDS mortality decreased significantly across all broad birth weight and gestational age categories. If the decline in the prevalence of prone positioning that has been reported since 1992 has occurred across all birth weight and gestational age, these data support the hypothesis that supine or side sleep positioning is effective in preterm/low birth weight infants as well as term infants.
Evaluation and Management of Proteinuria and Nephrotic Syndrome in Children: Recommendations From a Pediatric Nephrology Panel Established at the National Kidney Foundation Conference on Proteinuria, Albuminuria, Risk, Assessment, Detection, and Elimination (PARADE)
Authors: Hogg Ronald J. , Portman Ronald J. , Milliner Dawn , Lemley Kevin V. , Eddy Allison , Ingelfinger Julie
Published: August 2004

Objective.

The development of this review article evolved from a National Kidney Foundation consensus conference on recent advances in the importance of evaluating and treating proteinuria. From this conference, a series of recommendations for the evaluation of adults with proteinuria was published. Because specific pediatric aspects of the problem were outside the scope of the original National Kidney Foundation publication, an ad hoc committee of 6 pediatric nephrologists who were active participants in the National Kidney Foundation conference was established to provide primary care physicians with a concise, up-to-date reference on this subject.

Methods.

The recommendations that are given represent the consensus opinions of the authors. These are based on data from controlled studies in children when available, but many of the opinions are, by necessity, based on uncontrolled series in children or controlled trials performed in adults, because controlled trials in children have not been performed to evaluate many of the treatments described.

Results and Conclusions.

These recommendations are intended to provide primary care physicians with a useful reference when they are faced with a young child or teenager who presents with proteinuria, whether this is mild and asymptomatic or more severe, leading to nephrotic syndrome.
Changing Indications for Pediatric Cholecystectomy
Authors: Miltenburg Darlene M. , Schaffer Randolph , Breslin Tara , Brandt Mary L.
Published: August 2004

Purpose.

The purpose of this study was to determine indications for gallbladder surgery and risk factors for urgent surgery.

Methods.

We reviewed all patients <19 years old, who underwent cholecystectomy between 1980 and 1996.

Results.

There were 128 patients (mean age: 10 years). Fifty-two patients had an underlying hematologic disorder, 47 had another medical disorder, and 29 had no preexisting illness or identifiable risk factor for gallstone disease. Twenty-five percent (32/128) of cholecystectomies were performed urgently. Postoperative complications developed in 5 of 32 patients (16%) who underwent emergency surgery and 6 of 96 patients (6%) who underwent elective surgery. There were 3 deaths, all occurring in patients undergoing emergency cholecystectomy (odds ratio: 23). Furthermore, all who died had congenital heart disease (odds ratio: 183), making congenital heart disease an independent risk factor for gallstone-related mortality.

Conclusions.

Cholecystectomy is recommended when medically possible for children with underlying medical diseases. Patients with medical disorders that make them a high surgical risk can be followed clinically, realizing that if urgent surgery is necessary, the morbidity is relatively high. Those children with congenital heart disease and gallstones are at a prohibitively high risk for death after urgent cholecystectomy. For these patients, the risk of an elective cholecystectomy may be acceptable when weighed against the high risk of complications from their gallstones.
The Impact of Managed Care Insurance on Use of Lower-Mortality Hospitals by Children Undergoing Cardiac Surgery in California
Authors: Erickson Lars C. , Wise Paul H. , Cook E. Francis , Beiser Alexa , Newburger Jane W.
Published: August 2004

Context.

Managed care plans aggressively seek to contain costs, but few data are available regarding their impact on access to high quality care for their members.

Objective.

To assess the impact of managed care health insurance on use of lower-mortality hospitals for children undergoing heart surgery in California.

Design.

Retrospective cohort study using state-mandated hospital discharge datasets.

Setting.

Pediatric cardiovascular surgical centers in California.

Patients.

Five thousand seventy-one children admitted for open cardiac surgical procedures during 1992–1994.

Results.

Hospitals were divided into lower- and higher-mortality groups according to adjusted surgical mortality. Using multivariate logistic regression analysis to control for medical, socioeconomic, demographic, and distance factors, children with managed care insurance were less likely to be admitted to a lower-mortality hospital for surgery relative to children with indemnity insurance (odds ratio: .53; 95% confidence interval: .45,.63). Similar findings resulted when the analysis was stratified by race/ethnicity. In addition, length of stay, a correlate of health care costs, was no longer for children admitted to lower-mortality centers than for those at higher-mortality centers (adjusted difference: .54 days shorter at lower-mortality centers; 95% confidence interval: −1.50,.41).

