bluuebunny/crossref_metadata_2025 huggingface dataset:
Growth Until 3 Years of Age in a Prospective, Randomized Trial of a Diet With Reduced Saturated Fat and Cholesterol
Authors: Niinikoski Harri , Lapinleimu Helena , Viikari Jorma , Rönnemaa Tapani , Jokinen Eero , Seppänen Ritva , Terho Pirjo , Tuominen Juhani , Välimäki Ilkka , Simell Olli
Published: August 2004

Objective. Modification of fat intake in childhood may decrease children's future risk for atherosclerosis. Excessive changes in fat intake have been linked with possible growth failure. This study evaluates the effects of a low–saturated fat diet on growth during the first 3 years of life.

Design. Half of 1062 healthy infants were randomized at 7 months of age to the intervention group (n = 540) to receive at 1- to 6-month intervals individualized dietary counseling aimed at reducing their exposure to atherosclerosis risk factors. Five hundred twenty-two children served as control children. Growth and serum lipids were measured regularly, and nutrient intakes were analyzed using 3- to 4-day food records at 5- to 12-month intervals.

Results. The intervention children consistently consumed slightly less energy than did the control children. The mean fat intake of children in both groups was lower than expected, especially during the first 2 years of life (29.0 [SD, 4.7] percentage of energy intake [E%] and 28.8 [4.1] E% in the intervention and control children, respectively, at 8 months, formula-fed children only). At 13, 24, and 36 months, fat intake in the intervention and control children accounted for 26.2 (6.0) and 27.9 (4.9) E%, 29.9 (5.0) and 32.8 (4.8) E%, and 30.8 (4.9) and 33.2 (4.6) E%, respectively. From 13 to 36 months, the baseline adjusted mean serum cholesterol concentration was lower in the intervention children than the control children (95% confidence interval for the difference between means, −0.27 to −0.12 mmol/L). The true mean of the height of the boys in the intervention group during the trial was at most 0.34 cm more or 0.57 cm less (95% confidence interval), and the weight was at most 0.19 kg more or 0.22 kg less than that of the control boys. The respective values for girls were at most 0.77 cm more or 0.16 cm less and at most 0.42 kg more or 0.04 kg less. The numbers of slim children were similar in both groups.

Conclusions. Fat intake by young children is markedly lower than assumed. A supervised low–saturated fat, low-cholesterol diet has no influence on growth during the first 3 years of life.
Inhaled Glucocorticoid Therapy of Childhood Asthma Is Associated With Reduced Peripheral Blood T Cell Activation and ‘Th2-Type’ Cytokine mRNA Expression
Authors: Gemou-Engesaeth Vasso , Bush Andy , Kay A. Barry , Hamid Qutayba , Corrigan Chris J.
Published: August 2004

Objective. To investigate the role of activated T cells and their cytokine products in the pathogenesis of childhood asthma.

Methods. PBMC were obtained from 17 symptomatic asthmatic children (age 7 to 15 yr) and 7 nonasthmatic controls matched for age and atopic status. Asthmatics were placed in 2 groups with initial prebronchodilator FEV1 <75% (Group I, n = 9) or ≥75% (Group II, n = 8) predicted. Expression of activation markers on peripheral blood T cells (asthmatics), and expression of cytokine mRNA (asthmatics and controls) were measured using flow cytometry and in situ hybridization respectively. Measurements were repeated in the asthmatics 3 to 6 months later following initiation or escalation of inhaled GC therapy for control of symptoms.

Results. The more severe (Group I) as compared with the milder (Group II) asthmatics showed evidence of increased peripheral blood T cell activation, with elevated percentages of CD4 cells expressing the activation markers CD25 and HLA-DR, and CD8 cells expressing CD25. Elevated percentages of CD4 cells also expressed CD45RO, consistent with ongoing cellular activation. The asthmatics had higher percentages of PBMC expressing mRNA encoding IL-5, IL-4, GM-CSF and IL-2, but not IFN-γ, as compared with controls. The percentages of PBMC expressing IL-5 mRNA correlated with disease severity (% predicted FEV1). During follow up, patients in both groups required increased mean daily dosages of inhaled GC. In Group I this was associated with improvements in PEFR, FEV1 and night time wheeze and reduced percentages of CD4/CD25 and CD4/HLA-DR peripheral blood T cells. Reductions in the percentages of CD4/CD25 T cells correlated with improvements in baseline FEV1. Group II patients showed improvement in FEV1 and day time cough and wheeze but no significant changes in PEFR, other symptoms or peripheral blood T cell marker expression. Increased GC therapy of both groups taken together was associated with significant reductions in the percentages of PBMC expressing mRNA encoding IL-5, IL-4 and IL-2 and an increase in those expressing IFN-γ mRNA.

Conclusions. Compared with controls, children with symptomatic asthma have higher percentages of activated peripheral blood T cells synthesising cytokines believed to regulate bronchial mucosal eosinophilic inflammation. Clinical improvement with increased inhaled GC therapy is associated with reduced T cell activation and cytokine mRNA expression.
Pediatric Injury Prevention Counseling Priorities
Authors: Cohen Lisa R. , Runyan Carol W. , Downs Stephen M. , Bowling J. Michael
Published: August 2004

Objective. Child health care providers have a unique opportunity to conduct injury prevention counseling but limited empirical evidence for choosing prevention strategies. Efficient use of time requires that prevention strategies of higher priority be discussed before lower priority strategies. Our aim was to assess consensus among experts about the prioritization of prevention strategies for office based injury prevention counseling for parents of children under age two.

