bluuebunny/crossref_metadata_2025 huggingface dataset:
Intussusception After Administration of the Rhesus Tetravalent Rotavirus Vaccine (Rotashield): The Search for a Pathogenic Mechanism
Authors: Lynch Maureen , Shieh Wun-Ju , Bresee Joseph S. , Tatti Kathleen M. , Gentsch Jon R. , Jones Tara , Jiang Baoming , Hummelman Erik , Zimmerman Christopher M. , Zaki Sherif R. , Glass Roger I.
Published: May 2006

OBJECTIVES. The rhesus tetravalent rotavirus vaccine (RRV) was withdrawn from the routine program for childhood immunization in the United States because of the rare and unexpected occurrence of intussusception in the 2-week period after administration of the first dose.

METHODS. To search for the pathogenesis of this association, we compared the pathology of surgical specimens from infants who had surgical reduction of their intussusceptions within 2 weeks of receiving the vaccine (case patients; n = 8) with the pathology of specimens from children who had surgery >2 weeks after immunization (n = 6) or who had never been immunized (n = 26). Tissue was examined for evidence of the vaccine strain of rotavirus by reverse transcriptase-polymerase chain reaction (RT-PCR), in situ hybridization, and immunohistochemical staining.

RESULTS. RRV was identified by RT-PCR in tissue samples from 7 of the 8 case patients and in 2 of the 6 children who received the vaccine at a more distant time (29 and 58 days before surgery), but it was not identified in samples from any of the nonvaccinated children. No evidence of rotavirus tissue involvement was detected in any of the children by in situ hybridization or immunohistochemical staining. Pathologic evidence (for example, inclusion bodies, smudge cells) of adenovirus infection was present in 35% of the 37 specimens examined by routine staining and immunohistochemistry.

CONCLUSIONS. The fact that RRV was detected by RT-PCR but not by either of the other assays could be explained by RRV being present in the lumen of the gut but not in the tissues of appendix, ileum, or Peyer's patches. The Peyer's patches were not hyperplastic, and we could not establish the pathogenic mechanism for this association.
Sickle Cell Disease: A Question of Equity and Quality
Authors: Smith Lauren A. , Oyeku Suzette O. , Homer Charles , Zuckerman Barry
Published: May 2006

Thirty years ago, the first major federal legislation concerning sickle cell disease treatment was passed, resulting in the development of comprehensive sickle cell centers. We are now at another watershed moment in the treatment of this illness with the passage in October 2004 of the Sickle Cell Treatment Act, designed to substantially expand specialized sickle cell treatment programs. This legislation offers a remarkable opportunity to significantly improve health outcomes for individuals with sickle cell disease if it is implemented with a specific focus on the distinct but related issues of equity and quality. Despite major advances in sickle cell disease treatment that have occurred over the past 3 decades, important gaps exist both in the equity of government and private philanthropic support for research and in the uniform provision of high quality clinical care. This article assesses the current gaps in funding support and in the implementation of improvements in clinical care in order to suggest strategies for making optimal use of the opportunity that the new legislation presents to improve the health of all individuals affected by this disease.
Differences in Infant and Parent Behaviors During Routine Bed Sharing Compared With Cot Sleeping in the Home Setting
Authors: Baddock Sally A. , Galland Barbara C. , Bolton David P.G. , Williams Sheila M. , Taylor Barry J.
Published: May 2006

OBJECTIVES. To observe the behavior of infants sleeping in the natural physical environment of home, comparing the 2 different sleep practices of bed sharing and cot sleeping quantifying to factors that have been identified as potential risks or benefits.

METHODS. Forty routine bed-sharing infants, aged 5–27 weeks were matched for age and season of study with 40 routine cot-sleeping infants. Overnight video and physiologic data of bed-share infants and cot-sleep infants were recorded in the infants' own homes. Sleep time, sleep position, movements, feeding, blanket height, parental checks, and time out of the bed or cot were logged.

RESULTS. The total sleep time was similar in both groups (bed-sharing median: 8.6 hours; cot-sleeping median: 8.2 hours). Bed-sharing infants spent most time in the side position (median: 5.7 hours, 66% of sleep time) and most commonly woke at the end of sleep in this position, whereas cot-sleeping infants most commonly slept supine (median: 7.5 hours, 100%) and woke at the end of sleep in the supine position. Prone sleep was uncommon in both groups. Head covering above the eyes occurred in 22 bed-sharing infants and 1 cot-sleeping infant. Five of these bed-sharing infants were head covered at final waking time, but the cot-sleeping infant was not. Bed-sharing parents looked at or touched their infant more often (median: 11 vs 4 times per night) but did not always fully wake to do so. Movement episodes were shorter in the bed-sharing group as was total movement time (37 vs 50 minutes respectively), whereas feeding was 3.7 times more frequent in the bed-sharing group than the cot-sleeping group.

CONCLUSIONS. Bed-share infants without known risk factors for sudden infant death syndrome (SIDS) experience increased maternal touching and looking, increased breastfeeding, and faster and more frequent maternal responses. This high level of interaction is unlikely to occur if maternal arousal is impaired, for example, by alcohol or overtiredness. Increased head covering and side sleep position occur during bed-sharing, but whether these factors increase the risk of SIDS, as they do in cot sleeping, requires further investigation.
Incidence and Predictors of Serious Bacterial Infections Among 57- to 180-Day-Old Infants
Authors: Hsiao Allen L. , Chen Lei , Baker M. Douglas
Published: May 2006

BACKGROUND. Numerous researchers have investigated fever in infants <2 months of age. However, the etiology of fever and usefulness of screening tests in older (2–6 months) infants is not well studied.

