bluuebunny/crossref_metadata_2025 huggingface dataset:
Cochleovestibular Impairment in Pediatric Cogan’s Syndrome
Authors: Ndiaye Issa C. , Rassi Simon J. , Wiener-Vacher Sylvette R.
Published: August 2004

Cogan’s syndrome is a rare, chronic inflammatory disorder that typically targets the eyes and vestibuloauditory apparatus, but it may also involve other organs. Three pediatric cases of Cogan’s syndrome (ages 5, 13, and 18 years) are reported with long-term follow-up and complete and regular cochleovestibular functional evaluation and ophthalmologic and neurologic examinations. One case was a typical form (characterized by an interstitial keratitis and cochleovestibular impairment), whereas the other 2 cases were atypical forms with uveitis and polyarthritis. In all 3 cases, the first clinical sign was nonspecific eye redness misdiagnosed as a banal conjunctivitis, initially or secondarily associated with bilateral endocochlear sensorineural hearing loss and complete bilateral peripheral vestibular deficit. During the acute phase, early steroid treatment (prednisone, 1 mg/kg/day) was effective in treating the ocular lesions (3 of 3 cases) and improving hearing (2 of 3 cases) but less effective for the vestibular loss (2 of 3 cases). Adverse effects and dependence on the steroid occurred in 2 cases, and immunosuppressive drugs were necessary to avoid recurrences in 1 case. Over the long-term, the disease was controlled in 2 cases but continued to progress in the other. Cogan’s syndrome in childhood should be suspected in cases of conjunctivitis associated with inner-ear symptoms; a prompt steroid treatment can avoid progressive impairment of multiple sensorineural functions (vision, balance, hearing). Long-term management involves limiting disease recurrences by adaptive therapies, screening for complications (aortitis in particular), and planning rehabilitation for the sensorial deficits.
Use of an Internet-Based Community Surveillance Network to Predict Seasonal Communicable Disease Morbidity
Authors: Hammond Lucinda , Papadopoulos Spyridon , Johnson Candice F. , MaWhinney Samantha , Nelson Bernard , Todd James K.
Published: August 2004

Objectives. We designed an Internet-based surveillance network that linked community clinic diagnoses with viral isolation rates and admission patterns at a related children’s hospital. We hypothesized that community surveillance would successfully predict subsequent hospital admissions and laboratory viral isolations. Secondarily, we expected the network to monitor trends in disease and that posting this information on a Web site would be useful to physicians in daily practice.

Study Design. Data were collected from December 1999 through August 2000. Information was summarized and posted weekly on a Web site. Active public piloting of the site took place during August 2000, after which the project was evaluated through an electronic mail survey. The predictive ability of the community surveillance data was evaluated by multivariate linear regression.

Results. Increases in the community diagnosis of most syndromes under surveillance, including lower respiratory infections (adjusted R2 = 0.7086) and gastroenteritis (adjusted R2 = 0.6532) successfully predicted an increase in subsequent hospital admissions. Community surveillance also successfully predicted laboratory isolation of associated viral organisms. Physicians completing the evaluation (N = 11) indicated that the site provided information useful in daily practice for both physician and parent education.

Conclusions. An Internet-based surveillance network linking a hospital with community physicians is beneficial to the hospital in predicting waves of severe cases requiring admission and reciprocally provides useful information to physicians in daily practice regarding the incidence and cause of seasonal disease in the community.
Internet Use in Families With Children Requiring Cardiac Surgery for Congenital Heart Disease
Authors: Ikemba Catherine M. , Kozinetz Claudia A. , Feltes Timothy F. , Fraser Charles D. , McKenzie E. Dean , Shah Naeema , Mott Antonio R.
Published: August 2004

Objective. We sought to document the prevalence of Internet access and usage patterns among families who have children with congenital heart disease presenting for cardiac surgery.

Design. A cross-sectional study was performed utilizing a questionnaire (10 questions) as the study tool. Statistical analysis was performed on all completed questionnaires. The χ2 test was used to evaluate categorical variables and the t test to evaluate continuous variables.

Results. Two hundred seventy-five questionnaires were completed and analyzed. Thirty-seven percent (102/275) of the children had a cyanotic congenital heart defect. There were 21 children with Trisomy 21. Fifty-eight percent (160/275) of families had access to the Internet. The most common locations for accessing the Internet were home (80%; 129/160) and work (51%; 82/160). There were no significant differences in Internet access with regards to underlying individual congenital heart defect, cyanotic versus acyanotic heart defects, or congenital heart defects with functional univentricular hearts versus biventriuclar hearts. Families with older children (12–24 years) were more likely to have Internet access. Families of children undergoing placement of a right ventricle to pulmonary artery conduit were more likely to have Internet access.

Of the 160 families with Internet access, 58% (93/160) used the Internet to obtain information related to their child’s cardiac diagnosis. Eighty-two percent (76/93) characterized locating cardiology-related information as easy. Six parents created interactive personal Web sites specifically related to their child’s congenital heart defect. Although families with older patients (12–24 years) were more likely to have access to the Internet, this did not translate into greater use of the Internet to obtain cardiology-related information. Among families who accessed the Internet for cardiology-related information, 95% (88/93) of families characterized the information as helpful or very helpful in furthering the understanding of their child’s heart defect.

