bluuebunny/crossref_metadata_2025 huggingface dataset:
Adverse Clinical Outcomes Associated With Short Stature at Dialysis Initiation: A Report of the North American Pediatric Renal Transplant Cooperative Study
Authors: Furth Susan L. , Stablein Don , Fine Richard N. , Powe Neil R. , Fivush Barbara A.
Published: August 2004

Objective. We examined whether height less than the 1% for age (z score <−2.5) at dialysis initiation predicts adverse clinical outcomes for children with kidney failure.

Design. National cohort study of children initiating dialysis, followed for a minimum of 1 month to a maximum of 8 years.

Setting. Voluntary consortium of pediatric nephrology centers across the United States and Canada in the North American Pediatric Renal Transplant Cooperative Study.

Patients. Two thousand three hundred six patients ≤21 years old initiated on dialysis between 1992 and 2000.

Outcome Measures. School attendance, transplant wait listing, hospitalization rates, and survival.

Results. Although there were no differences in transplant wait listings, school-aged children with short stature were less likely to be attending school full-time than were their counterparts with more normal height, even if medically capable. Short-stature patients have significantly more hospital days per month of dialysis follow-up than those patients with better growth (mean: 1.92 vs 1.58; median: 0.73 vs 0.44 hospital days per month of follow-up). Cox proportional hazards regression analyses show that children with height <1% for age have a twofold higher risk of death than those with more normal height, even after controlling for patient age, race, gender, cause of end-stage renal disease, wait list status, and dialysis modality.

Conclusions. Poor growth during chronic renal insufficiency leading to short stature at dialysis initiation is a marker for a more complicated clinical course for children with kidney failure. Aggressive nutritional support and early referral to a nephrologist to optimize growth may improve long-term outcomes for children with chronic kidney disease.
Improving Childhood Asthma Outcomes in the United States: A Blueprint for Policy Action
Authors: Lara Marielena , Rosenbaum Sara , Rachelefsky Gary , Nicholas Will , Morton Sally C. , Emont Seth , Branch Marian , Genovese Barbara , Vaiana Mary E. , Smith Vernon , Wheeler Lani , Platts-Mills Thomas , Clark Noreen , Lurie Nicole , Weiss Kevin B.
Published: August 2004

Background/Objective. Asthma is increasingly being recognized as an important public health concern for children in the United States. Effective management of childhood asthma may require not only improving guideline-based therapeutic interventions, but also addressing social and physical environmental risk factors. The objective of this project was to create a blueprint for improvement of national policy in this area.

Design/Methods. A nominal group process with nationally recognized experts and leaders (referred to as “the committee”) in childhood asthma.

Results. The committee identified 11 policy recommendations (numbered in order below) in 2 broad categories: Improving Health Care Delivery and Financing, and Strengthening the Public Health Infrastructure. Recommendations regarding Improving Health Care Delivery and Financing include the development and implementation of quality-of-care standards in 1) primary care, 2) self-management education, and 3) case-management interventions, and the expansion of insurance coverage and benefit design by 4) extending continuous health insurance coverage for all children, 5) developing model insurance benefits packages for essential childhood asthma services, and 6) educating health care purchasers in how to use them. Recommendations for Strengthening the Public Health Infrastructure include public funding of asthma services that fall outside the insurance system through establishing 7) public health grants to foster asthma-friendly communities and 8) school-based asthma initiatives. 9) Launching a national asthma public education campaign, 10) developing a national asthma surveillance system, and 11) establishing a national agenda for asthma prevention research, with an emphasis on epidemiologic and behavioral sciences, are also recommended.

Conclusions. Implementing these recommendations will require coordination of activities at the national, state, and local community level, and within and outside the health care delivery system. With a further commitment of national and local resources, implementation of these recommendations will likely lead to improved child and family asthma outcomes in the United States. childhood asthma, health care policy, health care services.
Chronic Lung Disease After Activated Charcoal Aspiration
Authors: Graff Gavin R. , Stark James , Berkenbosch John W. , Holcomb George W. , Garola Robert E.
Published: August 2004

The ingestion of toxic substances is a common pediatric emergency. Activated charcoal is part of the standard treatment for most toxic ingestions and is considered a benign therapy. We report a case of inadvertent administration of activated charcoal into the trachea that resulted in the development of chronic lung disease.
Is It More Than Just Constipation?
Authors: Gereige Rani S. , Frias Jaime L.
Published: August 2004

We report an infant presenting with constipation, whose history and physical examination initiated the investigation that led to the diagnosis of the Currarino triad in the proband and 2 other family members.
Diffuse Alveolar Hemorrhage in Pediatric Hematopoietic Cell Transplant Patients
Authors: Heggen Judith , West Carla , Olson Ellen , Olson Thomas , Teague Gerald , Fortenberry James , Yeager Andrew M.
Published: August 2004

Objective. Diffuse alveolar hemorrhage (DAH) is defined as a syndrome of hypoxia, dyspnea, infiltrates on chest radiograph, and bloody fluid on successive bronchoalveolar lavages without apparent infection. Minimal experience has been reported with DAH after hematopoietic cell transplant (HCT) in children. We reviewed the incidence, management and outcome of DAH in a pediatric HCT population.