Conclusions.

During this study, children with managed care insurance had significantly reduced use of lower-mortality hospitals for pediatric heart surgery in California compared with children with indemnity insurance. Further study is necessary to determine the mechanisms of this apparent insurance-specific inequity.
Effect of Neonatal Test Environment on Recording Transient-Evoked Otoacoustic Emissions
Authors: Headley Gillian M. , Campbell Deborah E. , Gravel Judith S.
Published: August 2004

Objective.

To examine the effect of test environment on recording transient-evoked otoacoustic emissions (TEOAE) in neonates.

Methods.

Thirty-two infants from the newborn nursery (NBN) who passed a screening auditory brainstem response (SABR) test and were at least 34 weeks' postconceptional age were studied. One ear of each newborn was tested using TEOAE in 5 different test environments: open bassinet in the NBN (E1), working isolet located in the NBN (E2), nonfunctioning isolet in the NBN (E3), nonfunctioning isolet in a quiet room off the NBN (E4), and open bassinet in a quiet room (E5). The number of high noise samples (HNS), the test duration (in seconds), the signal-to-noise ratio (SNR; in dB) measured at bandwidths centered at 1.6, 2.4, 3.2, and 4.0 kHz, and the percentage of neonates with a fail screening outcome based on a common pass–fail screening criteria were compared in the 5 test environments.

Results.

There were statistically significant differences in the number of HNS accumulated in the 5 test environments (F = 6.79). The use of a nonfunctioning isolet in both the NBN and within a room off the NBN (E3 and E4, respectively) resulted in significantly fewer HNS than when TEOAEs were recorded in the other 3 test environments (E1, E2, and E5). Mean test duration was significantly different among the 5 locations (F = 6.53). Posthoc analyses revealed that test time in E3 and E4 was significantly shorter than in E1 and E2. The percentage of newborns with a fail (≤3 dB SNR at 2.4, 3.2, and 4.0 kHz) outcome was lowest in E3 (6.3%) and the same in E1 and E4 (12.5%). A high percentage of infants received a fail outcome when tested in both the working isolet and in the open bassinet in a room off the nursery (21.8% and 25%, respectively). SNR (in dB) for bandwidths centered at 1.6, 2.4, and 3.2 kHz was negatively correlated with the HNS in the working isolet. SNR (in dB) at 4.0 kHz was negatively correlated with the HNS when TEOAEs were recorded in the open bassinet in a room adjacent to the NBN. The number of HNS was correlated with overall test time in each environment.

Conclusions.

Test environments typically used for newborn hearing screening can influence the recording of TEOAEs. Performing the TEOAE test with the neonate placed in a nonfunctioning isolet located in either the NBN or in a room off of the NBN resulted in the most desirable outcomes (shortest test times, fewest HNS, highest SNR (in dB), and fewest fail outcomes).
Evaluation of Covert Video Surveillance in the Diagnosis of Munchausen Syndrome by Proxy: Lessons From 41 Cases
Authors: Hall David E. , Eubanks Laura , Meyyazhagan LCSW*; Swarnalatha , Kenney Richard D. , Johnson Sherry Cochran
Published: August 2004

Objective.

In 1993, Children's Healthcare of Atlanta at Scottish Rite (formery Scottish Rite Children's Medical Center, Atlanta, GA) added facilities to perform inpatient covert video surveillance (CVS) of suspected cases of Munchausen syndrome by proxy (MSBP). Forty-one patients were monitored from 1993 to 1997. This study was performed to review our experience with these cases. How useful was video surveillance in making the diagnosis? What were the characteristics of families with children who were victims of MSBP?

Methodology.

Medical, social work, security, and administrative records of all children who underwent covert video monitoring at Children's Healthcare of Atlanta at Scottish Rite from 1993 through 1997 were reviewed retrospectively by a team of physicians, risk managers, and social workers.

Results.