Conclusion. Families are utilizing the Internet to educate themselves about congenital heart disease. Most parents consider the process easy and the information obtained helpful to the understanding of their child’s congenital heart defect and surgery. Internet use in this patient population is expected to increase. Our vigilance in providing accurate Internet references, as well as in identifying inaccurate Internet information available to our patients and their parents, is of paramount importance.
Impact of Necrotizing Enterocolitis on Length of Stay and Hospital Charges in Very Low Birth Weight Infants
Authors: Bisquera Jennifer A. , Cooper Timothy R. , Berseth Carol Lynn
Published: August 2004

Objective. To determine the impact of necrotizing enterocolitis (NEC) on length of stay and hospital charges.

Design. Case-control study.

Setting. Two neonatal intensive care units in an academic medical center.

Patients. Infants born in 1992–1994 with birth weight <1500 g, matched by gestational age, hospital, and month of birth.

Measurements and Main Results. We performed odds ratio and t testing. As with previous studies, there was no single factor that increased the risk for developing NEC. However, the diagnosis of NEC increased the risk for death, infection, and the need for central line placement. Infants with surgical NEC had lengths of stay that exceeded those of controls by 60 days, whereas lengths of stay among infants with medical NEC exceeded those of controls by 22 days. Based on length of stay, the estimated total hospital charges for infants with surgical NEC averaged $186 200 in excess of those for controls and $73 700 more for infants with medical NEC. The yearly additional hospital charges for NEC were $6.5 million or $216 666 per survivor.

Conclusions. A diagnosis of NEC in the very low birth weight infant imposes a significant additional financial burden to the individual patient as well as the neonatal community as a whole. This expense justifies additional research into preventive measures and potentially costly therapies aimed at reducing the incidence of NEC. These data also provide an estimated cost to compare the cost effectiveness of new preventive measures for NEC.
Noninvasive Continuous Monitoring of the Effects of Head Position on Brain Hemodynamics in Ventilated Infants
Authors: Pellicer Adelina , Gayá Francisco , Madero Rosario , Quero José , Cabañas Fernando
Published: August 2004

Hypothesis. Laying supine with the head in midline position improves cerebral venous return by preventing functional occlusion of the vessels of the neck.

Objectives. To assess changes in cerebral blood volume (ΔCBV) and cerebral blood flow (CBF) with the position of the head in ventilated patients using a noninvasive method. The influence of the type of ventilation and birth weight was evaluated.

Methods. Thirteen conventionally ventilated and 8 high-frequency oscillatory ventilated infants, with mean gestational ages and birth weights of 31 ± 5 weeks (24–38) and 1575 ± 803 g (560–3000), respectively, were studied 5.8 ± 7.8 days (1–33) after birth. ΔCBV (mL/100 g) and CBF (mL/100 g/min) were measured by near-infrared spectroscopy with the head in supine midline position (ΔCBVs, CBFs) and rotated 90° to one side (ΔCBVlat, CBFlat). Heart rate, peripheral saturation, transcutaneous Pco2, and blood pressure were monitored continuously. Ventilatory settings remained constant throughout the study period.

Results. Mean ΔCBVs was lower than mean ΔCBVlat, although no changes in blood pressure, transcutaneous Pco2, oxygenation, or heart rate occurred. This change in ΔCBV was not associated with the type of ventilation or birth weight, but the differences tended to be greater (dΔCBV = ΔCBVlat−ΔCBVs) in the smallest infants (<1200 g). In contrast, CBF did not vary.

Conclusion. The supine midline position of the head favors cerebral venous drainage and helps to prevent elevation of CBV.

Speculation. This finding may be important in the first days of life, particularly in tiny preterm infants recovering from lung disease with improving lung compliance, in which functional obstruction of cerebral venous drainage should be avoided.
Genetic Screening for Maternal Uniparental Disomy of Chromosome 7 in Prenatal and Postnatal Growth Retardation of Unknown Cause
Authors: Hannula Katariina , Lipsanen-Nyman Marita , Kristo Paula , Kaitila Ilkka , Simola Kalle O. J. , Lenko Hanna Liisa , Tapanainen Päivi , Holmberg Christer , Kere Juha
Published: August 2004

Objective. Many short-statured children lack an etiologic explanation for their retarded growth. Recently, uniparental disomy (UPD), the inheritance of both chromosomes of a chromosome pair from only 1 parent, has been associated with short stature for many chromosomes. Silver-Russell syndrome (SRS) represents an extreme syndrome of intrauterine growth retardation (IUGR) and slight dysmorphic signs, and maternal UPD of human chromosome 7 (matUPD7) has been observed in approximately 10% of SRS cases. In addition, matUPD7 has been reported in patients with only slight dysmorphic features and prenatal or postnatal growth retardation. The objectives of this study were to study the role of matUPD7 in growth failure of unknown cause and in cases of SRS, and to evaluate the efficiency of genetic testing for matUPD7 as a diagnostic tool.

Methods. DNA samples were studied from 205 children, 92 girls and 113 boys, with short stature of unknown cause and their parents. The patient cohort included 39 cases of SRS, 91 patients with IUGR and subsequent postnatal short stature, and 75 patients with postnatal growth retardation only. MatUPD7 was screened for by genotyping DNA samples from the patient, mother, and father with 13 chromosome-7-specific polymorphic microsatellite markers.

Results. Six (3%) of 205 matUPD7 cases were observed exclusively among 39 (15%) SRS patients studied. Patients with IUGR and/or postnatal growth retardation and with dysmorphic features did not reveal cases of matUPD7.