Methods. Retrospective review of 138 patients undergoing allogeneic (n = 89) or autologous (n = 49) HCT at a referral children’s medical center between January 1996 and April 2000.

Results. Seven (5.1%) of 138 patients met criteria for DAH; all were allogeneic recipients. Mean age of DAH patients was 11 years (range: 1.4–15.2). Median onset of DAH following HCT was day 24 (range: 10–50), median day of engraftment day 20 and white blood cell count 0.54 × 109/L (range: < 0.1–7.03), with no difference between survivors and nonsurvivors. All patients developed clinical respiratory failure and 6 required intubation, with Pao2/fraction of inspired oxygen <200. Patients were intubated a median of 12 days (range: 1–75). All patients experienced >1 episode of bleeding and 3 patients required reintubation after successful extubation resulting from recurrent DAH. Bronchoalveolar lavage fluid cultures were negative for viruses, bacteria and fungi. All DAH patients received steroids. Three patients died with progressive pulmonary failure and other organ system involvement. Four of 7 DAH patients (57%) survived to discharge, but 3 died from disease relapse at days 116, 138, and 273 post-HCT.

Conclusion. DAH occurred more frequently in allogeneic HCT recipients compared with autologous recipients. Onset of DAH coincided closely with white blood cell engraftment. Although associated with significant respiratory failure and need for mechanical ventilation, HCT patients can survive DAH.
Late Diagnosis of Severe Colchicine Intoxication
Authors: Güven Ayfer Gür , Bahat Elif , Akman Sema , Artan Reha , Erol Meltem
Published: August 2004

A 4-year-old Turkish girl was referred to our hospital with the findings of encephalopathy and pancytopenia. She had a history of severe abdominal cramps and gastrointestinal bleeding. A confused state, muscle pain and weakness, erythema-bullous and erythema-nodosum–like skin lesions, and alopecia were observed at her hospitalization. All of these symptoms resolved on follow-up. On laboratory investigation severe thrombocytopenia and leukopenia, mild anemia, a moderate increase in aspartate aminotransferase and alanine aminotransferase levels were detected. After reevaluating her medical history, it was learned that she had accidentally taken 1.3 to 1.5 mg/kg of colchicine 3 to 4 days before her first hospitalization.

The possibility of misdiagnosis of colchicine intoxication should be borne in mind, and pediatricians must be aware of its toxic effects, especially in areas where patients with familial Mediterranean fever are present.
Red Reflex Examination in Infants
Authors:   Section on Ophthalmology
Published: August 2004

Red reflex examination is recommended for all infants. This statement describes the indications for and the technique to perform this examination, including indications for dilation of the pupils before examination and indications for referral to an ophthalmologist.
Pediatric Organ Donation and Transplantation
Authors:   Committee on Hospital Care and Section on Surgery
Published: August 2004

Pediatric organ donation and organ transplantation can have a significant life-extending benefit to the young recipients of these organs and a high emotional impact on donor and recipient families. Pediatricians should become better acquainted with evolving national strategies involving organ procurement and organ transplantation to help acquaint families with the benefits of organ donation and to help shape public policies that will aid in efforts to provide a system of procurement, distribution, and finance that is fair and equitable to children and adults. Major issues of concern are availability and access; oversight and control; pediatric medical and surgical consultation throughout the organ donation and transplantation process; ethical, social, financial, and follow-up issues; insurance coverage issues; and public awareness of the need for organ donors of all ages.
How Should a Fever Mercury Thermometer be Disposed of? A Survey of Those Likely to be Asked
Authors: DiCarlo Michele , Ruck Bruce , Marcus Steven
Published: August 2004

The American Academy of Pediatrics’ recent technical report entitled “Mercury in the Environment: Implications for Pediatricians” was widely reported on by the news media. After the media reports, the New Jersey Poison Information and Education System experienced a notable increase in the volume of calls on this topic. We surveyed local, county, and state health officers who would likely be contacted by citizens with the question: “How should a fever mercury thermometer be disposed of?” Our initial contacts with health officers corroborated our caller’s account: a lack of uniformity of response. This led us to question if there was any consensus in advice being offered to the public at large.
Alcohol, Breastfeeding, and Development at 18 Months
Authors: Little Ruth E. , Northstone Kate , Golding Jean ,   ALSPAC Study Team
Published: August 2004

Objective. We aimed to replicate a previous study of 1-year-olds that reported a deficit in motor development associated with moderate alcohol use during lactation, using a different but comparable population.

Methodology. The mental development of 915 18-month-old toddlers from a random sample of a longitudinal population-based study in the United Kingdom was measured using the Griffiths Developmental Scales. Frequent self-administered questionnaires during and after pregnancy provided maternal data. The dose of alcohol available to the lactating infant was obtained by multiplying the alcohol intake of the mother by the proportion of breast milk in the infant’s diet. We compared this dose with the Griffiths Scales of Mental Development, taking into account potentially confounding variables.

Result. Three of the Griffiths scales increased slightly but significantly with increasing infant alcohol exposure; there was no association in the remaining 2 or average of the scales.