Design. We used a modified Delphi technique with 23 childhood injury prevention experts nationwide. Participants were blinded to the identities of each other.

Measures. The first questionnaire, distributed via facsimile transmission, consisted of open ended questions about prevention strategies participants believe should be included and their prioritization methods. The second questionnaire was closed ended and based on the results of the first.

Results. Seventeen injury problems and 21 prevention strategies were suggested for counseling. Participants emphasized environmental strategies over more active, educational ones. Motor vehicle occupant injuries and car seats were given high priority scores by all participants. Smoke detectors, lowering the hot water heater temperature, and pool fencing also received high priority ratings. Participants based their decisions on the severity of the injury, the frequency with which the injury occured, and the availability of environmental strategies. However, they disagreed about the relative importance of these factors. Time constraints and parents' inability to absorb information led them to suggest limiting, to fewer than four, the number of prevention strategies addressed at any one visit.

Conclusions. This study illustrates areas of consensus as well as unresolved dilemmas about pediatric injury prevention counseling. A rational decision making approach to prioritizing elements of clinical counseling is needed. Meanwhile, clinicians can use the findings of this study to derive their own judgments.
Physicians’ Experience With Allegations of Medical Malpractice in the Neonatal Intensive Care Unit
Authors: Meadow William , Bell Anthony , Lantos John
Published: August 2004

Objective. To assess the personal experience of all practitioners of neonatal intensive care unit (NICU) medicine in the United States with the medical malpractice system; in particular, to assess the circumstances of malpractice allegations in which they themselves had personal experience, and to extrapolate from their individual experiences to the field of neonatology in general.

Design. Written survey of all MDs practicing NICU medicine in the US.

Participants. Two thousand four hundred ninety-eight NICU physicians as determined from three sources: a) the American Board of Medical Specialists; b) the American Academy of Pediatrics Section of Neonatal/Perinatal Medicine; and c) a listing of neonatologists provided by Ross Laboratories.

Main Outcome Measures. Responses to survey questions.

Results. We received 1813 responses, representing ∼75% of all physicians practicing NICU medicine in the US. Overall, 43% of respondents had experienced at least one claim of malpractice against them. The probability of a malpractice allegation increased with years in practice, from ∼20% for NICU physicians in practice ≤5 years (65/337), to ∼60% for NICU physicians in practice >15 years (276/469). Men and women were equally likely to have been sued, accounting for years in practice. Physicians practicing in community NICUs were more likely to be sued than those in university settings. On a scale of 1 to 4 (4 being most reasonable) the median assessment of the reasonableness of malpractice allegations was 1, mean 1.2. On a scale of 1 to 4 (4 being the highest) the median assessment of effectiveness of the current system in identifying true malpractice was 1, mean 1.4. The respondents believed that approximately 80% of malpractice allegations were inappropriate; conversely, they believed that approximately 80% of true medical malpractice escaped detection. On a scale of 1 to 4 (4 being the highest), the median assessment of the detrimental effect of the present malpractice system on health care was 4, mean 3.4.

Conclusions. Most NICU physicians will be sued if they practice long enough. In this context, efforts to use malpractice claims to seek out evildoers (such as underlie the National Practitioners Data Bank) appear ill-conceived. Similarly, exhortations for physicians to become either more educated or more sensitive are unlikely to reduce malpractice claims. Our data suggest that malpractice in the NICU appears to function more like a lottery than like a mechanism for either quality assurance or just retribution. medical malpractice, NICU, standard of care, neonatologists.
Diagnostic Testing for Acute Head Injury in Children: When Are Head Computed Tomography and Skull Radiographs Indicated?
Authors: Quayle Kimberly S. , Jaffe David M. , Kuppermann Nathan , Kaufman Bruce A. , Lee Benjamin C. P. , Park T. S. , McAlister William H.
Published: August 2004

Objective. Despite the frequent occurrence of head injury in children, there is no agreement about clinical screening criteria that indicate the need for imaging studies. This study was undertaken to provide information relevant to the choice of imaging modalities in children with acute head trauma.

Methodology. A prospective cohort of 322 children seeking care consecutively in an urban pediatric emergency department for nontrivial head injury was assembled. Skull radiographs, head computed tomography, and data forms including mechanism of injury, symptoms, and physical findings were completed for each child.

Results. Intracranial injury occurred in 27 children (8%), whereas 50 (16%) had skull fractures. Of those with intracranial injury, 16 (59%) had normal mental status and no focal abnormalities, and 1 of those 16 required surgery for evacuation of an epidural hematoma. Six (38%) of the 16 were younger than 1 year, 5 of whom had scalp contusion or hematoma without other symptoms. Findings not significantly associated with intracranial injury were scalp contusion, laceration, hematoma, abrasion, headache, vomiting, seizure, drowsiness, amnesia, and loss of consciousness for less than 5 minutes. Findings associated with intracranial injury were skull fracture, signs of a basilar skull fracture, loss of consciousness for more than 5 minutes, altered mental status, and focal neurologic abnormality.