A diagnosis of MSBP was made in 23 of 41 patients monitored. CVS was required to make the diagnosis in 13 (56.1%) of these 23, and supportive of the diagnosis in 5 (21.7%) cases. In 4 patients, this surveillance was instrumental in establishing innocence of the parents. MSBP was more common in Caucasian patients than in other ethnic groups seen at our hospital. Fifty-five percent of mothers gave a history of health care work or study, and another 25% had previously worked in day care. Although many of caretakers fit the profile of MSBP, such as excessive familiarity with medical staff, eagerness for invasive medical testing, and history of health care work, these characteristics were not sensitive indicators of MSBP in our study. Even when present, they were not sufficiently compelling to make the diagnosis.

Conclusions.

CVS is required to make a definitive and timely diagnosis in most cases of MSBP. Without this medical diagnostic tool, many cases will go undetected, placing children at risk. All tertiary care children's hospitals should develop facilities to perform CVS in suspected cases.
Diagnostic Imaging of Child Abuse
Authors:   Section on Radiology
Published: August 2004

The role of imaging in cases of child abuse is to identify the extent of physical injury when abuse occurs, as well as to elucidate all imaging findings that point to alternative diagnoses. Diagnostic imaging of child abuse is based on both advances in imaging technology, as well as a better understanding of the subject based on scientific data obtained during the past 10 years.1–3 The initial recommendation was published in Pediatrics(1991;87:262–264).
Education of Children With Human Immunodeficiency Virus Infection
Authors:   Committee on Pediatric AIDS
Published: August 2004

This Policy Statement was retired April 2016.

Treatment for human immunodeficiency virus (HIV) infection has enabled more children and youths to attend school and participate in school activities. Children and youths with HIV infection should receive the same education as those with other chronic illnesses. They may require special services, including home instruction, to provide continuity of education. Confidentiality about HIV infection status should be maintained with parental consent required for disclosure. Youths also should assent or consent as is appropriate for disclosure of their diagnosis.
A Proposed Solution for Addressing the Challenge of Patient Cries for Help Through an Analysis of Unsolicited Electronic Mail
Authors: D'Alessandro Donna M. , D'Alessandro Michael P. , Colbert Stephana I.
Published: August 2004

Background.

Unsolicited electronic mail (e-mail) is e-mail sent to a physician from a person unknown to the physician, who is seeking professional help. The purpose of this project was to analyze unsolicited e-mails sent to a digital textbook author to: 1) characterize the e-mails, 2) determine what resources would be necessary to answer the e-mails, and 3) propose a standard approach to reply to e-mails in a helpful yet medicolegally-responsive manner.

Materials and Methods.

All e-mails (315) sent to a digital textbook author from October 1995 through October 1998 were abstracted. Variables included: date and location, sender type, patient age, subject, medical content, and resources necessary to answer the question. Data frequencies were obtained.

Results.

The most common location was the .com domain (47.6%). The most common senders were laypersons (66%). Overall, 44.4% of the e-mails concerned children. Detailed, patient-specific information was sent in 63.2% of the e-mails. The most common subjects were overviews of a disease or problem (32.4%), differential diagnosis (16.8%), and therapy/treatment questions (15.9%). The medical content covered a broad range of specialties. Specialists were overwhelmingly the resource necessary to answer the e-mails (74.9%).

Conclusions.

Pediatricians with educational information on the Internet can expect an increase in the number of unsolicited e-mails as Internet usage expands. Laypersons regard even short passages to mean the author is an expert in that particular area. Pediatricians need to consider the ethical and medicolegal implications of responding to unsolicited e-mails. A nonpersonalized, standard e-mail reply is proposed that directs the sender to quality information resources that may be of further assistance. unsolicited electronic mail, e-mail, medical informatics, legal issues, ethical issues, digital libraries.
Child Care Practices in Nonindustrialized Societies
Authors: Nelson Edmund Anthony Severn , Schiefenhoevel Wulf , Haimerl Felizitas
Published: August 2004

Objective.

To described child care practices associated with an increased risk of sudden infant death syndrome (SIDS) in nonindustrialized 19th and 20th century societies.

Methodology.

The Human Relations Area Files collection is a unique source of information on the cultures of the world. The electronic version of the Human Relations Area Files represents 200 000 pages of fully indexed cultural material on a stratified random sample of 60 nonindustrialized societies. Using various keyword combinations, texts containing information related to sleeping conditions, social interaction, temperature regulation, feeding, and smoking were identified and using structured questionnaire practices were recorded as being present, absent, or not stated.

Results.