Discussion. We were unable to replicate the earlier deficit in motor skills associated with lactation alcohol use. One reason may be that the dose of alcohol reaching the lactating infant is small, and tests of infants and toddlers have limited ability to pick up small effects. Studies of older children may resolve the question of the safety of drinking while nursing.
Left Ventricular Structure and Function in Obese Adolescents: Relations to Cardiovascular Fitness, Percent Body Fat, and Visceral Adiposity, and Effects of Physical Training
Authors: Mitchell Brett M. , Gutin Bernard , Kapuku Gaston , Barbeau Paule , Humphries Matthew C. , Owens Scott , Vemulapalli Sarita , Allison Jerry
Published: August 2004

Objective. Little is known about the relations of fitness and fatness to left ventricular structure and function in obese adolescents. This project had 2 purposes: 1) to determine the correlations of cardiovascular fitness and adiposity to left ventricular parameters in obese adolescents; and 2) to see the effect of 8 months of physical training (PT) at low and high intensities.

Design. Obese 13- to 16-year-olds (N = 81) were tested at baseline and then randomly assigned to lifestyle education (LSE) alone, LSE plus moderate-intensity PT, or LSE plus high-intensity PT. Follow-up testing was conducted 8 months later. Because no significant differences were found between moderate-intensity and high-intensity PT, the groups were combined to form a LSE + PT group.

Intervention. Eight months of PT, offered 5 days per week with the target energy expenditure for all PT participants being 250 kcal/session, and LSE every 2 weeks.

Outcome Measures. Left ventricular mass divided by height to the 2.7th power (LVM/Ht2.7), midwall fractional shortening (MFS), and relative wall thickness (RWT) were measured using M-mode echocardiography. Cardiovascular fitness was measured by a maximal multistage treadmill test; percent body fat (%BF) with dual-energy radiograph absorptiometry; and visceral adipose tissue (VAT) with magnetic resonance imaging.

Results. At baseline, high levels of VAT were associated with higher RWT (r = 0.30) and lesser MFS (r = −0.29). Compared with the LSE-alone group, the LSE + PT group significantly improved in cardiovascular fitness and decreased in %BF and VAT. However, there were no significant differences between groups on changes in LVM/Ht2.7, MFS, or RWT. Individual changes in cardiovascular fitness, %BF, and VAT did not correlate significantly with interindividual changes in left ventricular structure and function.

Conclusions. High levels of VAT were associated with unfavorable left ventricular structure and function. However, no evidence was provided that an 8-month PT program, which improved cardiovascular fitness and reduced general and visceral adiposity, improved left ventricular structure and function. Future studies consisting of longer training programs and/or greater weight reductions are needed to see whether the adverse left ventricular effects of obesity can be ameliorated by exercise training.
An English-Language Clinic-Based Literacy Program Is Effective for a Multilingual Population
Authors: Silverstein Michael , Iverson Leslie , Lozano Paula
Published: August 2004

Objective.To assess the effectiveness of a clinic-based pediatric literacy intervention on a multilingual population.

Background.Clinic-based literacy interventions are effective among English- and Spanish-speaking children. No data exist for multilingual populations.

Setting.Pediatric clinic in an urban county hospital.

Design/Methods.Reading practices of 2 cross-sectional groups were assessed by standardized interview before and after the intervention. The intervention consisted of waiting-room volunteers reading to children, literacy counseling, and gift of a children’s book at each well-child visit from 6 months to 5 years. Outcomes were assessed separately for primary English-speaking and primary non-English-speaking families.

Results.The baseline (N=85) and postintervention (N=95) groups were similar with respect to child age and sex, parental education, and length of time in the United States. Fourteen languages were represented in total, the most common being English (41%), Somali (28%), Spanish (9%), Vietnamese (7%), Oromo (3%), and Tigrinyan (3%). Compared with baseline, postintervention respondents were more likely to report reading as a favorite activity for the child (10% vs 25%) and parent (18% vs 40%), to read to their child before bed at least weekly (45% vs 71%), and to possess over 10 children’s books at home (49% vs 63%). Among English-speaking families (N=30 baseline, N=40 postintervention), weekly bedtime reading increased (63% to 93%), reading as child’s favorite activity increased (7% vs 30%), and reading as the parent’s favorite activity to do with child increased (33% vs 58%). The proportion of English-speaking families possessing over 10 books at home and those reading with their children at least weekly showed no difference between the baseline and postintervention groups. Among non-English-speaking families (N=55 baseline, N=55 postintervention), weekly bedtime reading increased (36% vs 56%), reading as the parent’s favorite activity increased (11% vs 27%), and the number of families to possess >10 children’s books in the home increased (31% vs 49%). Reading as child’s favorite activity (13% vs 24%) and weekly book sharing (60% vs 76%) showed nonsignificant trends between the non-English-speaking baseline and postintervention groups.