Conclusions. Our results indicate that matUPD7 cases are predominantly observed among patients meeting the criteria of SRS, and matUPD7 is not a common cause for growth retardation. Genetic screening for cases of matUPD7 among growth-retarded patients should be focused on patients with severe IUGR and features of SRS. In addition, matUPD7 screening is advisable in individuals with cystic fibrosis and other recessive disorders mapped to chromosome 7 who have unusually short stature.
The Significance of Gastric Residuals in the Early Enteral Feeding Advancement of Extremely Low Birth Weight Infants
Authors: Mihatsch Walter A. , von Schoenaich Patrik , Fahnenstich Hubert , Dehne Norma , Ebbecke Hartmut , Plath Christian , von Stockhausen Hans-Burkhardt , Muche Rainer , Franz Axel , Pohlandt Frank
Published: August 2004

Objective. To evaluate whether the mean gastric residual volume (GRV) and green gastric residuals (GR) themselves are significant predictors of feeding intolerance in the early enteral feeding advancement in extremely low birth weight (ELBW; <1000 g) infants.

Design. Ninety-nine ELBW infants were fed following a standardized protocol (day 3–14). At 48 hours of age, milk feeding was started (12 mL/kg/d increments, 12 meals per day). GR were checked before each feeding, and a GRV up to 2 mL/3 mL in infants ≤750 g/>750 g was tolerated. In cases of increased GRV, feedings were reduced or withheld. The color of GR was assessed as clear, milky, green-clear, green-cloudy, blood-stained, or hemorrhagic. Multiple regression analysis was used to study the effect of the mean GRV and the color of GR on the feeding volume on day 14 (V14).

Results. The median V14 was 103 mL/kg/d (0–166). V14 increased with an increasing percentage of milky GR, whereas the mean GRV and the color green did not have a significant effect.

Conclusions. 1) Early enteral feeding could be established in ELBW infants. The critical GRV seems to be above 2 mL/3 mL because there was no significant negative correlation between the mean GRV and V14. 2) Green GR were not negatively correlated with V14 and should not slow down the advancement of feeding volumes in absence of other clinical signs and symptoms.
The Usefulness of Children’s Drawings in the Diagnosis of Headache
Authors: Stafstrom Carl E. , Rostasy Kevin , Minster Anna
Published: August 2004

Objective. To determine whether drawings can aid in the differential diagnosis of headaches in children.

Methods. Before taking any history, 226 children who were seen consecutively for the evaluation of headache were asked to draw a picture to show how their headache felt. The pictures were then scored as migraine or nonmigraine by pediatric neurologists who were blinded to the clinical history. A clinical diagnosis of headache type was determined independently by another pediatric neurologist using the usual history and examination. The diagnoses of headache type based on the pictures drawn and the clinical findings obtained were then compared to calculate the sensitivity, specificity, and predictive values of the drawings for the diagnosis of migraine.

Results. Children produced dramatic and insightful headache drawings. Compared with the clinical diagnosis (gold standard), headache drawings had a sensitivity of 93.1%, a specificity of 82.7%, and a positive predictive value (PPV) of 87.1% for migraine. That is, drawings that contained an artistic feature consistent with migraine (eg, pounding pain, nausea/vomiting, desire to lie down, periorbital pain, photophobia, visual scotoma) predicted the clinical diagnosis of migraine in 87.1% of cases. Predictive values were also calculated for specific migraine-associated features on drawings: artistic depiction of focal neurologic signs, periorbital pain, recumbency, visual symptoms (photophobia, scotomata), or nausea/vomiting had a PPV of >90% for migraine; severe or pounding pain had a PPV of >80% for migraine. Band-like pain was not predictive of migraine (PPV of 11.1%). Features on drawings such as sadness or crying did not differentiate migraine from nonmigraine headaches.

Conclusions. Children’s headache drawings are a simple, inexpensive aid in the diagnosis of headache type, with a very high sensitivity, specificity, and predictive value for migraine versus nonmigraine headaches. We encourage the use of drawings in the evaluation of any child with a headache, as an adjunct to the clinical history and physical examination.
Hypospadias and Early Gestation Growth Restriction in Infants
Authors: Hussain Naveed , Chaghtai Azhar , Herndon C. D. Anthony , Herson Victor C. , Rosenkrantz Ted S. , McKenna Patrick H.
Published: August 2004

Objective. There has been a major increase in the incidence of hypospadias in infants in the 1990s, but the risk factors are not known. Although there are scattered reports in the literature regarding the association of low birth weight and hypospadias, this has not been systematically studied. The objective of this study was to determine the association between early gestation intrauterine growth and hypospadias.

Methods. A retrospective review of 13 years of admissions to 2 tertiary care neonatal intensive care units (NICUs) in Connecticut (1987–2000) showed that 112 (1.66%) of 6746 male infants had any degree of hypospadias. Of these, 8 were part of a genetic syndrome and were excluded. A retrospective cohort analysis of these 6738 infants was performed. Infant growth parameters at birth (weight, head circumference, and length) were analyzed along with maternal risk factors known to be associated with changes in fetal growth, including maternal age, race, diagnosis of preeclampsia, gestational diabetes, and maternal use of alcohol or tobacco or substance abuse during pregnancy.