METHODS. This was a prospective study of febrile infants 57–180 days old. Evaluation included blood and urine tests and direct fluorescent antibody (DFA) of nasal swabs for respiratory viruses. Additional studies were performed at the discretion of managing clinicians.

RESULTS. Serious bacterial illness (SBI) was diagnosed in 44 (10.3%) of 429 infants: 41 with bacteruria and 4 with bacteremia (1 infant had concurrent Escherichia coli bacteruria and bacteremia). Lumbar puncture, performed in 58 (13.5%) infants, revealed no cases of bacterial meningitis. DFAs were positive in 163 (38.0%) infants: the majority were respiratory syncytial virus or influenza A. SBI was noted in 4.9% of infants with positive DFA. Age and height of fever were not significant predictors of SBI. White blood cell count (17.1 K/mm3 vs 12.4 K/mm3) and CRP (2.6 mg/dL vs 0.9 mg/dL) were elevated in infants with SBI, as was the Yale Observation Score (9.4 vs 8.0).

CONCLUSIONS. A substantial proportion (10.3%) of older febrile infants has SBI. In the postpneumococcal vaccine era, only 1 infant had pneumococcal disease; bacteremia was noted in 0.9%. Bacteruria is commonly associated with fever in this age range. Infants older than 8 weeks remain at risk for bacteremia and bacteruria, regardless of positive DFA or other apparent source of fever. CRP is a better indicator than white blood cell count, but no single ideal indicator of SBI was identified for this age group.
Qualitative Analysis of Mothers' Decision-Making About Vaccines for Infants: The Importance of Trust
Authors: Benin Andrea L. , Wisler-Scher Daryl J. , Colson Eve , Shapiro Eugene D. , Holmboe Eric S.
Published: May 2006

BACKGROUND. The high visibility of controversies regarding vaccination makes it increasingly important to understand how parents decide whether to vaccinate their infants.

OBJECTIVE. The purpose of this research was to investigate decision-making about vaccinations for infants.

DESIGN. We conducted qualitative, open-ended interviews.

PARTICIPANTS. Subjects included mothers 1 to 3 days postpartum and again at 3 to 6 months.

RESULTS. We addressed 3 topics: attitudes to vaccination, knowledge about vaccination, and decision-making. Mothers who intended to have their infants vaccinated (“vaccinators,” n = 25) either agreed with or did not question vaccination or they accepted vaccination but had significant concerns. Mothers who did not intend to vaccinate (“nonvaccinators,” n = 8) either completely rejected vaccination or they purposely delayed vaccinating/chose only some vaccines. Knowledge about which vaccines are recommended for children was poor among both vaccinators and nonvaccinators. The theme of trust in the medical profession was the central concept that underpinned all of the themes about decision-making. Promoters of vaccination included trusting the pediatrician, feeling satisfied by the pediatrician’s discussion about vaccines, not wanting to diverge from the cultural norm, and wanting to adhere to the social contact. Inhibitors included feeling alienated by or unable to trust the pediatrician, having a trusting relationship with an influential homeopath/naturopath or other person who did not believe in vaccinating, worry about permanent side effects, beliefs that vaccine-preventable diseases are not serious, and feeling that since other children are vaccinated their child is not at risk.

CONCLUSION. Trust or lack of trust and a relationship with a pediatrician or another influential person were pivotal for decision-making of new mothers about vaccinating their children. Attempts to work with mothers who are concerned about vaccinating their infants should focus not only on providing facts about vaccines but also on developing trusting and positive relationships.
Adverse Neonatal Outcomes Associated With Antenatal Dexamethasone Versus Antenatal Betamethasone
Authors: Lee Ben H. , Stoll Barbara J. , McDonald Scott A. , Higgins Rosemary D. ,   for the National Institute of Child Health and Human Development Neonatal Research Network
Published: May 2006

OBJECTIVE. Antenatal dexamethasone and betamethasone may not be equally efficacious in the prevention of adverse neonatal outcomes. We compared the risks of periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), and neonatal death among very low birth weight infants who were exposed to dexamethasone, betamethasone, or neither steroid.

METHODS. Infants (401–1500 g) in the National Institute of Child Health and Human Development Neonatal Research Network were studied. Multivariate logistic regression analyses compared the 3 groups with regard to PVL, IVH, ROP, and neonatal death, adjusting for network center and selected covariates.

RESULTS. A total of 3600 infants met entry criteria. Compared with no antenatal steroids, there were trends for a reduced risk for PVL associated with dexamethasone and betamethasone but no difference in risk between dexamethasone and betamethasone. Dexamethasone reduced the risk for IVH and severe IVH, compared with no antenatal steroid exposure. Betamethasone reduced the risk for IVH, severe IVH, and neonatal death, compared with no antenatal steroids. Compared with betamethasone, dexamethasone had a statistically significant increased risk for neonatal death. There were trends for greater risks associated with dexamethasone compared with betamethasone for IVH and severe ROP.