Conclusions.This clinic-based literacy intervention influences home literacy behavior in this multiethnic setting, in both English-speaking and non-English-speaking families. Although efforts should be made to make such programs more appropriate for linguistic minorities, non-English-speaking families do stand to benefit from English-language-oriented programs. literacy, Reach Out and Read, pediatrics, reading, child development.
Ultrasonographic Evaluation of Cervical Lymph Nodes in Kawasaki Disease
Authors: Tashiro Norimichi , Matsubara Tomoyo , Uchida Masashi , Katayama Kumiko , Ichiyama Takashi , Furukawa Susumu
Published: August 2004

Objective. Kawasaki disease (KD) is one of the common causes of cervical lymphadenopathy during early childhood. The purpose of this study was to compare the ultrasonographic feature of cervical lymph nodes in patients with KD, bacterial lymphadenitis, and infectious mononucleosis.

Design. We studied 22 patients with KD, 8 with presumed bacterial lymphadenitis, and 5 with Epstein-Barr virus infectious mononucleosis. We examined the cervical nodes by ultrasonography using a 7.5-MHz or 10-MHz transducer of a B-mode sector scanner in all patients with a chief complaint of fever and a visible cervical mass during a fixed time interval (July 1995-March 2000).

Results. In KD patients, transverse ultrasonograms demonstrated multiple hypoechoic-enlarged nodes forming one palpable mass, which resembled a cluster of grapes. The ultrasonographic appearance of these nodes was similar in patients with acute Epstein-Barr virus infection, but differed from the pattern in presumed bacterial lymphadenitis. Five KD patients had had fever and cervical lymphadenopathy for several days before other manifestations of KD were noted. In these patients, it was possible to differentiate by ultrasonography between KD and presumed bacterial lymphadenitis at an early stage.

Conclusion. Ultrasonographic features of cervical lymph nodes were different for KD than for presumed bacterial lymphadenitis. Ultrasonographic evaluation might be of value for diagnosis of KD patients with cervical lymphadenopathy at an early stage of the disease.
Mortality Associated With Congenital Syphilis in the United States, 1992–1998
Authors: Gust Deborah A. , Levine William C. , St. Louis Michael E. , Braxton Jim , Berman Stuart M.
Published: August 2004

Objective. To summarize national trends in the incidence of congenital syphilis (CS) and associated mortality.

Methods. We analyzed CS surveillance data reported to the Centers for Disease Control and Prevention by 50 states and the District of Columbia from 1992–1998.

Results. From 1992–1998, 942 deaths, including 760 stillbirths, were reported among 14 627 cases of CS, yielding a case fatality ratio (stillborns and deaths/all cases) of 6.4%. Untreated, inadequately treated, or undocumented treatment of syphilis during pregnancy accounted for 87.4% of reported cases. Among CS cases, there was an inverse relationship between the number of prenatal care visits (0, 1–4, 5–9, ≥10) and risk of fatal outcome. Among deaths, 52% of deliveries occurred by 30 weeks’ gestation. Among live born infants with CS, death occurred more often in infants for whom no radiograph or cerebrospinal fluid evaluation was reported. Although both cases and deaths from CS declined from 1992–1998, there was no significant change in the case fatality ratio.

Conclusion. Mortality associated with CS continues to be an important public health problem that will resurge if adult syphilis rates increase. Because a large proportion of deaths occur at low gestational age, earlier diagnosis and treatment of maternal syphilis may substantially reduce the case fatality ratio.
Black-White Differences in Health Care Utilization Among US Children With Frequent Ear Infections
Authors: Park Christina H. , Kogan Michael D. , Overpeck Mary D. , Casselbrant Margaretha L.
Published: August 2004

Objective. To examine differences in patterns of and barriers to health care utilization between black and white children who have frequent ear infections (FEI).

Methods. Analysis was conducted using the 1997 and 1998 National Health Interview Survey-Sample Child Files. Data on 25 497 children under 18 years of age and 1985 who were reported by the parent/guardian to have had “3 or more ear infections during the past 12 months” were analyzed. The data were weighted and analyzed to represent all black and white children nationwide, accounting for the complex survey design.

Results. Of white and black children under 18 years of age in the United States, 8.0 and 6.6%, respectively, had FEI in the past year. Among those with FEI, whites and blacks exhibited significantly different patterns in the type of health insurance they had and in the usual source of care. After accounting for sociodemographic factors, health insurance, and usual source of care, there were still significant differences in health care use between whites and blacks. The affected black children had an increased risk of getting delayed care because of transportation problems (odds ratio [OR]: 2.32) and a reduced likelihood of seeing a medical specialist (OR: 0.49) and having surgery (OR: 0.39) in comparison to white children.

Conclusion. Although black children with FEI were as likely as white children to be covered by health insurance and have a usual place of health care, they were significantly more likely to face barriers in obtaining the care, especially the more specialized care.
Is More Neonatal Intensive Care Always Better? Insights From a Cross-National Comparison of Reproductive Care
Authors: Thompson Lindsay A. , Goodman David C. , Little George A.
Published: August 2004

Background. Despite high per capita health care expenditure, the United States has crude infant survival rates that are lower than similarly developed nations. Although differences in vital recording and socioeconomic risk have been studied, a systematic, cross-national comparison of perinatal health care systems is lacking.