Results. The incidence of hypospadias in the NICU population increased 10-fold from 0.4% in 1987 to 4% in the first quarter of 2000. Hypospadias was significantly more common in infants who had uniformly poor intrauterine growth (<10th percentiles) in the various parameters measured: birth weight, length, or head circumference. There were no significant differences in maternal age or race, nor were there differences in the use of alcohol, tobacco, or street drugs by the mother. There were no differences between singletons and multiple-gestation births. However, the frequency of occurrence was significantly higher among first-born infants (1.9%) compared with all other infants (0.9%).

Conclusions. The incidence of hypospadias in our NICU population has increased 10-fold during the 13-year period of study. There was a significant association of hypospadias with poor intrauterine growth. The growth restriction was probably of early gestational cause as there was proportionate involvement of somatic (weight and length) and brain growth (head circumference). The increasing frequency of hypospadias and its association with poor intrauterine growth originating in early gestation suggests that common environmental factor(s) that have an impact on both conditions may be involved.
Appendicostomy for Antegrade Enema: Effects on Somatic and Psychosocial Functioning in Children With Myelomeningocele
Authors: Aksnes Gunnar , Diseth Trond H. , Helseth Are , Edwin Bjørn , Stange Marianne , Aafos Gabrielle , Emblem Ragnhild
Published: August 2004

Objective. To assess changes in somatic variables, psychosocial functioning, mental health and self-esteem after appendicostomy for antegrade enema (MACE) in children with myelomeningocele (MMC).

Methods. We performed the MACE procedure in 20 children, aged 6.3 to 17.0 years. Twelve patients had an open and 8 had a laparoscopic operation. Somatic function was assessed preoperatively and 6 and 16 months postoperatively. Psychosocial functioning and mental health were assessed preoperatively and 6 months postoperatively by a structured clinical interview and standardized questionnaires, Youth Self-Report, Child Behavior Checklist, and Harter’s Self-Perception Profile for Adolescents.

Results. Preoperatively, 9 patients had fecal leaks several times a week, 7 had leaks 1 to 4 times per month, and 4 were continent. The corresponding numbers 6 and 16 months postoperatively were 0, 6, and 14 and 0, 3, and 16. Six patients have had postoperative stoma complications that required surgery; 5 had a well-functioning stoma thereafter, and 1 had a colostomy 7 months later. Preoperatively, 14 patients reported considerable, 4 moderate, 2 minor, and 0 no psychosocial problems related to bowel control and emptying regimen. Six months postoperatively, the corresponding numbers were 1, 2, 6, and 11. The standardized questionnaires revealed substantial psychopathology in the MMC patients. The Child Behavior Checklist and Youth Self-Report scores were not significantly changed postoperatively, but global self-esteem score and close friends score from the Self-Perception Profile for Adolescents were significantly improved.

Conclusions. Fecal incontinence and constipation were greatly reduced by MACE. Children with MMC often have psychological and psychosocial problems, but important improvements in self-esteem and psychosocial function were observed 6 months after the MACE procedure.
A Pediatric, Practice-Based, Randomized Trial of Drinking and Smoking Prevention and Bicycle Helmet, Gun, and Seatbelt Safety Promotion
Authors: Stevens Marguerite M. , Olson Ardis L. , Gaffney Cecelia A. , Tosteson Tor D. , Mott Leila A. , Starr Pamela
Published: August 2004

Objective. To prevent early adolescent health risk behaviors and to maintain or improve safety behaviors, we compared the effects of 2 interventions, delivered through pediatric primary care practices. The interventions, based on an office systems’ approach, sought to prevent early drinking and smoking or to influence bicycle helmet use, gun storage, and seatbelt safety for children who were followed from fifth/sixth grades through eighth/ninth grades.

Design. Settings and Participants. Twelve pediatric practices in New England were paired according to practice size and assigned randomly within pairs to deliver the multicomponent interventions, which built on pediatric primary care clinicians performing as counselors and role models during health supervision visits and other office encounters.

Intervention. One intervention arm focused on alcohol and tobacco use. The other intervention arm focused on gun safety, bicycle helmet, and seatbelt use. Office systems provided infrastructure that supported the clinician’s role. Clinician messages encouraged family communication and rule setting about the issues of the middle school years. The intervention was initiated during a health supervision visit and continued for 36 months. Both child and parent received quarterly newsletters to reinforce the clinician messages.

Outcome Measures. The primary outcomes were ever drinking alcohol, ever smoking, ever using smokeless tobacco, using a bicycle helmet in the previous year, using a seatbelt in the previous 30 days, and guns in the child’s home in locked storage.

Results. The pediatric practices recruited 85% (N = 3525) of the practices’ fifth/sixth grade children and their responding parents. We obtained 36 months’ follow-up data on 2183 child-parent pairs. Chart audit verified that the intervention was implemented. Additional data from interviews and surveys showed that parents, children, and pediatric clinicians found the intervention useful. Despite this, comparisons between the 2 study arms show no significant intervention effects in the prevention of alcohol and tobacco use or gun storage or seatbelt safety. There was a negative effect in the alcohol arm. Only bicycle helmet use showed a positive outcome.

Conclusion. With rigorous evaluation, 2 office interventions failed to produce desired outcomes. Coordinated multiple settings for prevention interventions are probably necessary.
Seven-Year Follow-up of Vaccine Response in Extremely Premature Infants
Authors: Kirmani Khaver I. , Lofthus Geraldine , Pichichero Michael E. , Voloshen Timothy , D’Angio Carl T.
Published: August 2004

Objective. To assess the immune response of 7-year-old former extremely preterm (PT) infants to routine childhood immunizations.