CONCLUSIONS. Betamethasone was associated with a reduced risk for neonatal death, with trends of decreased risk for other adverse neonatal outcomes, compared with dexamethasone. It may be in the best interest of neonates to receive betamethasone rather than dexamethasone when available.
Prolonged Indomethacin Exposure Is Associated With Decreased White Matter Injury Detected With Magnetic Resonance Imaging in Premature Newborns at 24 to 28 Weeks' Gestation at Birth
Authors: Miller Steven P. , Mayer Eleanor E. , Clyman Ronald I. , Glidden David V. , Hamrick Shannon E.G. , Barkovich A. James
Published: May 2006

OBJECTIVES. Newborns delivered before 28 weeks' gestation commonly have white matter lesions on MRI that are associated with adverse neurodevelopmental outcomes. Our objective was to determine the risk factors for MRI-detectable white matter injury in infants delivered before 28 weeks' gestation who were treated with prophylactic indomethacin.

METHODS. This was a prospective cohort study conducted at the intensive care nursery at University of California San Francisco Children's Hospital. Patients included 57 premature newborns between 24 and 27 (+6 days) weeks' gestation at birth (October 1998 to October 2004). We identified perinatal and neonatal risk factors associated with moderate-severe “white matter injuries” (T1 signal abnormalities >2 mm or >3 areas of T1 abnormality) and moderate-severe “brain abnormality” (moderate-severe white matter injuries, any degree of ventriculomegaly, or severe intraventricular hemorrhage) on MRI. Infants were studied with MRI at 31.1 weeks’ postmenstrual age (median).

RESULTS. Moderate-severe white matter injuries were detected in 12 (21%) of 53 preterm newborns, and 20 (35%) of 57 had moderate-severe brain abnormality. Prolonged indomethacin exposure was the only risk factor independently associated with a lower risk of white matter injury or brain abnormality, even when adjusting for the presence of a hemodynamically significant PDA, gestational age at birth, prenatal betamethasone, systemic infection, and days of mechanical ventilation.

CONCLUSIONS. In this observational study, a longer duration of indomethacin exposure was associated with less white matter injury in infants delivered before 28 weeks' gestation. A randomized trial of prolonged indomethacin treatment is needed to determine whether indomethacin can decrease white matter injury and neurodevelopmental abnormalities.
Psychological Differences Between Children With and Without Soiling Problems
Authors: Joinson Carol , Heron Jon , Butler Ursula , von Gontard Alexander ,   the Avon Longitudinal Study of Parents and Children Study Team
Published: May 2006

OBJECTIVES. Previous studies, based on clinic samples, report that childhood soiling is associated with behavior problems and reduced self-esteem. This population-based study investigates the prevalence of psychological problems associated with childhood soiling.

METHODS. A total of 8242 children aged 7–8 years born to mothers in the United Kingdom–based Avon Longitudinal Study of Parents and Children were studied. Parents completed postal questionnaires assessing common childhood emotional and behavioral problems, and children were asked questions at a research clinic concerning their behavior, friendships, bullying, and self-esteem. The rate of psychological problems was compared in children who soil frequently (once a week or more), those who soil occasionally (less than once a week), and those with no soiling problems (controls). Analyses were adjusted for developmental delay, gender, sociodemographic background, and stressful life events.

RESULTS. Children who soil were reported by their parents to have significantly more emotional and behavioral problems compared with children who do not soil. Children who soil frequently had significantly more problems than those who soil occasionally. The rate of attention and activity problems, obsessions and compulsions, and oppositional behavior was particularly high in frequently soiling children. Children with soiling problems reported significantly higher rates of involvement in overt bullying (as both perpetrator and victim) and antisocial activities compared with controls.

CONCLUSIONS. The current study finds significantly higher rates of behavior and emotional problems, bullying, and antisocial activities in children who soil compared with those who do not soil. Children who soil frequently are more likely to have these problems than those who soil occasionally.
Intrahepatic Cholestasis of Pregnancy and Neonatal Respiratory Distress Syndrome
Authors: Zecca Enrico , De Luca Daniele , Marras Marco , Caruso Alessandro , Bernardini Tommaso , Romagnoli Costantino
Published: May 2006

OBJECTIVES. We sought to verify the association between maternal intrahepatic cholestasis of pregnancy (ICP) and neonatal respiratory distress syndrome (RDS) and to determine how bile acids levels alter the risk of developing neonatal RDS.

METHODS. We extracted data from our divisional database about all of the newborns born during the years 2000–2004. We compared 77 neonates born from pregnancies complicated by ICP with 427 neonates in the same range of gestational age born from noncomplicated pregnancies. We studied maternal bile acids levels immediately before delivery in mothers with ICP and measured bile acid levels during the first 24 hours of life in their newborns.

RESULTS. The incidence of RDS in newborns from cholestatic pregnancies was twice that the reference population (28.6% vs 14%). The multivariate analysis showed that the risk of RDS in these newborns was ∼2.5 times higher than in control infants. Within the ICP group, maternal and neonatal bile acid levels of infants affected by RDS were not significantly higher than those of healthy infants. The multivariate analysis showed that a low gestational age was the most important risk factor, but the probability of respiratory distress syndrome also increased by 2‰ for every additional micromole of the interaction term “neonatal by maternal bile acids level.”