Conclusions. Intracranial injury may occur with few or subtle signs and symptoms, especially in infants younger than 1 year. The relative risk for intracranial injury is increased almost fourfold in the presence of a skull fracture, although the absence of a skull fracture does not rule out intracranial injury. The significance of nonsurgical intracranial injury in neurologically normal children needs further study. brain injuries, head injuries, skull fractures, computed tomo-graphy, radiography.
Efficacy of Bidirectional Fiber-optic Phototherapy for Neonatal Hyperbilirubinemia
Authors: Tan K. L.
Published: August 2004

Objective. To evaluate the efficacy of fiber-optic phototherapy using the standard Ohmeda Biliblanket, a large version, double standard Biliblankets, and conventional phototherapy using daylight fluorescent lamps in full-term, healthy infants with nonhemolytic hyperbilirubinemia.

Methods. Full-term, healthy infants with nonhemolytic hyperbilirubinemia (bilirubin concentration, >255 μmol/L or 222 μmol/L at <48 hours of age) were allocated randomly to one of four modes of phototherapy: standard fiber-optic mat (Ohmeda Biliblanket), a large version, double standard Biliblankets, and conventional phototherapy. Bilirubin levels were monitored every 12 hours. Exposure was stopped when bilirubin levels were less than 185 μmol/L, the minimum duration being 24 hours.

Results. A total of 171 infants were studied; 42 were exposed to standard fiber-optic phototherapy, 43 to large fiber-optic phototherapy, 42 to double–fiber-optic phototherapy, and 44 to conventional phototherapy. Durations of exposure were 87.05 ± 6.09 (SEM), 82.57 ± 5.84, 64.85 ± 5.43, and 62.61 ± 3.74 hours, respectively; the 24-hour decline rates were 10.26% ± 1.84%, 14.50% ± 1.53%, 21.82% ± 1.71%, and 19.00% ± 1.65%, respectively; the overall decline rates over the whole exposure period were 0.47% ± 0.03%, 0.52% ± 0.04%, 0.71% ± 0.05%, and 0.75% ± 0.04% per hour, respectively. The efficacy of double–fiber-optic phototherapy and conventional phototherapy was similar and significantly better than that of the large fiber-optic mat and the standard fiber-optic mat in duration, 24-hour decline rate, and overall decline rate. The large mat was slightly better than the standard-size mat with regard to 24-hour decline rate and overall decline rate, but this difference was not significant. Failure of phototherapy occurred only in the large fiber-optic mat group (3 of 43) and the standard fiber-optic mat group (4 of 42); none occurred in the other two groups, but differences not statistically significant. The nursing personnel were more comfortable with single fiber-optic phototherapy, which caused no initial disturbance to the swaddled infants as did conventional phototherapy, but found double–fiber-optic phototherapy difficult to use.

Conclusion. For efficacy of fiber-optic phototherapy in full-term infants to be comparable to that of our conventional phototherapy, the light dose of the standard mats needs to be doubled. fiber-optic phototherapy, neonatal hyperbilirubinemia, efficacy.
Childhood Poisoning Involving Transdermal Nicotine Patches
Authors: Woolf Alan , Burkhart Keith , Caraccio Thomas , Litovitz Toby
Published: August 2004

Objective. To describe the circumstances, medical complications, and outcomes of children exposed to a transdermal nicotine patch (TNP).

Design. Prospective case series; postmarketing surveillance study over a 24-month period.

Setting. Thirty-four United States poison centers.

Patients. Children 0 to 15 years old exposed to a TNP.

Interventions. None.

Outcome Measures. Exposure circumstances, symptoms and signs of toxicity, complications, disposition, and hospital length of stay.

Results. Reports were received concerning 36 exposures to TNP in children younger than 16 years old (mean: 3 years old). Eighteen of these TNP exposures were dermal; 18 additional children had bitten, chewed, or swallowed part of a patch. All four commercial brands of TNP were represented; no brand was associated with more symptoms or an increased severity of illness. Fourteen children (39%) developed symptoms, including gastrointestinal distress (nausea, vomiting, diarrhea, abdominal pain), weakness, dizziness, or localized rashes. Occurrence of symptoms after a dermal exposure to a TNP was associated with an estimated nicotine dose ≥.10 mg (≥.01 mg/kg body weight). Ten children were seen in the emergency department; two were admitted overnight. All recovered fully.

Conclusions. In this series, unintentional exposures to TNPs among young children usually involved used patches, were transient (<20 minutes duration), and required only skin decontamination and supportive care. Continued monitoring of inadvertent childhood exposures to TNPs is recommended to confirm these observations. nicotine, poisoning, transdermal nicotine patch, overdose, pediatric poisoning, intoxication.
Parent and Physician Response to Children’s Cholesterol Values of 200 mg/dL or Greater: The Child and Adolescent Trial for Cardiovascular Health Experiment
Authors: Nader Philip R. , Yang Minhua , Luepker Russell V. , Parcel Guy S. , Pirie Phyllis , Feldman Henry A. , Stone Elaine J. , Webber Larry S.
Published: August 2004

Objective. To determine parental actions and concerns and physician responses to parental notification that a child’s cholesterol value was 200 mg/dL or greater, a value recommended by the National Cholesterol Education Program to warrant physician follow-up and evaluation.