Methods. Sixteen PT (<29 weeks and <1000 g) infants, followed since their primary immunizations at the recommended chronological ages, and 16 age-matched full-term (FT) control subjects were evaluated at 7 years of age. Antibodies to Haemophilus influenzae type b polyribosylribitol phosphate (Hib-PRP), tetanus, pertussis, diphtheria, polio, and hepatitis B (HBsAb) were measured.

Results. The FT group had higher antidiphtheria geometric mean titers (GMT) than the PT group (1.07 vs 0.36 IU/mL). All FT and 13 of 16 PT had protective diphtheria antibody titers (>0.1 IU/mL). The tetanus GMT were 4.22 IU/mL (FT) and 1.99 IU/mL (PT). All children had protective tetanus titers (>0.01 IU/mL). Pertussis titers did not differ between FT and PT. Hib-PRP GMT were higher in FT than in PT (3.21 vs 1.41 μg/mL). All children had anti-PRP ≥0.15 μg/mL; 12 of 16 FT and 10 of 16 PT had levels ≥1.0 μg/mL. Polio serotype 1 and 2 GMT were similar between groups, and all children had protective titers (≥8). Polio serotype 3 GMT were 59 (FT) and 24 (PT) Karber units; all FT and 12 of 16 PT had protective titers. Among children who had received hepatitis B vaccine, GMT were similar in FT and PT children (120 vs 186 mIU/mL, and similar proportions of children (11 of 16 FT and 12 of 14 PT) had protective HBsAb titers (>10 mIU/mL).

Conclusions. At 7 years of age, PT children had lower antibody titers to many vaccine antigens than FT children. However, most PT children maintained antibody titers in the protective range.
Two Wrongs Don’t Make a Right: Harm Aggravated by Inaccurate Information on the Internet
Authors: Crocco Anthony George , Villasis-Keever Miguel , Jadad Alejandro R.
Published: August 2004

There has been much concern expressed in the literature about the use of medical information on the Internet by patients and families. Although much work has been done to quantify the misinformation available on the Internet, there have not been reports of actual harm to children resulting from this misinformation. We present the case of a 1-year-old boy whose clinical course of diarrhea was complicated not only by inaccurate advice given by the emergency room physician, but also by the same advice received from the Internet.
Use of Photoscreening for Children’s Vision Screening
Authors:   Committee on Practice and Ambulatory Medicine and Section on Ophthalmology
Published: August 2004

This statement asserts that all children should be screened for risk factors associated with amblyopia. Guidelines are suggested for the use of photoscreening as a technique for the detection of amblyopia and strabismus in children of various age groups. The American Academy of Pediatrics favors additional research of the efficacy and cost-effectiveness of photoscreening as a vision screening tool.
Health Supervision for Children with Sickle Cell Disease
Authors:   Section on Hematology/Oncology and Committee on Genetics
Published: August 2004

This Clinical Report was revised. See https://doi.org/10.1542/peds.2024-066842.

Sickle cell disease (SCD) is a group of complex genetic disorders with multisystem manifestations. This statement provides pediatricians in primary care and subspecialty practice with an overview of the genetics, diagnosis, clinical manifestations, and treatment of SCD. Specialized comprehensive medical care decreases morbidity and mortality during childhood. The provision of comprehensive care is a time-intensive endeavor that includes ongoing patient and family education, periodic comprehensive evaluations and other disease-specific health maintenance services, psychosocial care, and genetic counseling. Timely and appropriate treatment of acute illness is critical, because life-threatening complications develop rapidly. It is essential that every child with SCD receive comprehensive care that is coordinated through a medical home with appropriate expertise.
Health Care of Young Children in Foster Care
Authors:   Committee on Early Childhood, Adoption, and Dependent Care
Published: August 2004

Greater numbers of infants and young children with increasingly complicated and serious physical, mental health, and developmental problems are being placed in foster care. All children in foster care need to receive initial health screenings and comprehensive assessments of their medical, mental, dental health, and developmental status. Results of these assessments must be included in the court-approved social services plan and should be linked to the provision of individualized comprehensive care that is continuous and part of a medical home. Pediatricians have an important role in all aspects of the foster care system.
Skateboard and Scooter Injuries
Authors:   Committee on Injury and Poison Prevention
Published: August 2004

Skateboard-related injuries account for an estimated 50 000 emergency department visits and 1500 hospitalizations among children and adolescents in the United States each year. Nonpowered scooter-related injuries accounted for an estimated 9400 emergency department visits between January and August 2000, and 90% of these patients were children younger than 15 years. Many such injuries can be avoided if children and youth do not ride in traffic, if proper protective gear is worn, and if, in the absence of close adult supervision, skateboards and scooters are not used by children younger than 10 and 8 years, respectively.
Guidelines for Pediatric Cardiovascular Centers
Authors:   Section on Cardiology and Cardiac Surgery
Published: August 2004

Pediatric cardiovascular centers should aim to provide high-quality therapeutic outcomes for infants and children with congenital and acquired heart diseases. This policy statement describes critical elements and organizational features of centers in which high-quality outcomes have the greatest likelihood of occurring. Center elements include noninvasive diagnostic modalities, cardiac catheterization, cardiovascular surgery, and cardiovascular intensive care. These elements should be organizationally united in centers in which pediatric cardiac physician specialists and specialized pediatric staff work together to achieve and surpass existing quality-of-care benchmarks.
Selecting and Using the Most Appropriate Car Safety Seats for Growing Children: Guidelines for Counseling Parents
Authors:   Committee on Injury and Poison Prevention
Published: August 2004