CONCLUSIONS. Maternal ICP is significantly associated with the occurrence of RDS in the newborn. We hypothesize that bile acids can produce surfactant depletion in the alveoli reverting the reaction of phospholipase A2. This hypothesis could potentially be confirmed by bronchoalveolar lavage study.
Environmental Tobacco Smoke Exposure: Prevalence and Mechanisms of Causation of Infections in Children
Authors: Kum-Nji Philip , Meloy Linda , Herrod Henry G.
Published: May 2006

BACKGROUND AND OBJECTIVES. Environmental tobacco smoke (ETS) exposure is probably one of the most important public health hazards in our community. Our aim with this article is to (1) review the prevalence of ETS exposure in the United States and how this prevalence is often measured in practice and (2) summarize current thinking concerning the mechanism by which this exposure may cause infections in young children.

METHODS. We conducted a Medline search to obtain data published mainly in peer-reviewed journals.

RESULTS. There is still a very high prevalence of ETS exposure among US children ranging from 35% to 80% depending on the method of measurement used and the population studied. The mechanism by which ETS may be related to these infections is not entirely clear but may be through suppression or modulation of the immune system, enhancement of bacterial adherence factors, or impairment of the mucociliary apparatus of the respiratory tract, or possibly through enhancement of toxicity of low levels of certain toxins that are not easily detected by conventional means.

CONCLUSIONS. The prevalence of ETS exposure in the United States is still very high, and its role in causing infections in children is no longer in doubt even if still poorly understood. Research, therefore, should continue to focus on the various mechanisms of causation of these infections and how to best reduce the exposure levels.
Effect of Pneumococcal Conjugate Vaccine on Nasopharyngeal Bacterial Colonization During Acute Otitis Media
Authors: Revai Krystal , McCormick David P. , Patel Janak , Grady James J. , Saeed Kokab , Chonmaitree Tasnee
Published: May 2006

The heptavalent pneumococcal conjugate vaccine (PCV7) has been shown to reduce the incidence of acute otitis media (AOM) caused by Streptococcus pneumoniae by 34% and reduces the overall incidence of AOM by 6% to 8%. More recent studies have shown increases in the proportion of Haemophilus influenzae and Moraxella catarrhalis in the middle-ear fluid of PCV7-immunized children. There has been no report on the effect of PCV7 on all 3 bacterial pathogens combined, either in the middle-ear fluid or nasopharynx of individual children with AOM. We investigated the impact of PCV7 on nasopharyngeal colonization with bacterial pathogens during AOM in the pre-PCV7 and post-PCV7 vaccination eras. Four hundred seventeen children (6 months to 4 years of age) were enrolled onto AOM studies between September 1995 and December 2004. Of these, 200 were enrolled before the vaccine use (historical controls), and 217 were enrolled after the initiation of PCV7 vaccination (101 were underimmunized, and 116 were immunized). Although the nasopharyngeal colonization rate for S pneumoniae was not different between the 3 groups, a significantly higher proportion of PCV7-immunized children with AOM were colonized with M catarrhalis. Overall, the mean number of pathogenic bacteria types isolated from immunized children (1.7) was significantly higher than in controls (1.4). The increase in bacterial colonization of the nasopharynx during AOM could be associated with an increase in AOM pathogens and theoretically can predispose PCV7-immunized children with AOM to a higher rate of antibiotic treatment failure or recurrent AOM.
Does Familiarity Breed Acceptance? The Influence of Policy on Physicians' Attitudes Toward Newborn Screening Programs
Authors: Koopmans Joy , Ross Lainie Friedman
Published: May 2006

OBJECTIVE. As newborn screening (NBS) programs expand to include conditions that challenge traditional public health criteria, little is known about what influences physicians' attitudes toward screening. We examined the effect of state policy and perceived state policy on pediatricians' attitudes toward screening.

METHODS. Six hundred pediatricians from the American Academy of Pediatrics who practiced in Wisconsin, Colorado, Florida, or Illinois were queried about (1) testing high-risk infants and (2) universal NBS for cystic fibrosis (CF), glucose-6-phosphate dehydrogenase deficiency (G6PD), and type 1 diabetes.

RESULTS. A total of 225 (41%) of 548 eligible pediatricians returned 223 surveys with usable data. The majority were supportive of NBS for CF (n = 188 [84%]) and G6PD (n = 130 [58%]), whereas only 25% (n = 55) supported type 1 diabetes screening. Pediatricians who lived in states that screen for a condition were more likely to support screening than those who lived in states that did not (CF: 117 of 119 [98%] vs 71 of 89 [80%]; type 1 diabetes: 32 of 88 [36%] vs 23 of 109 [21%]). Physicians also were more likely to support NBS when they believed that it was offered in their state versus when they believed that it was not (CF: 117 of 119 [98%] vs 52 of 65 [80%]; G6PD: 28 of 32 [88%] vs 75 of 108 [69%]; type 1 diabetes: 7 of 14 [50%] vs 25 of 102 [25%]).