Methodology. A telephone survey of parents (n = 784) and physicians (n = 117) was carried out after parental notification of a total blood cholesterol value obtained as part of measurement done while participating in the Child and Adolescent Trial for Cardiovascular Health in 96 schools located in California, Louisiana, Minnesota, and Texas.

Results. Only 20% of parents contacted physicians. Factors associated with this action included whether the parent was notified once or twice, the level of the cholesterol, previous cholesterol testing in the parent, and medical insurance that covered the visit. Family history of cardiovascular disease, when other factors were considered, did not increase the likelihood that a physician contact would be made. After contact with the physician, 59% of physicians reported evaluating children for cholesterol; about half reported repeating the cholesterol determination.

Conclusion. Parental knowledge of a child’s cholesterol value of 200 mg/dL or greater did not result in substantially further seeking of health care. children, elevated cholesterol, parental response, physician response.
Validity and Reliability of Clinical Signs in the Diagnosis of Dehydration in Children
Authors: Gorelick Marc H. , Shaw Kathy N. , Murphy Kathleen O.
Published: August 2004

Objective. To determine the validity and reliability of various clinical findings in the diagnosis of dehydration in children.

Design. Prospective cohort study.

Setting. An urban pediatric hospital emergency department.

Participants. One hundred eighty-six children ranging in age from 1 month to 5 years old with diarrhea, vomiting, or poor oral fluid intake, either admitted or followed as outpatients. Exclusion criteria included malnutrition, recent prior therapy at another facility, symptoms for longer than 5 days’ duration, and hyponatremia or hypernatremia.

Methods. All children were evaluated for 10 clinical signs before treatment. The diagnostic standard for dehydration was fluid deficit as determined from serial weight gain after treatment.

Main Results. Sixty-three children (34%) had dehydration, defined as a deficit of 5% or more of body weight. At this deficit, clinical signs were already apparent (median = 5). Individual findings had generally low sensitivity and high specificity, although parent report of decreased urine output was sensitive but not specific. The presence of any three or more signs had a sensitivity of 87% and specificity of 82% for detecting a deficit of 5% or more. A subset of four factors—capillary refill >2 seconds, absent tears, dry mucous membranes, and ill general appearance—predicted dehydration as well as the entire set, with the presence of any two or more of these signs indicating a deficit of at least 5%. Interobserver reliability was good to excellent for all but one of the findings studied (quality of respirations).

Conclusions. Conventionally used clinical signs of dehydration are valid and reliable; however, individual findings lack sensitivity. Diagnosis of clinically important dehydration should be based on the presence of at least three clinical findings. dehydration, capillary refill, clinical assessment, interobserver agreement.
Adverse Events Associated With Exchange Transfusion in Healthy and Ill Newborns
Authors: Jackson J. Craig
Published: August 2004

Objective. To determine the incidence of adverse events attributable to exchange transfusion during the past 15 years and compare the incidence of severe complications between healthy and ill infants.

Design. Medical records for the past 15 years from two teaching hospitals with neonatal intensive care units were reviewed. Those newborns who underwent exchange transfusions were classified as healthy or ill. Adverse events were analyzed to determine whether they were attributable to the procedure.

Results. Of the 106 patients who underwent exchange transfusion, 81 were healthy and had no medical problems other than jaundice. The remaining 25 patients were classified as ill and had medical problems ranging from mild to severe. At least 2 (2%) of the 106 patients died of complications probably attributable to exchange transfusion. None of the 81 healthy infants died, but 1 had severe necrotizing enterocolitis requiring surgery. Of the 25 ill infants, at least 3 (12%) experienced severe complications (including 2 deaths) probably attributable to exchange transfusion. Serious complications from the most common adverse events, hypocalcemia and thrombocytopenia, were limited to the group of infants already ill with other medical problems.

Conclusions. Because of the significantly greater rate of severe complications in ill infants, exchange transfusion should be delayed until the risk of bilirubin encephalopathy is as high as the risks of severe complications from the procedure itself (12%). These results do not support recommendations to use lower exchange levels in ill infants compared with healthy infants. exchange transfusion, whole-blood; adverse events, jaundice, neonatal; kernicterus, infant, newborn.
Intravenous Methohexital for Brief Sedation of Pediatric Oncology Outpatients: Physiologic and Behavioral Responses
Authors: Freyer David R. , Schwanda Allison E. , Sanfilippo Dominic J. , Hackbarth Richard M. , Hassan Nabil E. , Kopec John S. , Neirotti Maria Teresa
Published: August 2004

Objective. In this successor to a preliminary retrospective study, we sought to confirm the apparent safety and efficacy of intravenous methohexital (MHX) for brief, unconscious sedation of pediatric hematology/oncology outpatients undergoing painful, invasive procedures.

Methods. This prospective study was conducted in a children’s hospital-based hematology/oncology clinic. Following published monitoring guidelines for deep pediatric sedation, MHX (1.0 mg/kg) was administered immediately before each procedure, 1% xylocaine was given locally, and additional MHX was titrated to maintain minimal response to pain during the procedure. For each patient, the procedural and physiologic response data reported below were recorded from the onset of sedation through recovery. Behavioral distress responses were measured using a standardized pediatric observational tool (Procedure Behavioral Checklist).