Despite the existence of laws in all 50 states requiring the use of car safety seats or child restraint devices for young children, more children are still killed as passengers in car crashes than from any other type of injury. Pediatricians and other health care professionals need to provide up-to-date, appropriate information for parents regarding car safety seat choices and proper use. Although the American Academy of Pediatrics is not a testing or standard-setting organization, this policy statement discusses the Academy’s current recommendations based on the peer-reviewed literature available at the time of publication and sets forth some of the factors that parents should consider before selecting and using a car safety seat.
A Double-Blind, Placebo-Controlled Study of Modified-Release Methylphenidate in Children With Attention-Deficit/Hyperactivity Disorder
Authors: Greenhill Laurence L. , Findling Robert L. , Swanson James M. ,   MPH MR ADHD Study Group
Published: August 2004

Objective. To compare the efficacy, safety, and tolerability of once-daily administration of modified-release methylphenidate (MPH MR) with placebo in children with attention-deficit/hyperactivity disorder (ADHD).

Methods. The study was a 3-week, double-blind, 32-site, randomized clinical trial comparing MPH MR with placebo. Children were 6 to 16 years of age, had a diagnosis of ADHD, and had not failed a previous trial of stimulant treatment for ADHD. After a 1-week, single-blind, placebo-washout period, participants received a once-daily dose of MPH MR or placebo, which was started with 1 capsule (20 mg) and individually titrated up to a maximum of 3 capsules (60 mg). The primary outcome measure was specified as a reduction in ADHD symptom severity from the teacher version of the 10-item Conners’ Global Index. Investigators, teachers, and parents evaluated safety.

Results. The study randomized 321 children: 158 to MPH MR and 163 to placebo. Children in the MPH MR group were started on a dose of 20 mg/d and reached a mean dose of 40.7 mg/d (1.28 mg/kg/d) at endpoint. Compared with placebo, MPH MR significantly reduced ADHD symptoms ratings on the teacher version of the 10-item Conners’ Global Index, on the parent version of the Conners’ Global Index, on the parent assessment of global efficacy, and on investigator assessment of global improvement. The most common adverse events in the MPH MR group were headache, anorexia, abdominal pain, and insomnia. Only anorexia occurred at a rate that was significantly greater than placebo.

Conclusion. MPH MR administered once daily in the morning is effective and safe in controlling ADHD symptoms throughout the school day.
Outpatient and Hospital Visits Associated With Otitis Media Among American Indian and Alaska Native Children Younger Than 5 Years
Authors: Curns Aaron T. , Holman Robert C. , Shay David K. , Cheek James E. , Kaufman Stephen F. , Singleton Rosalyn J. , Anderson Larry J.
Published: August 2004

Objective. To describe the burden of otitis media (OM) among American Indian and Alaska Native (AI/AN) children.

Methods. OM morbidity among AI/AN younger than 5 years was evaluated using OM-associated outpatient visit and hospitalization rates. These rates were compared with outpatient and hospitalization rates for the general US population of children younger than 5 years. AI/AN children who were younger than 5 years and receiving care through the Indian Health Service or tribally operated facilities and US children younger than 5 years of age were studied.

Results. From 1994–1996, the average annual rate of AI/AN OM-associated outpatient visits was 138 per 100 children younger than 5 years. Among AI/AN children younger than 1 year (infants), these rates were almost 3 times greater than those for US infants (318 vs 110 visits per 100 infants, respectively). AI/AN children 1 to 4 years of age had rates 1.5 times greater than US children of the same age (107 vs 65 visits per 100 children, respectively). AI/AN children also experienced higher rates of OM-associated hospitalization than did US children (5643 vs 2440 per 100 000 infants, 823 vs 665 per 100 000 1- to 4-year-olds).

Conclusion. We found that AI/AN children, especially AI/AN infants, have higher OM-associated outpatient and hospitalization rates than those for the general US population of children. The disparity in rates suggests that additional prevention programs and continued resources are needed to reduce OM morbidity among AI/AN children.
Nutritional Factors That Affect the Postnatal Metabolic Adaptation of Full-Term Small- and Large-for-Gestational-Age Infants
Authors: de Rooy Laura , Hawdon Jane
Published: August 2004

Objective. To document metabolic adaptation to ex utero life in small- (SGA) and large-for-gestational-age (LGA) infants in relation to fetal nutrition and postnatal feeding practices.

Methods. In a prospective study, 65 SGA (≤second centile) and 39 LGA (≥98th centile) full-term infants were recruited. Anthropometry was performed within the first 48 hours. There was full support of breastfeeding and close clinical observation. Blood glucose and ketone body (kb) concentrations were measured prefeed for the first 7 postnatal days. Infants were exclusively breastfed (BF), breastfed with formula milk supplementation (FS), or exclusively formula milk fed (FF).