CONCLUSIONS. Most pediatricians are supportive of NBS for CF and G6PD but not type 1 diabetes. Pediatricians who live in states that screen or believe that their states screen are more likely to support screening.
Sudden Cardiac Arrest in an Intubated Premature Infant With Cerebellar and Brainstem Injury: Is There a Link?
Authors: Chen R. Victoria , Perlman Jeffrey
Published: May 2006

The ventilated premature infant frequently exhibits unprovoked desaturation episodes accompanied by bradycardia. In most instances, these episodes are short-lived and recover spontaneously or with minimal interventions. However, in some infants these episodes may be more profound and require substantial interventions to restore cardiorespiratory status. Here we present the case of a ventilated premature infant who had experienced prolonged, multiple daily desaturation episodes accompanied by bradycardia that required significant interventions. Postoperatively, after placement of a tracheotomy and despite a patent airway, the infant developed acute bradycardia that progressed rapidly to sudden death. At autopsy, significant cerebellar and brainstem injury was noted. We hypothesize that the specific cerebellum and brainstem injury may have contributed to autonomic dysfunction and sudden death.
Venous Thrombosis Associated With Staphylococcal Osteomyelitis in Children
Authors: Gonzalez Blanca E. , Teruya Jun , Mahoney Donald H. , Hulten Kristina G. , Edwards Rachael , Lamberth Linda B. , Hammerman Wendy A. , Mason Edward O. , Kaplan Sheldon L.
Published: May 2006

BACKGROUND. Venous thrombosis (VT) in children with Staphylococcus aureus osteomyelitis occurs rarely. We describe clinical features of infections and molecular characterization of isolates of children at Texas Children's Hospital with S aureus osteomyelitis and VT.

METHODS. We reviewed records and imaging studies (chest radiographs, ultrasound, computed tomography, and MRI) of 9 patients at Texas Children's Hospital with acute S aureus osteomyelitis and new onset VT between August 1999 and December 2004. Isolates were fingerprinted by pulsed-field gel electrophoresis and tested for the presence of genes encoding selective virulence factors.

RESULTS. The mean age of the patients was 10.6 years. All 9 of the patients had osteomyelitis with sites of infection adjacent to the VT. The femoral and popliteal veins were most commonly affected. Two patients had VTs develop on the same side in which a central line had been in place. Four patients had chest radiographs consistent with septic emboli; inferior vena cava filters were placed in 3. Evaluation for hypercoagulable state revealed 3 patients with lupus anticoagulant, 1 with anticardiolipin IgG antibody, and 5 with no defect. Most laboratory abnormalities had resolved at follow-up. Seven patients had infections caused by methicillin-resistant S aureus belonging to the same clonal group (USA300); all were community acquired. Seven isolates carried the Panton-Valentine leukocidin (luk-S-PV and luk-F-PV) genes.

CONCLUSIONS. The predominant community-acquired, methicillin-resistant S aureus clone in Houston, Texas, (USA300) may have a unique propensity to cause VT in association with osteomyelitis. Management of the venous thrombosis in this setting may be complicated by the rapid evolution of septic emboli.
Verbal Abuse by the Teacher and Child Adjustment From Kindergarten Through Grade 6
Authors: Brendgen Mara , Wanner Brigitte , Vitaro Frank
Published: May 2006

OBJECTIVES. Many adults mention past incidences of verbal abuse by the teacher as the most overwhelming negative experience in their lives. The present study examined (1) the course and stability of verbal abuse by the teacher from kindergarten through grade 4 and (2) the link between verbal abuse by the teacher and children's behavioral, emotional, and academic adjustment.

DESIGN. Participants were 399 children (177 girls) who were assessed yearly over a period of 7 years, starting in kindergarten. Verbal abuse by the teacher, as well as acceptance versus rejection by the peer group from kindergarten through grade 4, were assessed through peer nomination. Child adjustment from kindergarten through grade 4 (antisocial behavior, attention problems, anxiety) was evaluated by the teacher. Child adjustment in early adolescence (delinquent behavior, depressive feelings, academic performance) was assessed by teacher evaluations and self-reports.

RESULTS. The vast majority of children (∼85%) have almost 0 risk of becoming a target of verbal abuse by the teacher over the course of elementary school. However, a small minority of children (15%) seems to be at relatively high risk of verbal abuse by the teacher in kindergarten, and this risk increases even further over the course of elementary school. Boys, as well as children with high levels of early antisocial behavior and attention problems in kindergarten, are at high risk of verbal abuse by the teacher during elementary school. In turn, verbal abuse by the teacher is significantly related to subsequent delinquent behavior and academic difficulties in early adolescence, although this effect depends on child characteristics.

CONCLUSIONS. Verbal abuse by the teacher seems to be a highly stable phenomenon for at-risk children. Children who are relatively well adjusted are at low risk of becoming the target of verbal abuse by the teacher. If they do, however, these children are the most vulnerable to subsequent developmental difficulties.
Comparison of Enzyme-Linked Immunospot Assay and Tuberculin Skin Test in Healthy Children Exposed to Mycobacterium tuberculosis
Authors: Hill Philip C. , Brookes Roger H. , Adetifa Ifedayo M.O. , Fox Annette , Jackson-Sillah Dolly , Lugos Moses D. , Donkor Simon A. , Marshall Roger J. , Howie Stephen R.C. , Corrah Tumani , Jeffries David J. , Adegbola Richard A. , McAdam Keith P.W.J.
Published: May 2006

OBJECTIVE. To compare the enzyme-linked immunospot (ELISPOT) assay with the tuberculin skin test (TST) in children for the diagnosis of Mycobacterium tuberculosis infection in the Gambia.