Results. Two hundred and thirty-three procedures were carried out in 76 patients ranging .1 to 19.6 years of age. The mean cumulative MHX dose/procedure was 4.6 ± 2.9 mg/kg. The mean lengths of time from initiation of sedation until completion of the invasive procedure, attainment of patient arousability, discontinuation of monitoring, and attainment of patient alertness were 8 ± 5, 19 ± 8, 19 ± 9, and 22 ± 9 minutes, respectively. Relative to presedation values, mean arterial pressure (MAP), heart rate, and respiratory rate showed maximum mean percent changes of −16.6, +17.8, and +13.4, respectively (all clinically insignificant). Complications among procedures were transient and included hiccoughs and myoclonus (each 10%); oropharyngeal secretions (6%); and pain at the injection site, emergence phenomena, and mild stridor (each ≤3%). Of two procedures (.9%) affected by transient upper airway obstruction associated with emesis or secretions, only one briefly needed mask ventilation. No procedures required intubation or early termination. In 49 additional procedures assessed for patient distress, observed pain responses were absent to mild in 45 (92%) and moderate in 4.

Conclusion. MHX appropriately administered provides sedation which is effective, safe, well tolerated, and of short duration, making MHX attractive for use in pediatric oncology outpatients and other populations with similar sedation needs. methohexital, pain, procedures, quality of life, sedation.
Health Care Utilization and Cost Among Children With Asthma Who Were Enrolled in a Health Maintenance Organization
Authors: Lozano Paula , Fishman Paul , VonKorff Michael , Hecht Julia
Published: August 2004

Objective. To measure the impact of asthma on the use and cost of health care by children in a managed care organization.

Design. Population-based historical cohort study.

Setting. A medium-sized staff model health maintenance organization in western Washington state.

Subjects. All 71 818 children, between age 1 to 17 years, who were enrolled and used services during 1992.

Outcome Measures. Children were identified with one or more asthma diagnoses during 1992 using automated encounter data. Nonurgent outpatient visits, pharmacy fills, urgent care visits, and hospital days, as well as associated costs were measured. All services were categorized as asthma care or nonasthma care. Multivariate regression analysis was used to compute marginal cost for asthma (difference in total cost between children with asthma and other children using services, adjusted for covariates).

Results. Treated prevalence of asthma was 4.9%. Children with asthma incurred 88% more costs ($1060.32 vs $563.81/yr), filled 2.77 times as many prescriptions (11.59 vs 4.19/yr), made 65% more nonurgent outpatient visits (5.75 vs 3.48/yr), and had twice as many inpatient days (.23 vs .11/yr) compared with the general population of children using services. Asthma care represented 37% of all health care received by children with asthma, while the remaining 63% were for nonasthma services. Almost two-thirds of asthma-related costs were attributable to nonurgent outpatient care and prescriptions; only one third was attributable to urgent care and hospitalizations. Controlling for age, sex, and comorbidities, the marginal cost of asthma was $615.17/yr (95% confidence interval $502.73, $727.61), which includes asthma as well as nonasthma services. This marginal cost represents 58% of all health care costs for children with asthma.

Conclusions. Children with asthma use significantly more health services (and incur significantly more costs) than other children using services, attributable largely to asthma care. The majority of all health care costs for children with asthma were for nonasthma services. Urgent care visits and hospitalizations are less important components of asthma costs in this managed care organization than has been found in other national studies.
The Associations of Suicide Attempts in Adolescents
Authors: Woods Elizabeth R. , Lin Yvonne G. , Middleman Amy , Beckford Patricia , Chase Louise , DuRant Robert H.
Published: August 2004

Objective. Suicide completion has increased in the United States among 15- to 24-year-olds from 4.5 per 100 000 (1950) to 13.2 per 100 000 (1990). Suicide attempts have been found to be associated with depression, substance use, overall number of life stressors, gender, and impulsive behaviors. We hypothesized that suicide attempt is associated with many other health risk behaviors.

Design. To evaluate this hypothesis, we analyzed the data from the 1993 Massachusetts Youth Risk Behavior Survey from a representative sample of students in grades 9 through 12 in public and private high schools. We examined the relationships between ever attempting suicide and engaging in other health risk or problem behaviors (eg, sexual activity, substance use, violence, and seat belt nonuse).

Results. The 3054 students were distributed among the 9th to 12th grades; 50.7% were female, 77.7% white, 6.7% black, 5.9% Hispanic, 4.6% Asian, .8% Native American, and 4.4% other; and the mean age was 16 ± 1.2 years. Based on logistic regression analysis, ever attempting suicide was associated with physical fights in the past 12 months (odds ratio [OR] = 1.3[95% confidence interval (CI), 1.22–1.44]), regular cigarette use in the past 30 days (2.0[1.41–2.97]), female gender (3.2[2.21–4.71]), lack of seat belt use (1.3[1.21–1.34]), gun carrying in the past 30 days (1.4[1.12–1.70]), substance use before last sexual activity (1.4[1.09–1.84]), Native American or other (2.4[1.21–4.71]), and lifetime use of other drugs (1.2[1.04–1.40]). The full model correctly assigned 92% of the youth. There were small differences in models for males, females, and sexually active youth. Same gender sexual experiences for sexually active youth did not significantly improve the model (partial r = .0, OR = .87 [95% CI, .33–2.30]) and fewer (88%) of the youth were correctly assigned by the model.