Relevant information was identified for 53 societies. None of 4 societies mentioning sleep position used the prone position. Swaddling and restraint were commonly practiced, often for extended periods of time. Most information was available on infant feeding and the predominant pattern was of demand breastfeeding for long periods. In many of the cultures, infants are seen as being the focus of attention, in close contact with and under the constant supervision of the mother, siblings, and other relatives.

Conclusions.

The study produced no clear evidence that these primarily nonindustrialized societies followed child care practices likely to protect against SIDS. Despite limitations, the information presented should be of interest to those involved in developing reduce the risks programs for SIDS prevention, because it highlights the considerable variation in child care practices and emphasizes that health education messages may not always be cross-culturally valid.
Twenty-Year Follow-Up of Antenatal Corticosteroid Treatment
Authors: Dessens Arianne B. , Haas Hetty Smolders-de , Koppe Janna G.
Published: August 2004

Objective.

To study late side effects of antenatal corticosteroid treatment on health and sexual development in subjects 20 to 22 years old.

Methods.

A follow-up study among young adults whose mothers had, because of a threatening delivery, participated in a randomized, double-blind, placebo- controlled trial of betamethasone to prevent neonatal respiratory distress syndrome. Measurements were taken on general health, growth, development in puberty, reproductivity, genital or gynecological complaints, gender development, sexual orientation, sex-specific cognitive functioning, and psychoneuroticism. In addition, some measurements were performed on family diseases, socioeconomic status, and education.

Results.

No differences were found between the corticosteroid-treated and placebo groups as to medical or psychological variables. In general, the subjects were healthy and had normal intellectual capacities. Groups did not differ on gender development, sexual orientation, sex-specific cognitive functioning, and psychoneuroticism. Systolic blood pressure was significantly lower in the corticosteroid group, but the groups did not differ as to diastolic blood pressure.

Conclusions.

Our 20-year follow-up study indicates that 1 course of antenatally administered corticosteroid to prevent respiratory distress syndrome does not have adverse effects up to adulthood.
Gastrostomy Tube Insertion for Improvement of Adherence to Highly Active Antiretroviral Therapy in Pediatric Patients With Human Immunodeficiency Virus
Authors: Shingadia Delane , Viani Rolando M. , Yogev Ram , Binns Helen , Dankner Wayne M. , Spector Stephen A. , Chadwick Ellen Gould
Published: August 2004

Objectives.

Newer combination antiretroviral therapies used to treat human immunodeficiency virus (HIV)-infected individuals have resulted in dramatic delays in HIV progression, with reduction in mortality and morbidity. However, adherence to highly active antiretroviral therapy (HAART) may be problematic, particularly in HIV-infected children. Reasons for nonadherence include refusal, drug tolerability, and adverse reactions. We assess: 1) the potential benefits of gastrostomy tube (GT) for the improvement of adherence to HAART in HIV-infected children, and 2) the factors that may result in improved viral suppression after GT placement.

Methods.

The medical records of 17 pediatric HIV-infected patients, in whom GT was used to improve HAART adherence, were retrospectively reviewed for clinical and laboratory parameters. Each record was reviewed for the period of 1 year before and after GT insertion. The main outcome parameters were virologic (plasma HIV RNA polymerase chain reaction quantification) and immunologic (CD4 cell counts). Documentation of adherence to medications in medical records was also assessed during the study. Parental questionnaires were used to determine GT satisfaction and medication administration times. The Wilcoxon rank sum test was used to assess change in viral load (VL) and CD4 cell percentages.

Results.

GT was well-tolerated with minor complications, such as local site tenderness, reported by 4 patients (23%). Before GT insertion, only 6 patients (35%) were documented as being adherent, compared with all patients after GT insertion. Ten patients (58%) had ≥2 log10 VL decline after GT insertion (median: 3.2 log10), compared with 7 patients (42%) who had ≤2 log10 VL decline (median: 1.27 log10). Both groups of patients (responders and nonresponders) did not differ significantly in baseline parameters, such as VL, CD4 cell percentages, or previous drug therapy. However, in all 10 patients with ≥2 log10 VL decline, therapy was changed at the time of or soon after GT insertion (median: .8 months; range: 0–6 months), compared with 7 patients with <2 log10 VL decline who had therapy changed before GT insertion (median: 3.2 months; range: 1–8 months). Parental questionnaires reported significantly shorter medication administration times after GT insertion, with 70% of patients taking >5 minutes before GT, compared with 0% after GT. Questionnaires indicated satisfaction with GT, with perceived benefits being reduced medication administration time and improved behavior surrounding taking medications.