METHODS. We divided child contacts of sputum smear-positive tuberculosis cases into 3 age categories (<5, 5–9, and 10–14 years) and assessed agreement between the 2 tests plus their relationship to prior Bacille Calmette-Guerin (BCG) vaccination. We categorized a child's level of M tuberculosis exposure according to where he/she slept relative to a case: the same room, same house, or a different house. The relationship between exposure and test result was assessed by multiple logistic regression.

RESULTS. In child contacts of 287 cases, 225 (32.5%) of 693 were positive by TST and 232 (32.3%) of 718 by ELISPOT. The overall agreement between tests was 83% and the discordance was not significant. Both tests responded to the M tuberculosis exposure gradient in each age category. The percentage of those who were TST positive/ELISPOT negative increased with increasing exposure. At the lowest exposure level, the percentage of ELISPOT-positive children who were TST negative was increased compared with the highest exposure level. Neither test had evidence of false positive results because of BCG.

CONCLUSIONS. In Gambian children, the ELISPOT is slightly less sensitive than the TST in the diagnosis of M tuberculosis infection from recent exposure, and neither test is confounded by prior BCG vaccination. Evidence of reduced TST sensitivity in subjects with the lowest known recent M tuberculosis exposure suggests that, when maximal sensitivity is important, the 2 tests may be best used together.
Impaired Flow-Mediated Vasodilation, Carotid Artery Intima-Media Thickening, and Elevated Endothelial Plasma Markers in Obese Children: The Impact of Cardiovascular Risk Factors
Authors: Meyer Andreas Alexander , Kundt Günther , Steiner Michael , Schuff-Werner Peter , Kienast Wolfgang
Published: May 2006

OBJECTIVES. Childhood obesity contributes to the development of adult obesity and subsequent cardiovascular disease. The present study aimed to assess vascular status (flow-mediated vasodilation [FMD], intima-media thickness [IMT]) and to analyze plasma surrogate endothelial markers (von Willebrand factor [vWf], E-selectin, and thrombomodulin) in obese children as compared with controls. Associations between early morphologic and functional vascular changes, surrogate soluble markers of early atherosclerosis, and the cardiovascular risk profile were determined.

METHODS. We examined 32 obese children versus 20 control subjects. All of the children underwent identical screening, comprehensive risk factor assessment, and measurements of E-selectin, vWf, thrombomodulin, FMD, and IMT.

RESULTS. Compared with controls, obese children demonstrated significantly impaired FMD and increased IMT. Concentrations of soluble E-selectin and thrombomodulin were significantly elevated in obese children, whereas vWf showed no significant differences between obese children and controls. FMD, IMT, E-selectin, and thrombomodulin were significantly associated with various risk factors, including the extent of obesity, arterial hypertension, fibrinogen, C-reactive protein, and low physical fitness.

CONCLUSIONS. The present study documented increased IMT, impaired endothelial function, and elevated plasma markers of endothelial activation and injury in obese children. Morbid obesity, arterial hypertension, subclinical inflammation, and low physical fitness formed a risk profile associated with the risk of early atherosclerosis in these children. Sonographic assessment of vascular status and the estimation of soluble endothelial plasma markers, combined with comprehensive risk factor screening, may form a rationale to identify high-risk children susceptible to early atherosclerotic disease and to monitor vascular changes during follow-up studies and therapeutic measures.
Persistent Cough and Failure to Thrive: A Presentation of Foreign Body Aspiration in a Child With Asthma
Authors: Kugelman Amir , Shaoul Ron , Goldsher Moshe , Srugo Isaak
Published: May 2006

Severe failure to thrive (FTT) in a child with asthma and a persistent cough should not be explained solely by asthma and warrants a thorough and prompt evaluation. The finding of a foreign body in our case was surprising, because it does not usually present as or lead to FTT. Good clinical judgment and habits could prevent the course of events that we described in this case. Following are the key lessons to be learned from this presentation: (1) maintain a high index of suspicion for foreign body aspiration, even in toddlers with asthma, (2) pay special attention to a child with FTT, (3) be aware of localizing findings on physical examination and chest radiographs, and (4) perform a chest radiograph no later than after 1 month of chronic cough.
Evaluation of a Learning Collaborative to Improve the Delivery of Preventive Services by Pediatric Practices
Authors: Young Paul C. , Glade Gordon B. , Stoddard Gregory J. , Norlin Chuck
Published: May 2006

OBJECTIVE. Effective delivery of preventive services is an essential component of high-quality pediatric health care. However, both variation in and deviation from accepted guidelines have been reported. Learning collaboratives (LCs) have been shown to result in improvement in several aspects of pediatric care. The objective of this study was to determine whether pediatric practices that participated in a preventive services LC would improve their delivery of preventive services.

METHODS. After conducting an initial audit of the medical records of twenty 2-year-olds and twenty 4-year-olds for documentation of preventive services on the basis of national standards, practice teams attended a quality improvement workshop. They were presented with evidence to support the value of preventive services and the results of their audits and taught quality improvement methods, eg, rapid cycles of change. Each team developed plans to improve 1 or more services. Brief audits with feedback and monthly conference calls were used to support practices to conduct rapid cycles of change, to discuss barriers and solutions, and to monitor progress. The results of final chart audits of twenty 2-year-olds and 4-year-olds were compared with the initial chart audits. A Preventive Service Score (PSS) was assigned to each practice on the basis of the number of services provided, and initial to final comparisons were made.