Conclusions. Ever attempting suicide is associated with other problem behaviors. This research proposes an empirical model of the relationship between suicide attempts and other health risk behaviors. Identifying which adolescents are at risk for suicide attempts from the presence of accompanying risk behaviors will help clinicians to evaluate suicide risk when other problem behaviors are identified, thus enabling the design of possible prevention strategies.
Clinicopathological Correlations in Postasphyxial Organ Damage: A Donor Organ Perspective
Authors: Barnett Christopher P. , Perlman Max , Ekert Paul G.
Published: August 2004

Objectives. 1) To assess pathology in the heart, kidneys, lungs, liver, and intestine in babies dying of postasphyxial hypoxic ischemic encephalopathy (HIE), and their suitability for organ transplantation. 2) To analyze the correlation between in vivo clinical markers of collateral organ damage and autopsy findings.

Study Design. Retrospective cohort study of 58 infants who died of postasphyxial HIE and had autopsies during 1985 to 1994. Collateral organ damage was evaluated clinically and pathologically, and the results compared.

Results. Severe pathological changes were observed in 6% to 62% of the five organs studied; 59% of the four major organs had either minor or no pathology. The sensitivity of the clinical predictors ranged from 69% to 100%, and specificity from 50% to 97%.

Conclusions. The organs of newborns dying of severe HIE may be suitable for use as donor organs; predictions of their suitability were most accurate for liver, kidney, and lungs, and least accurate for the heart.
Ten-Year Clinical, Developmental, and Intellectual Follow-up of Children With Congenital Cytomegalovirus Infection Without Neurologic Symptoms at One Year of Age
Authors: Ivarsson Sten-A. , Lernmark Barbro , Svanberg Lars
Published: August 2004

Objective. This study was undertaken to ascertain whether children with congenital cytomegalovirus (CMV) infection at birth, but without neurologic symptoms at 1 year of age, differed in somatic, neurologic, developmental, or intellectual status from matched control children at long-term follow-up.

Material and Methods. Congenital CMV infection, as demonstrated by isolation of the virus within the first week of life, was diagnosed in 44 (0.5%) of 9806 infants. From this basic CMV-infected population, children who developed neurologic disturbances including sensorineural deafness before 1 year of age were excluded (n = 7), as were those unwilling to participate (n = 2). Congenitally infected infants (n = 35) and matched control infants (n = 53) were followed up clinically and neurologically. At 21 months, development was assessed with the Griffiths' Developmental Scale and at 7 years of age neurologic status was assessed with the Stott test and intellectual development with the Wechsler Intelligence Scale for Children.

Results. As reported previously, 18% (8/44) of the CMV-infected infants manifested symptoms at birth, as compared to 8% (4/53) in the control group. In the congenital CMV group 7% (2/30) children tested had abnormal Stott test results, as compared to 2% (1/43) in the control group. Thirty-two CMV-infected and 51 control group children were assessed with the Griffiths' scale at 21 months of age. The two groups did not differ significantly, either in mean scores (6.3 ± 2.3 vs 6.1 ± 1.9) or in the proportion of children with scores below normal (19% [6/32] vs 16% [8/51]). Twenty-five CMV-infected and 41 control group children were assessed with the Wechsler Intelligence Scale for Children at 7 years of age (median 86 months; range, 82 to 90 and 82 to 91, respectively). The two groups did not differ significantly, either in mean scores (5.8 ± 2.0 vs 6.4 ± 1.6) or in the proportion of children with scores below normal (12% [3/25] vs 5% [2/41]).

Conclusion. Children with congenital CMV infection are unlikely to be at an increased risk of subsequent neurodevelopmental or intellectual impairment if they show normal development at 12 months of age.
Newborn Screening for Cystic Fibrosis in Wisconsin: Comparison of Biochemical and Molecular Methods
Authors: Gregg Ronald G. , Simantel Amy , Farrell Philip M. , Koscik Rebecca , Kosorok Michael R. , Laxova Anita , Laessig Ronald , Hoffman Gary , Hassemer David , Mischler Elaine H. , Splaingard Mark
Published: August 2004

Objectives. To evaluate neonatal screening for cystic fibrosis (CF), including study of the screening procedures and characteristics of false-positive infants, over the past 10 years in Wisconsin. An important objective evolving from the original design has been to compare use of a single-tier immunoreactive trypsinogen (IRT) screening method with that of a two-tier method using IRT and analyses of samples for the most common cystic fibrosis transmembrane regulator (CFTR) (ΔF508) mutation. We also examined the benefit of including up to 10 additional CFTR mutations in the screening protocol.

Methods. From 1985 to 1994, using either the IRT or IRT/DNA protocol, 220 862 and 104 308 neonates, respectively, were screened for CF. For the IRT protocol, neonates with an IRT ≥180 ng/mL were considered positive, and the standard sweat chloride test was administered to determine CF status. For the IRT/DNA protocol, samples from the original dried-blood specimen on the Guthrie card of neonates with an IRT ≥110 ng/mL were tested for the presence of the ΔF508 CFTR allele, and if the DNA test revealed one or two ΔF508 alleles, a sweat test was obtained.