Conclusions.

GT is well-tolerated in pediatric HIV-infected patients and should be considered for selected patients to overcome difficulties with medication administration and to improve adherence. For maximal virologic response, combination therapy should be changed at the time of GT insertion.
Infant Massage Compared With Crib Vibrator in the Treatment of Colicky Infants
Authors: Huhtala Virpi , Lehtonen Liisa , Heinonen Riitta , Korvenranta Heikki
Published: August 2004

Objective.

To evaluate the effectiveness of infant massage compared with that of a crib vibrator in the treatment of infantile colic.

Methods.

Infants <7 weeks of age and perceived as colicky by their parents were randomly assigned to an infant massage group (n = 28) or a crib vibrator group (n = 30). Three daily intervention periods were recommended in both groups. Parents recorded infant crying and given interventions in a structured cry diary that was kept for 1 week before (baseline) and for 3 weeks during the intervention. Parents were interviewed after the first and third weeks of intervention to obtain their evaluation of the effectiveness of the given massage or crib vibration.

Results.

At baseline, the mean amount of total crying was 3.6 (standard deviation: 1.4) hours/day in the massage group infants and 4.2 (2.0) hours/day in the vibrator group infants. The mean amount of colicky crying was 2.1 (standard deviation: 1.1) hours/day and 2.9 (1.5) hours/day, respectively. The mean number of daily intervention periods was 2.2 in both groups. Over the 4-week study, the amount of total and colicky crying decreased significantly in both intervention groups. The reduction in crying was similar in the study groups: total crying decreased by a mean 48% in the massage group and by 47% in the vibrator group, and colicky crying decreased by 64% and 52%, respectively. The amount of other crying (total crying minus colicky crying) remained stable in both groups over the intervention. Ninety-three percent of the parents in both groups reported that colic symptoms decreased over the 3-week intervention, and 61% of the parents in the massage group and 63% of the parents in the crib vibrator group perceived the 3-week intervention as colic reducing.

Conclusions.

Infant massage was comparable to the use of a crib vibrator in reducing crying in colicky infants. We suggest that the decrease of total and colicky crying in the present study reflects more the natural course of early infant crying and colic than a specific effect of the interventions.
Forensic Evidence Findings in Prepubertal Victims of Sexual Assault
Authors: Christian Cindy W. , Lavelle Jane M. , De Jong Allan R. , Loiselle John , Brenner Lewis , Joffe Mark
Published: August 2004

Objective.

The American Academy of Pediatrics recommends forensic evidence collection when sexual abuse has occurred within 72 hours, or when there is bleeding or acute injury. It is not known whether these recommendations are appropriate for prepubertal children, because few data exist regarding the utility of forensic evidence collection in cases of child sexual assault. This study describes the epidemiology of forensic evidence findings in prepubertal victims of sexual assault.

Methods.

The medical records of 273 children <10 years old who were evaluated in hospital emergency departments in Philadelphia, Pennsylvania, and had forensic evidence processed by the Philadelphia Police Criminalistics Laboratory were retrospectively reviewed for history, physical examination findings, forensic evidence collection, and forensic results.

Results.

Some form of forensic evidence was identified in 24.9% of children, all of whom were examined within 44 hours of their assault. Over 90% of children with positive forensic evidence findings were seen within 24 hours of their assault. The majority of forensic evidence (64%) was found on clothing and linens, yet only 35% of children had clothing collected for analysis. After 24 hours, all evidence, with the exception of 1 pubic hair, was recovered from clothing or linens. No swabs taken from the child's body were positive for blood after 13 hours or sperm/semen after 9 hours. A minority of children (23%) had genital injuries. Genital injury and a history of ejaculation provided by the child were associated with an increased likelihood of identifying forensic evidence, but several children had forensic evidence found that was unanticipated by the child's history.

Conclusions.

The general guidelines for forensic evidence collection in cases of acute sexual assault are not well-suited for prepubertal victims. The decision to collect evidence is best made by the timing of the examination. Swabbing the child's body for evidence is unnecessary after 24 hours. Clothing and linens yield the majority of evidence and should be pursued vigorously for analysis.
Nutritional Guidance Is Needed During Dietary Transition in Early Childhood
Authors: Picciano Mary Frances , Smiciklas-Wright Helen , Birch Leann L. , Mitchell Diane C. , Murray-Kolb Laura , McConahy Kristen L.
Published: August 2004

Objective.