RESULTS. Fourteen practices participated. PSSs improved for all practices after the LC. Mean PSS for 2-year-olds increased from 4.0 ± 1.1 to 4.9 ± 1.2 and for 4-year-olds increased from 3.8 ± 1.8 to 5.6 ± 1.9. The proportions of children who received 9 of the 10 individual preventive services also improved significantly.

CONCLUSION. LCs are a potentially effective method of improving the quality of care that is delivered by pediatric practices.
The Safety of Trivalent Influenza Vaccine Among Healthy Children 6 to 24 Months of Age
Authors: Goodman Michael J. , Nordin James D. , Harper Peter , DeFor Teri , Zhou XingZhou
Published: May 2006

OBJECTIVE. The objective of this study was to assess the safety of routine trivalent influenza vaccine (TIV) administration among healthy children 6 through 23 months of age, after the Advisory Committee on Immunization Practices recommendation.

METHODS. The study was a retrospective case-control study of children receiving TIV in the first 2 seasons after the Advisory Committee on Immunization Practices recommendation. We assessed outcomes in the 42 days after vaccination in a population of 13383 children. Each case subject was matched, according to age and gender, with 3 control subjects. Hazard ratios were calculated with conditional logistic regression analysis.

RESULTS. We found no statistically significantly elevated hazard ratios for the first TIV dose. An elevated risk of pharyngitis was found for children receiving a second TIV dose. No elevated risk of seizure was found.

CONCLUSION. These results, for a population of healthy children, showed no medically significant adverse events related to TIV among children 6 to 23 months of age.
Early Vancomycin Therapy and Adverse Outcomes in Children With Pneumococcal Meningitis
Authors: Buckingham Steven C. , McCullers Jonathan A. , Luján-Zilbermann Jorge , Knapp Katherine M. , Orman Karen L. , English B. Keith
Published: May 2006

BACKGROUND. Experts recommend that children with suspected pneumococcal meningitis should empirically receive combination therapy with vancomycin plus either ceftriaxone or cefotaxime. The relationship between timing of the first dose of vancomycin relative to other antibiotics and outcome in these children, however, has not been addressed.

METHODS. Medical records of children with pneumococcal meningitis at a single institution from 1991–2001 were retrospectively reviewed. Vancomycin start time was defined as the number of hours from initiation of cefotaxime or ceftriaxone therapy until the administration of vancomycin therapy. Outcome variables were death, sensorineural hearing loss, and other neurologic deficits at discharge. Associations between independent variables and outcome variables were assessed in univariate and multiple logistic regression analyses.

RESULTS. Of 114 subjects, 109 received empiric vancomycin therapy in combination with cefotaxime or ceftriaxone. Ten subjects (9%) died, whereas 37 (55%) of 67 survivors who underwent audiometry had documented hearing loss, and 14 (13%) of 104 survivors were discharged with other neurologic deficits. Subjects with hearing loss had a significantly shorter median vancomycin start time than did those with normal hearing (<1 vs 4 hours). Vancomycin start time was not significantly associated with death or other neurologic deficits in univariate or multivariate analyses. Multiple logistic regression revealed that hearing loss was independently associated with vancomycin start time <2 hours, blood leukocyte count <15000/μL, and cerebrospinal fluid glucose concentration <30 mg/dL.

CONCLUSIONS. Early empiric vancomycin therapy was not clinically beneficial in children with pneumococcal meningitis but was associated with a substantially increased risk of hearing loss. It may be prudent to consider delaying the first dose of vancomycin therapy until ≥2 hours after the first dose of parenteral cephalosporin in children beginning therapy for suspected or confirmed pneumococcal meningitis.
Infantile Restrictive Cardiomyopathy Resulting From a Mutation in the Cardiac Troponin T Gene
Authors: Peddy Stacie B. , Vricella Luca A. , Crosson Jane E. , Oswald Gretchen L. , Cohn Ronald D. , Cameron Duke E. , Valle David , Loeys Bart L.
Published: May 2006

Here we report the first infantile case of restrictive cardiomyopathy caused by a de novo mutation of the cardiac troponin T gene. The patient presented with an apparent life-threatening event. She developed malignant arrhythmias and hemodynamic instability, requiring initial rescue support with extracorporeal membrane oxygenation, and subsequently underwent insertion of a biventricular assist device (VAD). She successfully received an orthotopic heart transplant 172 days after VAD implantation.
Ophthalmologic Examinations in Children With Juvenile Rheumatoid Arthritis
Authors: Cassidy James , Kivlin Jane , Lindsley Carol , Nocton James ,   the Section on Rheumatology,   and the Section on Ophthalmology
Published: May 2006

Unlike the joints, ocular involvement with juvenile rheumatoid arthritis is most often asymptomatic; yet, the inflammation can cause serious morbidity with loss of vision. Scheduled slit-lamp examinations by an ophthalmologist at specific intervals can detect ocular disease early, and prompt treatment can prevent vision loss.
Active Healthy Living: Prevention of Childhood Obesity Through Increased Physical Activity
Authors:   Council on Sports Medicine and Fitness and Council on School Health
Published: May 2006

This Policy Statement was retired April 2016.