Objective. To characterize systems of reproductive care for the United States, Australia, Canada, and the United Kingdom, including a detailed analysis of neonatal intensive care and mortality.

Design/Methods. Comparison of selected indicators of reproductive care and mortality from 1993–2000 through a systematic review of journal and government publications and structured interviews of leaders in perinatal and neonatal care.

Results. Compared with the other 3 countries, the United States has more neonatal intensive care resources yet provides proportionately less support for preconception and prenatal care. Unlike the United States, the other countries provided free family planning services and prenatal and perinatal physician care, and the United Kingdom and Australia paid for all contraception. The United States has high neonatal intensive care capacity, with 6.1 neonatologists per 10 000 live births; Australia, 3.7; Canada, 3.3; and the United Kingdom, 2.7. For intensive care beds, the United States has 3.3 per 10 000 live births; Australia and Canada, 2.6; and the United Kingdom, 0.67. Greater neonatal intensive care resources were not consistently associated with lower birth weight-specific mortality. The relative risk (United States as reference) of neonatal mortality for infants <1000 g was 0.84 for Australia, 1.12 for Canada, and 0.99 for the United Kingdom; for 1000 to 2499 g infants, the relative risk was 0.97 for Australia, 1.26 for Canada, and 0.95 for the United Kingdom. As reported elsewhere, low birth weight rates were notably higher in the United States, partially explaining the high crude mortality rates.

Conclusions. The United States has significantly greater neonatal intensive care resources per capita, compared with 3 other developed countries, without having consistently better birth weight-specific mortality. Despite low birth weight rates that exceed other countries, the United States has proportionately more providers per low birth weight infant, but offers less extensive preconception and prenatal services. This study questions the effectiveness of the current distribution of US reproductive care resources and its emphasis on neonatal intensive care.
How Good Is the Evidence Linking Breastfeeding and Intelligence?
Authors: Jain Anjali , Concato John , Leventhal John M.
Published: August 2004

Background. We conducted a critical review of the many studies that have tried to determine whether breastfeeding has a beneficial effect on intellect.

Design/Methods. By searching Medline and the references of selected articles, we identified publications that evaluated the association between breastfeeding and cognitive outcomes. We then appraised and described each study according to 8 principles of clinical epidemiology: 1) study design, 2) target population: whether full-term infants were studied, 3) sample size, 4) collection of feeding data: whether studies met 4 standards of quality— suitable definition and duration of breastfeeding, and appropriate timing and source of feeding data, 5) control of susceptibility bias: whether studies controlled for socioeconomic status and stimulation of the child, 6) blinding: whether observers of the outcome were blind to feeding status, 7) outcome: whether a standardized individual test of general intelligence at an age older than 2 years was used, and 8) format of results: whether studies reported an effect size or some other strategy to interpret the clinical impact of results.

Results. We identified 40 pertinent publications from 1929 to February 2001. Twenty-seven (68%) concluded that breastfeeding promotes intelligence. Many studies, however, had methodological flaws. Only 2 papers studied full-term infants and met all 4 standards of high-quality feeding data, controlled for 2 critical confounders, reported blinding, used an appropriate test, and allowed the reader to interpret the clinical significance of the findings with an effect size. Of these 2, 1 study concluded that the effect of breastfeeding on intellect was significant, and the other did not.

Conclusion. Although the majority of studies concluded that breastfeeding promotes intelligence, the evidence from higher quality studies is less persuasive.
Persistent Infant Crying and Hyperactivity Problems in Middle Childhood
Authors: Wolke Dieter , Rizzo Patrizia , Woods Sarah
Published: August 2004

Objective. To investigate whether persistent infant crying is associated with an increased risk for externalizing behavior problems in childhood.

Methods. Sixty-four infants who were referred for persistent crying in infancy (PC; mean age: 3.8 ± 1.3 months) were reassessed at 8 to 10 years of age and compared with 64 classroom controls (CC). The major outcome measure was pervasive hyperactivity or conduct problems defined as parent, child, and teacher ratings that across informants were within the borderline/clinical range according to the Strengths and Difficulties Questionnaire (SDQ). Ratings of other behavior problems, parent ratings of temperament, and teacher assessment of academic achievement were also obtained.

Results. Ten (18.9%) of 53 PC had pervasive hyperactivity problems (child, parent, and teacher reported) compared with 1 (18.9%) of 62 CC (odds ratio: 14.19 [1.75–114.96]). Parents (29 [45.3%] of 64 vs 11 [17.2%] of 64; 4.00 [1.77–9.01]) and children (30 [46.9%] of 64 vs 17 [26.6%] of 64; 2.44 [1.16–5.12]) but not the teachers reported more conduct problems. Parents of PC rated the temperament of their children to be more negative in emotionality (PC mean: 3.0 ± 1.0; CC: 2.4 ± 1.0; effect size: 0.6) and difficult-demanding (PC mean: 5.2 ± 1.3; CC: 6.3 ± 0.9; effect size: 1.0). Academic achievement was reported by teachers to be significantly lower for PC than CC, in particular for those children with pervasive hyperactivity problems.