Results. Within the SGA group, a measure of “thinness,” the midarm circumference/head circumference ratio, was significantly correlated to the number of episodes of blood glucose <2.00 mmol/L. Epoch (age at sampling) analysis in this group showed no difference in blood glucose levels across the different feeding groups but revealed a statistically significant greater kb concentration for infants who were exclusively breastfed. For SGA infants, the median peak kb concentration (peak kb) was significantly different for BF, FS, and FF groups. Multiple regression analysis for the SGA group demonstrated that peak kb concentration was negatively related to the volume of formula milk, independent of blood glucose levels and neonatal anthropometry. For LGA infants, low blood glucose levels were offset by kb concentrations equivalent to those observed in infants who were appropriate for gestational age.

Conclusion. Neonatal ability to generate kb when blood glucose values are low depends more on successful breastfeeding than on size for gestational age or neonatal nutritional status. Routine blood glucose monitoring of LGA infants with no additional risk factors is not necessary. Routine formula milk supplementation for LGA and SGA infants should not be recommended.
Hypoplasia of Medullary Arcuate Nucleus in Unexpected Late Fetal Death (Stillborn Infants): A Pathologic Study
Authors: Matturri Luigi , Minoli Iolanda , Lavezzi Anna Maria , Cappellini Anna , Ramos Simone , Rossi Lino
Published: August 2004

Objectives. To evaluate the frequency, morphology, and pathogenesis (primary or secondary) of the abnormally developed medullary arcuate nucleus (ARCn) in stillbirths.

Methods. We examined 26 stillbirths (24 antepartum, 2 intrapartum) that had a gestational age between 25 and 40 weeks and a normal karyotype. All of the stillborns were described as well-developed, with body length and weight proportional to their gestational age. Each case was submitted to complete autopsy examination, which included a systematic gross and microscopic evaluation of the body, the placental disk, and the umbilical cord and membranes. The brainstem was the particular focus of the histologic examination. The study of the various nuclei (nucleus hypoglossus, dorsal vagus motor nucleus, tractus solitarii nucleus, nucleus ambiguus, trigeminal tractus and nucleus, arcuate nucleus, and ventrolateral reticular formation and its neurons and parabrachial/Kölliker-Fuse complex) was performed on transversal serial sections through the entire pons and medulla oblongata. The histologic analysis was supplemented by volumetric reconstruction and immunohistochemical detection of both apoptosis and proliferating cell nuclear antigen.

Results. Histologic examination showed abnormalities of the medulla oblongata ARCn in 9 fetuses (35%). In 8, a marked hypoplasia was evident, characterized by a volume reduction of the nucleus accompanied by neuronal depletion, whereas in 1 fetus the nucleus was completely absent (agenesis). The absence of gliosis, the negativity of the proliferating cell nuclear antigen analysis, and the similarities in apoptotic indices between the hypoplastic and well-developed arcuate are in keeping with a primary developmental defect. This anomaly is frequently associated with hypoplasia of the reticular formation and chronic hypoxia.

Conclusions. A high frequency of hypoplasia of the ARCn occurs in fetuses who have died “sine causa,” ie, in a similar manner to that observed in sudden infant death syndrome. Chemoreceptors, although not involved in reflexogenic oxygenation in fetal life, become of vital importance intrapartum and postpartum; therefore, whenever impaired in the course of development, chemoreceptors may underlie cardioventilatory abnormalities critical to sudden infant death syndrome.
Increased Activity of Lysosomal Enzymes in the Peritoneal Fluid of Bacterial Peritonitis
Authors: Beratis Nicholas G. , Georgiou George , Eliopoulou Maria
Published: August 2004

Objective. The activity of lysosomal enzymes is increased in the cerebrospinal fluid of bacterial meningitis, suggesting that inflammation may cause leakage of lysosomal enzymes into the extracellular fluid. Our objective was to study the activity of 3 lysosomal enzymes in cell-free peritoneal fluid of patients with peritoneal inflammation.

Methods. The β-galactosidase, β-glucuronidase, and α-mannosidase activity (nmol 4-methylumbelliferone/mL/h); the total, polymorphonuclear, and mononuclear cell number; and chemical parameters were determined in the peritoneal fluid of 26 patients with culture-positive acute bacterial peritonitis, 13 patients (under antibiotic treatment) with culture-negative bacterial peritonitis, 6 patients with acute mesenteric lymphadenitis, and 26 control subjects who were operated on for surgical conditions without peritoneal inflammation.

Results. The median β-galactosidase activity in the culture-positive bacterial peritonitis, mesenteric lymphadenitis, and controls was 175 (range: 63–2210), 50 (range: 37–56), and 16 (range: 8–32), respectively. The β-glucuronidase was 488 (range: 79–998), 53 (range: 27–98), and 15 (range: 3–22), respectively. The α-mannosidase was 801 (range: 100-3172), 78 (range: 33–157), and 41 (range: 16–63), respectively. The differences of the enzyme activities among the groups of the subjects studied were significant, with the exception of the α-mannosidase activity between mesenteric lymphadenitis and controls. There was no significant correlation between the enzyme activities and the cytologic or chemical parameters studied.

Conclusions. The elevation of the lysosomal enzymes’ activity in the peritoneal fluid of patients with bacterial peritonitis seems to be a reliable index of peritoneal infection. Of the enzymes studied, the β-glucuronidase and β-galactosidase activities provide the best means for diagnosing bacterial inflammation of the peritoneal cavity.
Maternal Influences on 5- to 7-Year-Old Girls’ Intake of Multivitamin-Mineral Supplements
Authors: Lee Yoonna , Mitchell Diane C. , Smiciklas-Wright Helen , Birch Leann L.
Published: August 2004

Objective. To examine diet quality of girls who do or do not take multivitamin-mineral (MVM) supplements and to evaluate predictors of girls’ MVM use, including maternal eating behaviors, MVM use, beliefs, attitudes, and perceptions about child feeding, eating, and health.