Results. Both screening procedures had very high specificity. The sensitivity tended to be higher with the IRT/DNA protocol, but the differences were not statistically significant. The positive predictive value of the IRT/DNA screening protocol was 15.2% compared with 6.4% if the same samples had been screened by the IRT method. Assessment of the false-positive IRT/DNA population revealed that the two-tier method eliminates the disproportionate number of infants with low Apgar scores and also the high prevalence of African-Americans identified previously in our study of newborns with high IRT levels. We found that 55% of DNA-positive CF infants were homozygous for ΔF508 and 40% had one ΔF508 allele. Adding analyses for 10 more CFTR mutations has only a small effect on the sensitivity but is likely to add significantly to the cost of screening.

Conclusions. Advantages of the IRT/DNA protocol over IRT analysis include improved positive predictive value, reduction of false-positive infants, and more rapid diagnosis with elimination of recall specimens.
Milk-induced Hypoalgesia in Human Newborns
Authors: Blass Elliott M.
Published: August 2004

Objective. To determine whether milk and its components reduce crying in newborns during and after blood collection for phenylketonuria evaluation.

Methodology. Seventy-two normal newborns ingested 2 mL of milk (Similac), Ross Special Formula, fat, protein, lactose, sucrose, or water for the 2 minutes preceding blood collection via heel lance. Crying duration during and for the 3 minutes after the procedure was determined by scorers who were blind to the ingestive substance.

Results. Sucrose and Similac each reduced crying during the blood collection procedure. Sucrose, fat, protein, and Ross Special Formula were effective during the 3-minute recovery period. Neither water nor lactose were effective during or after blood collection.

Conclusion. Milk and some of its components are antinociceptive in human newborns. Based on previous studies, reduced crying during and after painful stimulation may be mediated through endogenous opioids. These findings are of potential clinical significance: natural protective mechanisms, normally engaged during suckling, may safely and noninvasively be activated to reduce newborn crying to painful stimulation.
An Economic Analysis of Developmental Detection Methods
Authors: Glascoe Frances Page , Foster E. Michael , Wolraich Mark L.
Published: August 2004

Objective. To assess the costs and benefits of various approaches to early detection of developmental disabilities.

Design. Cost-benefit analyses based on data from previously published studies of developmental screening tests.

Setting. General pediatric practices and day care centers.

Patients and Other Participants. A total of 247 parents and their 0- to 6-year-old children—103 from day care centers and 144 from pediatric practices.

Main Outcome Measures. Licensed psychological examiners administered a screening test of parents' concerns about children's development and one or two direct screening tests: the Denver-II and/or the Battelle Developmental Inventory Screening Test. For the day care sample, examiners also administered to each child measures of intelligence, adaptive behavior, and language. In the pediatric sample, children were administered additional assessments. At the same time, diagnostic measures were administered to a randomly selected subsample to make determinations about developmental status. Each screening method was evaluated for its short-term costs (administration, interpretation, diagnosis, and treatment) and long-term benefits (impact of early intervention on adult functioning as inferred from longitudinal studies by other researchers).

Results. When the long-term costs and benefits were considered, none of the approaches emerged as markedly superior to another. When viewing the short-term costs, the various screening approaches differed markedly. The use of parents' concerns was by far the least costly for physicians to administer and interpret.

Conclusion. Physicians can incur tremendous expenses when attempting to detect children with developmental problems. Although the benefits of early detection and intervention are substantial, physicians are not well-compensated for providing a critical service to society. Health policymakers and third-party payers must reconsider their minimal investment in early detection by health care providers. Nevertheless, our findings have encouraging implications for practice, because the use of parents' concerns as a screening technique offers substantial savings over and above other methods.
Evaluation and Medical Treatment of the HIV-Exposed Infant
Authors:   Committee on Pediatric AIDS
Published: August 2004

As a result of the expanding human immunodeficiency virus (HIV) infection epidemic and recently published recommendations for routine HIV testing with consent for all pregnant women in the United States, pediatricians are becoming increasingly involved in providing care to infants born to HIV-infected women. This article provides guidelines about counseling the parent or care giver of the infant, use of antiretroviral therapy to reduce the risk of infection in the infant, medical treatment of the HIV-exposed infant, laboratory testing to determine the infection status of the infant, laboratory monitoring of hematologic and immunologic parameters, prophylaxis for Pneumocystis carinii pneumonia, and recommendations for immunizations and tuberculosis screening.
Resource Utilization Among Neonatologists in a University Children’s Hospital
Authors: Adams James M. , Moreno Juan , Reynolds Kim , Campbell David W. , Smith E. O’Brian , Weisman Leonard E.
Published: August 2004

Objective. We studied factors affecting length of hospital stay and resulting hospital charges among patients managed by two separate groups of neonatologists in the same academic health science center.

Design. Retrospective analysis of clinical and financial data base information.

Methods. Neonatal intensive care was provided in the same acute care nursery in a large university children’s hospital by: (1) neonatologists in a full-time academic division (group A) and (2) a group associated with a private managed care organization (group B). Clinical and financial parameters of all neonates admitted in fiscal year 1994 were compared for the two provider groups. Stepwise regression analysis was used to evaluate factors influencing hospital charges and length of hospital stay (LOS) and to adjust for differences in clinical variables between the two groups.