Conclusions. Infants who are referred for PC problems and associated sleeping or feeding problems are at increased risk for hyperactivity problems and academic difficulties in childhood.
Natural History and Familial Relationships of Infant Spilling to 9 Years of Age
Authors: Martin A. James , Pratt Nicole , Kennedy J. Declan , Ryan Philip , Ruffin Richard E. , Miles Helen , Marley John
Published: August 2004

Objectives. To determine the natural history of infant spilling (regurgitation/vomiting) during the first 2 years of life and to determine the relationship between infant spilling and gastroesophageal reflux (GER) symptoms at 9 years of age.

Methods. A prospective birth cohort was followed with daily symptom diaries during the first 2 years of life and reviewed at 9 years of age (range: 8–11 years). The prevalence of infant spilling during the first 2 years of life, the prevalence of GER symptoms between 8 and 11 years of age (mean age: 9.7 years), relative risk of infant spilling predisposing to GER symptoms at 9 years of age, and prevalence of maternal GER symptoms and relationship with infant spilling and GER at 9 years of age were measured.

Results. A total of 693 children who represented 83% of an original sample of 836 children and were followed for 2 years from birth with daily symptom diaries were contacted at 9 (8–11) years of age. Spilling of most feeds each day was common in infancy and reached a peak prevalence of 41% between 3 and 4 months of age and thereafter declined to < 5% between 13 and 14 months of age. Infants with spilling on 90 days or more during the first 2 years of life (classified as frequent spilling) were more likely to have GER symptoms at 9 years of age. Children with frequent infant spilling, compared with those with no spilling, had a relative risk of 2.3 (95% confidence interval [CI]: 1.3–4.0) of 1 or more GER symptoms at 9 years of age, 4.6 (95% CI: 1.5–13.8) for heartburn, 2.7 (95% CI: 1.4–5.5) for vomiting, and 4.7 (95% CI: 1.6–14.0) for acid regurgitation. Gender, breastfeeding, and environmental tobacco smoke exposure were not significant factors related to infant spilling. Prepregnancy smoking and smoking in the same room as the child at the 9-month and 18-month follow-ups had a significant effect on GER symptoms at 9 years of age. Infant spilling and GER at 9 years of age were significantly related to maternal GER symptoms but not to paternal GER symptoms.

Conclusions. Spilling in infancy is very common, but the majority of children settle by 13 to 14 months of age. However, those with frequent spilling (>90 days) are more likely to have GER symptoms at 9 years of age. In addition, a maternal history of GER was significantly related both to infant spilling and to GER at 9 years, suggesting that a genetic component may be involved. Physicians should consider studying children with a history of frequent infant spilling to determine whether this group is at increased risk for GER disease.
Second Varicella Infections: Are They More Common Than Previously Thought?
Authors: Hall Susan , Maupin Teresa , Seward Jane , Jumaan Aisha O. , Peterson Carol , Goldman Gary , Mascola Laurene , Wharton Melinda
Published: August 2004

Objective. To describe the epidemiology and clinical characteristics of varicella reinfections reported to a surveillance project.

Methods. We investigated varicella cases reported to a surveillance project between January 1, 1995, and December 31, 1999—with more extensive investigation of cases reporting previous varicella with onset between January 1, 1998, and September 30, 1998—to provide a more detailed description of first and second varicella infections. A simple decision tree was used to assess the likelihood that reported first and second infections were varicella.

Results. Among varicella cases reported to the surveillance project, 4.5% of cases in 1995 and 13.3% of cases in 1999 reported previous varicella. More than 95% of first infections were physician diagnosed, epidemiologically linked to another case, or had a rash description consistent with varicella; the same was true for reported second infections. People who reported reinfections were generally healthy. There was a family history of repeat infections in 45% of people who reported reinfections.

Conclusions. Clinical varicella reinfections may occur more commonly than previously thought. Additional studies of the predictive value of a positive varicella history and laboratory studies of reported reinfections are indicated to guide varicella vaccination policy.
A Clinical Study to Evaluate the Efficacy of ELA-Max (4% Liposomal Lidocaine) as Compared With Eutectic Mixture of Local Anesthetics Cream for Pain Reduction of Venipuncture in Children
Authors: Eichenfield Lawrence F. , Funk Ann , Fallon-Friedlander Sheila , Cunningham Bari B.
Published: August 2004

Objective. A double-randomized, blinded crossover trial was performed to assess the efficacy of ELA-Max (4% liposomal lidocaine) as compared with eutectic mixture of local anesthetics (EMLA) for pain relief during pediatric venipuncture procedures. Safety was assessed by evaluation for topical or systemic effects and measurement of serum lidocaine concentrations.

Methods. A total of 120 children who were scheduled for repeat venipuncture for non–study-related reasons at 2 sites participated in the study. Patients were doubly randomized to treatment regimen (study medication application time of either 30 or 60 minutes) and to the order of application of the topical anesthetics for each venipuncture. The primary outcome measures were the child’s rating of pain immediately after the venipuncture procedures using a 100-mm visual analog scale (VAS) tool and the parent’s and blinded research observer’s Observed Behavioral Distress scores.