Design. Participants were 192 mother and daughter pairs. Daughters were categorized as MVM supplement users or nonusers based on whether girls were consistently given MVM supplements at 5 and 7 years. Girls’ and mothers’ nutrient and food group intakes, maternal child-feeding practices, and maternal eating behavior were compared between the groups.

Results. Mothers who used MVM supplements were more likely to give MVM supplements to daughters. Excluding nutrients from MVM supplements, MVM users and nonusers did not differ in vitamin and mineral intake, either for girls or mothers, and patterns of food group intake were similar for users and nonusers. Mothers of MVM users reported the following: higher levels of pressuring their daughters to eat healthier diets, more monitoring of daughters’ food intake, more success in dieting for weight control, more positive evaluations of their success in eating healthy diets, and lower body mass indexes than mothers who did not give MVMs to daughters.

Conclusions. Daughters’ MVM supplement use was predicted by mothers’ beliefs, attitudes, perceptions, and practices regarding mothers’ own eating and child feeding practices, rather than by daughters’ diet quality. For both MVM users and nonusers, daughters’ food group servings were below recommendations, whereas vitamin and mineral intakes exceeded recommendations, a pattern indicative of girls’ relatively high intakes of fortified foods. Mothers should be encouraged to foster healthier patterns of food intake in daughters, rather than providing MVM supplements.
Adolescent Reports of Physician Counseling for Smoking
Authors: Alfano Catherine M. , Zbikowski Susan M. , Robinson Leslie A. , Klesges Robert C. , Scarinci Isabel C.
Published: August 2004

Objective. Physicians can play an important role in reducing adolescent smoking by counseling their adolescent patients. The appropriate delivery of smoking prevention and cessation messages depends on adequate screening of adolescents, identification of smokers, and adolescents’ willingness to disclose their smoking. The present study assessed adolescent reports of physician screening and counseling and adolescents’ willingness to disclose smoking, as well as demographic and health status differences in these rates.

Methods. Adolescents (n = 5016), ages 16 to 19, completed a survey on smoking and health. Reports of the prevalence of physician screening, counseling, and adolescents’ willingness to disclose their smoking were examined, and logistic regression analyses assessed demographic and health status differences in these prevalence estimates.

Results. Overall, 43.4% of the sample reported physician screening, 42.1% reported receiving counseling, and only 28.8% of adolescents reported both. Furthermore, 79.3% of smokers reported that they would admit their smoking if asked. Screening, counseling, and disclosure rates differed by gender, neighborhood income level, smoking status, and asthma status.

Conclusions. More intensive provider-delivered intervention is needed. Efforts should focus on helping providers to identify smoking correctly and to communicate appropriate prevention or cessation messages. Persistence and sensitivity with boys, experimental smokers, and youths with chronic health conditions should be a focus of provider training, because the lower willingness of these youths to disclose their smoking may be a barrier to their identification and intervention.
Sequential Acquisition of Toilet-Training Skills: A Descriptive Study of Gender and Age Differences in Normal Children
Authors: Schum Timothy R. , Kolb Thomas M. , McAuliffe Timothy L. , Simms Mark D. , Underhill Richard L. , Lewis Marla
Published: August 2004

Objective. To compare the ages, by gender, at which normally developing children acquire individual toilet-training skills and to describe the typical sequence by which children achieve complete toileting success.

Methods. A longitudinal survey was conducted of a cohort of children who were 15 to 42 months of age and attending 4 pediatric practices in the Milwaukee area (2 inner city and 2 suburban) from 1995 through 1997. Parents completed background surveys, and each child’s development was assessed using the Bayley Scales of Infant Development II. Each week for 12 to 16 months, parents completed a training status survey (TSS). The TSS, designed for this project, included information on daily toilet-training status (eg, number of urine successes on a 5-point scale) and 28 weekly toilet-training behaviors rated on a 5-point Likert scale from 1 (never) to 5 (always). Children were considered to have acquired a particular skill when they received a rating of 4 or 5 on the TSS scale. The median age and interquartile range for children for each toilet-training skill are reported for girls and boys separately using survival curve analysis. Ages at which each gender achieved these skills are compared using a log-rank test.

Results. The study included 126 girls and 141 boys; 88% were white. Parents submitted a total of 10 741 weekly surveys (range: 1–73; median: 49 per child). Girls demonstrated toilet-training skills at earlier ages than boys. The median ages for “staying dry during the day” were 32.5 months (95% confidence interval: 30.9–33.7) and 35.0 months (95% confidence interval: 33.3–36.7) for girls and boys, respectively. The median ages for readiness skills for girls and boys, respectively, were as follows: “showing an interest in using the potty,” 24 and 26 months; “staying dry for 2 hours,” 26 and 29 months; “indicating a need to go to the bathroom,” 26 and 29 months. There was a marked concordance in the sequences in which girls and boys achieve individual skills. In addition, the interquartile ranges of the toileting skills varied from 6.9 to 11.4 months in girls and from 7.5 to 14.6 months in boys.

Conclusions. In this study population, girls achieve nearly all toilet-training skills earlier than boys, including successful completion. Most children do not master the readiness skills until after the second birthday. The range of normalcy for the attainment of individual skills may vary by as much as a year.