The current epidemic of inactivity and the associated epidemic of obesity are being driven by multiple factors (societal, technologic, industrial, commercial, financial) and must be addressed likewise on several fronts. Foremost among these are the expansion of school physical education, dissuading children from pursuing sedentary activities, providing suitable role models for physical activity, and making activity-promoting changes in the environment. This statement outlines ways that pediatric health care providers and public health officials can encourage, monitor, and advocate for increased physical activity for children and teenagers.
Correlation of magnetic resonance images with anatomic features of the equine tarsus
Authors: Latorre Rafael , Arencibia Alberto , Gil Francisco , Rivero Miguel , Henry Robert W. , Ramírez Gregorio , Váquez Jose M.
Published: May 2006

Objective—To correlate anatomic features of the equine tarsus identified in plastinated sections with images obtained via magnetic resonance imaging (MRI).

Animals—4 horses.

Procedure—MRI (1.5-Tesla magnet) of the tarsus was performed on the pelvic limbs of 4 clinically normal horses following euthanasia. After imaging, tarsocrural joint spaces and vasculature were injected with colored latex. Sagittal and transverse sections of the tarsi were plastinated to facilitate interpretation of MR images.

Results—Relevant anatomic structures were identified and labeled on the plastinated tissue slices and corresponding MR images. Results indicated high correlations between MRI findings and those of plastinated sections.

Conclusions and Clinical Relevance—The data obtained provided certain reference standards for normal anatomic structure sizes and positions in the equine tarsus. This information may aid future physiologic or clinical studies of this joint.
Serum concentrations and analgesic effects of liposome-encapsulated and standard butorphanol tartrate in parrots
Authors: Sladky Kurt K. , Krugner-Higby Lisa , Meek-Walker Elizabeth , Heath Timothy D. , Paul-Murphy Joanne
Published: May 2006

Objective—To compare serum concentrations of liposome-encapsulated butorphanol tartrate (LEBT) and standard butorphanol tartrate (STDBT) following SC and IM administration, respectively, and to evaluate analgesic effects of LEBT and STDBT after parenteral administration to Hispaniolan parrots.

Animals—11 adult Hispaniolan parrots.

Procedure—The ability of LEBT to prolong the duration of analgesia in an avian species was tested. Blood samples were collected at serial time points after SC administration of LEBT (10 mg/kg or 15 mg/kg) or IM administration of STDBT (5 mg/kg). Serum concentrations of butorphanol tartrate were determined by use of a commercial immunoassay that measured parent drug and metabolites. Analgesic efficacy was evaluated in parrots exposed to electrical and thermal stimuli. Foot withdrawal thresholds were recorded at baseline and at serial time points after LEBT (15 mg/kg), liposome vehicle, STDBT (2 mg/kg), or physiologic saline (0.9% NaCl) solution administration.

Results—LEBT had a prolonged in vivo release for up to 5 days. Negligible serum butorphanol and butorphanol metabolite concentrations were obtained at 24 hours after IM administration of STDBT. Analgesic efficacy of LEBT as measured by foot withdrawal threshold to noxious thermal and electrical stimuli persisted for 3 to 5 days following SC administration of LEBT.

Conclusions and Clinical Relevance—SC administration of LEBT provided analgesia and detectable serum butorphanol concentrations in Hispaniolan parrots for up to 5 days. The use of LEBT may allow for substantial improvement in long-term pain relief without subjecting birds to the stress of handling and multiple daily injections.
Effect of medetomidine on respiration and minimum alveolar concentration in halothane- and isoflurane-anesthetized dogs
Authors: Lerche Phillip , Muir William W.
Published: May 2006

Objective—To evaluate the effect of medetomidine on minimum alveolar concentration (MAC), respiratory rate, tidal volume, minute volume (VM), and maximum inspiratory occlusion pressure (IOCPmax) in halothane- and isoflurane-anesthetized dogs.

Animals—6 healthy adult dogs (3 males and 3 females).

Procedure—The MAC of both inhalants was determined before and 5, 30, and 60 minutes after administration of medetomidine (5 μg/kg, IV). Dogs were subsequently anesthetized by administration of halothane or isoflurane and administered saline (0.9% NaCl) solution IV or medetomidine (5 μg/kg, IV). Respiratory variables and IOCPmax were measured at specific MAC values 15 minutes before and 5, 30, and 60 minutes after IV administration of medetomidine while dogs breathed 0% and 10% fractional inspired carbon dioxide (FICO2). Slopes of the lines for VM/FICO2 and IOCPmax/FICO2 were then calculated.

Results—Administration of medetomidine decreased MAC of both inhalants. Slope of VM/FICO2 increased in dogs anesthetized with halothane after administration of medetomidine, compared with corresponding values in dogs anesthetized with isoflurane. Administration of medetomidine with a simultaneous decrease in inhalant concentration significantly increased the slope for VM/FICO2, compared with values after administration of saline solution in dogs anesthetized with halothane but not isoflurane. Values for IOCPmax did not differ significantly between groups.

Conclusions and Clinical Relevance—Equipotent doses of halothane and isoflurane have differing effects on respiration that are most likely attributable to differences in drug effects on central respiratory centers. Relatively low doses of medetomidine decrease the MAC of halothane and isoflurane in dogs.