Results. Both ELA-Max and EMLA seemed to alleviate venipuncture pain. There was no clinically or statistically significant difference in the patient VAS scores within the 30-minute or 60-minute treatment groups, and there was no clinical or statistical difference in VAS scores between the 30-minute ELA-Max treatment without occlusion and the 60-minute EMLA treatment with occlusion. There were no clinically or statistically significant differences between treatment with ELA-Max and EMLA in parental or blinded researcher Observed Behavioral Distress scores, the most frequent response at any observation time being “no distress.”

Conclusion. This study demonstrates that a 30-minute application of ELA-Max without occlusion is as safe and as effective for ameliorating pain associated with venipuncture as a 60-minute application of the prescription product EMLA requiring occlusion.
Child Neglect: Outcomes in High-Risk Urban Preschoolers
Authors: Dubowitz Howard , Papas Mia A. , Black Maureen M. , Starr Raymond H.
Published: August 2004

Background. Limited longitudinal research has been conducted on the impact of neglect on children’s health and well-being. There is a need to consider the impact of specific subtypes of neglect on children’s functioning. In addition, there is interest in examining the cumulative effect of experiencing >1 subtype of neglect.

Objective. To examine the individual and cumulative relationships among physical, psychological, and environmental neglect and children’s behavior and development at age 3, and the impact on changes in children’s behavior and development between ages 3 and 5.

Methods. One hundred thirty-six children and their primary caregivers participating in a prospective longitudinal study of children’s development and maltreatment were assessed when the children were aged 3 and 5 years. The children were recruited from primary care clinics because of failure to thrive, risk for human immunodeficiency virus, or as a comparison group. Evaluations were conducted in laboratory and home settings using observations, maternal self-report, and standardized testing of the children. Scores on physical, psychological, and environmental neglect were combined into a Cumulative Neglect Index. Regression analyses were run to examine the association of specific subtypes of neglect and of cumulative neglect with children’s functioning at age 3, controlling for group, sociodemographic risk, and maternal depression. The analyses were repeated examining the impact on child outcomes at age 5, controlling for the above 3 variables as well as the children’s cognitive development and behavior at age 3.

Results. Of the subtypes of neglect at age 3, only psychological neglect was significantly associated with increased internalizing and externalizing behavior problems at age 3; the Cumulative Neglect Index was associated with internalizing problems. None of the neglect subtypes or cumulative neglect were predictive of changes in children’s behavior and development between ages 3 and 5. Cognitive development of the entire sample was impaired at age 5, averaging 0.85 standard deviations below the norm, and their average externalizing behavior score was significantly problematic with an average of 0.60 standard deviations above the norm.

Conclusions. In the context of poverty where many preschool children have poor cognitive development and increased behavior problems, psychological neglect is significantly related to reported behavior problems. Children who experienced multiple types of neglect had increased internalizing problems. Neglect did not explain changes in children’s behavior or development between ages 3 and 5. There is a need for pediatricians to identify and address child neglect, particularly psychological neglect, as early as possible. Pediatricians should also screen for maternal depression.
Accuracy of Infant Admission Lengths
Authors: Corkins Mark R. , Lewis Pam , Cruse Wendy , Gupta Sandeep , Fitzgerald Joseph
Published: August 2004

Objective. A variety of methods are used to assess the length of infants at hospital admission. A tape-measure technique is commonly used; however, this measure is potentially inaccurate. We aimed to assess accuracy of tape measurement of infant lengths by comparison with the more accurate length-board technique.

Methods. During a 1-year period, 25 infants who were younger than 36 months were seen for a nutrition consultation. The length obtained at admission was compared with that obtained with a length-board by a trained dietitian.

Results. Overall, the lengths varied enough both positively and negatively that no overall statistical difference was seen; however, the average difference between the tape measure and the length-board was 2.23 cm. The change in length resulted in a change in the weight-for-length percentile range in 13 of 25 patients.

Conclusion. The more accurate length-board measurement should be applied at the time of admission of an infant.
Decreased Arousals in Infants Who Sleep With the Face Covered by Bedclothes
Authors: Franco Patricia , Lipshutz Willy , Valente Filomena , Adams Stephan , Scaillet Sonia , Kahn André
Published: August 2004

Objective. The risk of becoming a victim of sudden infant death syndrome is increased in infants who sleep with their face under bedding items. The present study was designed to evaluate auditory arousal thresholds of infants who sleep with their face covered by bedclothes.

Methods. Twenty healthy infants with a median age of 11.5 weeks (range: 4–22 weeks) were recorded polygraphically for 1 night. Although they slept in their usual supine position, a bed sheet was placed over their face for 60 minutes. Fifteen of the 20 infants were chosen at random and were exposed to white noises of increasing intensities to determine their auditory arousal thresholds. All infants were challenged with the face covered and with the face free during both rapid eye movement (REM) and non-REM (NREM) sleep. Seven infants were first challenged with the face covered, and 8 were challenged with the face free. The following variables were recorded simultaneously: electroencephalogram, breathing and heart rates, and rectal and pericephalic temperatures. In 5 infants who were not exposed to the auditory challenges, end tidal CO2 was recorded for 30 minutes while sleeping with the face covered.