To assess dietary nutritional quality during dietary transition to a modified adult-style diet in the second year of life.

Design.

A total of 55 children from 12 to 18 months old and their parents were studied. Dietary intake and indices of growth were measured monthly. Dietary data were collected monthly and tabulated using the Minnesota Nutrient Data System. Data were evaluated using repeated-measures analysis of variance, time trend, and correlational analyses.

Results.

Mean energy intake increased from 12 to 18 months of age (926 ± 24 kcal to 1062 ± 33 kcal) with contributions from energy-yielding macronutrients remaining relatively constant. Throughout the study, fat intakes were below 30% of energy for 22% to 33% of the sample. Micronutrient intake patterns were diverse with intake for some nutrients (vitamins A, C, B6, B12, and D and calcium) remaining above recommended levels despite changes over the course of the study. Folate intakes increased from 79% of the recommended value at 12 months old to ∼100% at 18 months old. Zinc and vitamin E intakes were well below recommended levels throughout the study, and iron decreased markedly from 96% of the recommended level at 12 months old to 76% at 18 months old.

Applications/Conclusions.

These data show that intakes of some key nutrients are low during the period of dietary transition in early childhood, and intakes for some nutrients actually decrease despite increases in energy intake. Furthermore, because a considerable portion of children studied were consuming low-fat diets, it is clear that many parents are not following the only pediatric nutrition recommendations that currently exist. These findings argue strongly for the development of dietary guidance that not only addresses fat restriction, but also assists parents in selecting diets that support optimum growth and development in young children. nutrient intake, infants, dietary density.
Hypothermia and Hyperthermia in Children After Resuscitation From Cardiac Arrest
Authors: Hickey Robert W. , Kochanek Patrick M. , Ferimer Howard , Graham Steven H. , Safar Peter
Published: August 2004

Objective.

In experimental models of ischemic-anoxic brain injury, changes in body temperature after the insult have a profound influence on neurologic outcome. Specifically, hypothermia ameliorates whereas hyperthermia exacerbates neurologic injury. Accordingly, we sought to determine the temperature changes occurring in children after resuscitation from cardiac arrest.

Study Design.

The clinical records of 13 children resuscitated from cardiac arrest were analyzed. Patients were identified through the emergency department and pediatric intensive care unit arrest logs. Only patients surviving for ≥12 hours after resuscitation were considered for analysis. Charts were reviewed for body temperatures, warming or cooling interventions, antipyretic and antimicrobial administration, and evidence of infection.

Results.

Seven patients had a minimum temperature (T min) of ≤35°C and 11 had a maximum temperature (T max) of ≥38.1°C. Hypothermia often preceded hyperthermia. All 7 patients with T min ≤35°C were actively warmed with heating lamps and 5 of 7 responded to warming with a rebound of body temperatures ≥38.1°C. None of the 6 patients with T min >35°C were actively warmed but all developed T max ≥38.1°C. Six patients received antipyretics and 11 received antibiotics. Fever was not associated with a positive culture in any case.

Conclusion.

Spontaneous hypothermia followed by hyperthermia is common after resuscitation from cardiac arrest. Temperature should be closely monitored after cardiac arrest and fever should be managed expectantly.
Evaluation of the Newborn With Developmental Anomalies of the External Genitalia
Authors:   Committee on Genetics,   Section on Endocrinology,   Section on Urology
Published: August 2004

This Policy Statement was retired October 2006.

The newborn with abnormal genital development presents a difficult diagnostic and treatment challenge for the primary care pediatrician. It is important that a definitive diagnosis be determined as quickly as possible so that an appropriate treatment plan can be established to minimize medical, psychological, and social complications. The purpose of this review is to identify which newborns among those with abnormal genital development need to be screened for intersexuality, to outline the investigations necessary, and to suggest indications for referral to a center with experience in the diagnosis and management of these disorders. An outline is also presented of the embryology of the external genitalia indicating where errors can arise to provide a framework for pediatricians to use when counseling families. Although the focus of this review is on newborns with what has been termed “ambiguous genitalia,” it should be recognized that most genital abnormalities in newborns do not result in an ambiguous appearance. These anomalies include hypospadias, in which the genitalia are clearly malformed, although the sex is unquestionably male.