Results. Group A physicians provided care for 340 infants, while 137 were treated by those of group B. Group A included older patients, more outborns, more level III patients, more sepsis, more intermittent positive pressure ventilation, and more patent ductus arteriosus. The incidence of transient tachypnea of the newborn was higher among group B patients. Hospital charges were primarily determined by LOS, which was similar for the two groups. When the data were corrected for differences in risk and patient acuity, however, a significant relationship between physician group and LOS was demonstrated, with LOS being an average of 7.8 days shorter for group A. A net reduction of $3 114 969 in hospital charges might have been realized had group A physicians provided care for all study patients.

Conclusions. Hospital charges were determined by LOS. In this setting, academic neonatologists produced shorter LOS and comparable clinical outcomes, despite caring for a population at greater risk. The reduction in LOS could have resulted in more than $3.1 million in annualized savings had the academic group provided care for all of the study patients. resource utilization, hospital changes, length of stay, neonatologists.
A Longitudinal Analysis of Infant Morbidity and the Extent of Breastfeeding in the United States
Authors: Scariati Paula D. , Grummer-Strawn Laurence M. , Fein Sara Beck
Published: August 2004

Background. Studies on the health benefits of breastfeeding in developed countries have shown conflicting results. These studies often fail to account for confounding, reverse causality, and dose-response effects. We addressed these issues in analyzing longitudinal data to determine if breastfeeding protects US infants from developing diarrhea and ear infections.

Methods.  Mothers participating in a mail panel provided information on their infants at ages 2, 3, 4, 5, 6, and 7 months. Infants were classified as exclusively breastfed; high, middle, or low mixed breast- and formula-fed; or exclusively formula-fed. Diarrhea and ear infection diagnoses were based on mothers’ reports. Infant age and gender; other liquid and solid intake; maternal education, occupation, and smoking; household size; family income; and day care use were adjusted for in the full models.

Results. The risk of developing either diarrhea or ear infection increased as the amount of breast milk an infant received decreased. In the full models, the risk for diarrhea remained significant only in infants who received no breast milk compared with those who received only breast milk (odds ratio = 1.8); the risk for ear infection remained significant in the low mixed feeding group (odds ratio = 1.6) and among infants receiving no breast milk compared with those who received only breast milk (odds ratio = 1.7).

Conclusions. Breastfeeding protects US infants against the development of diarrhea and ear infection. Breastfeeding does not have to be exclusive to confer this benefit. In fact, protection is afforded in a dose-response manner. The more breast milk an infant receives in the first 6 months of life, the less likely that he or she will develop diarrhea or ear infection. longitudinal analysis, diarrhea, ear infection, breastfeeding.
Acetaldehyde
Authors: Hagemeyer H.J.
Published: August 2004

Acetaldehyde is a product of most hydrocarbon oxidations. It occurs in trace amounts in all ripe fruits that have a tart taste before ripening. Acetaldehyde is also an intermediate product of fermentation. It may form in wine and other alcoholic beverages after exposure to air, imparting an unpleasant taste. Acetaldehyde occurs in trace quantities in blood. Acetaldehyde is a colorless, mobile liquid having a pungent, suffocating odor that is somewhat fruity and quite pleasant in dilute concentrations. It is a highly reactive compound undergoing numerous condensation, addition, and polymerization reactions. The liquid‐phase oxidation of ethylene is the process of choice for the manufacture of acetaldehyde. Acetaldehyde appears to paralyze respiratory muscles, causing panic. When breathed in high concentration, it causes headache and sore throat. In 1976 acetic acid production represented 60% of the acetaldehyde demand, which has diminished as a result of the rising cost of ethylene as feedstock.
Acetic Acid
Authors: Wagner Frank S.
Published: August 2004

Acetic acid, CH3COOH, is a corrosive organic acid having a sharp odor, burning taste, and pernicious blistering properties. It is found in ocean water, oilfield brines, rain, and at trace concentrations in many plant and animal liquids, and has a place in organic processes comparable to sulfuric acid in the mineral chemical industries. It is central to all biological energy pathways. Fermentation of fruit and vegetable juices yields 2–12% acetic acid solutions, usually called vinegar. Uses include the manufacture of vinyl acetate and acetic anhydride. Vinyl acetate is used to make latex emulsion resins for paints and adhesives. Acetic anhydride is used in making cellulose acetate fibers and cellulosic plastics. About half of the world production comes from methanol carbonylation and about one‐third from acetaldehyde oxidation. Glacial acetic acid is dangerous, but its precise toxic dose is not known for humans. Vinegar, on the other hand, which is dilute acetic acid, has been used in foods and beverages since ancient times.
Acetamide
Authors: Wagner Frank S.
Published: August 2004

Acetamide, C
2
H
5
NO, mol wt 59.07, is a white, odorless, hygroscopic solid derived from acetic acid and ammonia. The melt is a solvent for organic substances; it is used in electrochemistry and organic synthesis. Most commercial routes for the production of acetamide involve dehydration of ammonium acetate. Acetamide has been used experimentally as a source of nonprotein nitrogen for sheep and dairy cattle. It suppresses acid buildup in printing inks, lacquers, and perfumes, is a mild moisturizer, and is used as a softener for leather, textiles, and certain plastics.