Results. During REM sleep, arousals occurred for significantly more intense auditory stimuli when the infant’s face was covered than when free. No significant difference was seen in NREM sleep. Compared with the face-free periods, the face-covered sleep periods were characterized by greater rectal and pericephalic temperatures, a greater density of body movements, and a decrease in NREM sleep. Respiratory frequency was increased during the face-covered periods in both REM and NREM sleep. No differences were seen in the frequency or duration of apnea. There was a tendency for heart rate to increase during both sleep stages when the face was covered, compared with the face-free periods, but the changes were not statistically significant. A positive correlation was found between pericephalic temperatures and arousal thresholds (r = 0.60) during REM sleep. End tidal CO2 values increased when the face was covered, reaching a maximum value during the first 5 minutes of the experiment. No fall in oxygen saturation was seen.

Conclusions. Covering the infant’s face with a bed sheet was associated with a significant increase in auditory arousal threshold. The finding could be related to an elevation in temperatures within the infant’s microenvironment.
Comparison Between Pediatricians and Family Practitioners in the Use of the Prokinetic Cisapride for Gastroesophageal Reflux Disease in Children
Authors: Shaoul Ron , Shahory Ron , Tamir Ada , Jaffe Michael
Published: August 2004

Objective. The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition and the European Society of Pediatric Gastroenterology, Hepatology and Nutrition have recently issued treatment guidelines for the use of cisapride in children. Our hypothesis was that cisapride is misused in the community and is not prescribed according to suggested recommendations. Therefore, the aim of this study was to evaluate the knowledge of pediatricians and family practitioners regarding the prescribing practice and adverse effects of cisapride.

Methods. A standardized questionnaire was sent to a randomly selected group of pediatricians and family practitioners in Northern Israel. The questionnaire was designed to evaluate the knowledge of the physician regarding the treatment of gastroesophageal reflux disease and the use of cisapride in children (indications, dosages, duration of treatment, limitations in certain age groups, the need for pretreatment laboratory tests, interactions with other drugs, and contraindications). Replies were scored from 0 to 100 according to the treatment guidelines of both the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition and the European Society of Pediatric Gastroenterology, Hepatology and Nutrition. In addition, 2 questions dealt with the subjective efficacy of the drug and its adverse events.

Results. The knowledge scores were 62% and 51% in the pediatricians and family practitioners, respectively. Other major findings were as follows: 1) 40% of pediatricians and 65% of family practitioners do not prescribe the recommended dose of cisapride, 2) 6% of pediatricians and 42% of family practitioners prescribe cisapride for infantile colic, 3) only 50% of pediatricians and 22% of family practitioners were aware of possible interactions with macrolides, and 4) only 31% of pediatricians and 54% of family practitioners were aware that cisapride might cause prolongation of the QT interval. Only minor adverse events were reported.

Conclusions. The knowledge of both pediatricians and family practitioners in the use of cisapride in children is suboptimal. It is essential to improve the education of community physicians to reduce the potential for adverse events arising from the misuse of this prokinetic agent.
Use of Indoor Tanning Sunlamps by US Youth, Ages 11–18 Years, and by Their Parent or Guardian Caregivers: Prevalence and Correlates
Authors: Cokkinides Vilma E. , Weinstock Martin A. , O’Connell Mary C. , Thun Michael J.
Published: August 2004

Background. Tanning parlors have become common in the United States. Artificial ultraviolet radiation exposure from this source may be harmful and may increase the risk of melanoma, particularly when done for recreational purposes during childhood and early adult years. Population-based data on the prevalence and correlates of this activity is important in the evaluation of potential public health interventions for skin cancer prevention.

Study Design. In 1998, we conducted a population-based telephone survey of youth and their primary caregiver. The sample (N = 1192) was weighted to represent the population of US youth living in households with a primary caregiver. Interviewers used a standardized questionnaire to document the characteristics of the participant and their practices, attitudes, and experiences regarding ultraviolet exposures.

Method of Analysis. Weighted prevalence and adjusted prevalence odds ratios (aPOR) and 95% confidence interval (95% CI) were estimated. Independent factors were evaluated with multivariate logistic regression.

Results. Ten percent of youth and 8% of their primary caregivers used indoor tanning sunlamps in the previous year. Thirty percent of the youth whose caregivers used indoor tanning sunlamps did so themselves as well. Independent predictors associated with indoor tanning sunlamp use were as follows: age 17 to 18 years (aPOR = 11.1; 95% CI: 5.0, 25.0); female (aPOR = 8.3; 95% CI: 3.6, 19.2); having a parent who used indoor tanning sunlamps in the previous year (aPOR = 8.7; 95% CI: 4.0, 18.9); nonuser of Sun Protection Factor 15 sunscreen at the beach or pool (aPOR = 1.9; 95% CI: 1.0, 3.4); and low sun sensitivity (aPOR = 2.3; 95% CI: 1.0, 5.3).

Conclusion. A substantial minority of American youth engages in indoor tanning. However, it is particularly prevalent among older youth, girls, and youth whose parents themselves use indoor tanning sunlamps. The knowledge of these trends may help focus public health initiatives.