bluuebunny/crossref_metadata_2025 huggingface dataset:
Intussusception: Hospital Size and Risk of Surgery
Authors: Bratton Susan L. , Haberkern Charles M. , Waldhausen John H. T. , Sawin Robert S. , Allison Janice W.
Published: August 2004

Objective.

To determine whether the risk of operative management of children with intussusception varies by hospital pediatric caseload.

Design.

A cohort of all children with intussusception in Washington State from 1987 through 1996.

Setting.

All hospitals in Washington State.

Methods.

Five hundred seventy children with a hospital discharge diagnosis of intussusception were identified. Sixty-two were excluded because of missing data. Procedure codes for operative management and radiologic management were also identified.

Results.

Fifty-three percent of the children had operative reduction and 20% had resection of bowel. Children with operative reduction did not differ from those with nonoperative care by median age or gender; however, children with operative care were significantly more likely to receive care in hospitals with smaller pediatric caseloads and to have a coexisting condition associated with intussusception. Sixty-four percent of children who received care in a large children's hospital had nonoperative reduction, compared with 36% of children who received care in hospitals with 0 to 3000 annual pediatric admissions and 24% of children who had care in hospitals with 3000 to 10 000 annual pediatric admissions. Median length of stay and charges were significantly less in the large children's hospital, compared with other centers.

Conclusions.

Children who received care for intussusception in a large children's hospital had decreased risk of operative care, shorter length of stay, and lower hospital charges compared with children who received care in hospitals with smaller pediatric caseloads.
Positional Preference: Prevalence in Infants and Follow-Up After Two Years
Authors: Boere-Boonekamp Magda M. , van der Linden-Kuiper Lida T.
Published: August 2004

Objectives.

1) To determine the prevalence of positional preference in the general population of infants up to the age of 6 months; 2) to gather information on possible risk factors; 3) to determine the percentage of children with positional preference undergoing diagnostic evaluation and/or treatment; and 4) to assess the overall outcome of positional preference in infants and toddlers, with currently used diagnostic and treatment practices.

Setting.

Infant health care centers in The Netherlands.

Methods.

Seven thousand six hundred nine infants below the age of 6 months were screened for positional preference (cases:n = 623). Anamnestic data and physical signs of asymmetry of the range of motion and the shape of the head were recorded. These data were also registered of an immediate next child visiting the infant health care center with the same sex and about the same age but without positional preference (controls:n = 554). In a first follow-up study, 6 to 8 months after the original study, 468 of the 623 children with positional preference were reexamined for asymmetry of the range of motion and the shape of the head. In a second follow-up study, 24 to 32 months after the original study, 129 of 259 children who still had shown signs of asymmetry in the first follow-up study were again reexamined.

Results.

The prevalence of positional preference was 8.2% and was highest in children below 16 weeks of age. The boy:girl ratio was 3:2. Firstborns, premature children, and children with breech position at the time of delivery proved to have a higher risk for positional preference. The supine sleeping position of the child and a strong preference in offering the feeding always from the right or the left side were positively correlated with positional preference. In the first follow-up study, 12% still showed restricted active range of motion, 8% restricted passive range of motion, 47% asymmetric flattening of the occiput, and 23% of the forehead. Thirty-two percent of the children with positional preference had been referred for diagnostical/therapeutical intervention. In the second follow-up study, active range of motion was restricted in 6%, passive rotation in 2%, 45% had an asymmetric flattening of the occiput, and 21% of the forehead.

Conclusion.

Positional preference is frequently observed (8.2%) in The Netherlands. It leads to referral, additional diagnostics and, if necessary, treatment of almost 1 of every 3 affected children. Extrapolated to the original population in 1995, 2.4% of all children would still have a restricted range of motion and/or flattening of the skull at the age of 2 to 3 years. The high prevalence of positional preference in infancy, the persistency of accompanying signs, the large number of children referred for further diagnostic and/or treatment, and the resulting high medical expenses strongly call for a primary preventive approach. positional preference, deformational plagiocephaly, asymmetry, infants, population-based study.
Leukotriene Modifiers in Pediatric Asthma Management
Authors: Bisgaard Hans
Published: August 2004

Cysteinyl leukotrienes (Cys-LTs) are mediators released in asthma and virus-induced wheezing. Corticosteroids appear to have little or no effect on this release in vivo. Cys-LTs are both direct bronchoconstrictors and proinflammatory substances that mediate several steps in the pathophysiology of chronic asthma, including inflammatory cell recruitment, vascular leakage, and possibly airway remodeling. Blocking studies show that Cys-LTs are pivotal mediators in the pathophysiology of asthma. Cys-LTs are key components in the early and late allergic airway response and also contribute to bronchial obstruction after exercise and hyperventilation of cold, dry air in asthmatics. LT modifiers reduce airway eosinophil numbers and exhaled nitric oxide levels. Together these findings support an important role for the Cys-LTs in the asthma airway inflammation. Cys-LT receptor antagonists (Cys-LTRA) are generally well-tolerated. Phase III randomized, controlled clinical trials (RCT) show that LT modifiers are moderately effective, apparently with a particular between-patient variability in their clinical response. The clinical effects of LT modifiers are additive to those of β-agonists and corticosteroids. The onset of action of LT modifiers is within 1 to several days, and not rapid enough to make them useful as rescue treatment. Although LT modifiers possess some antiinflammatory activity, they cannot substitute for corticosteroids for inflammation control. LT modifiers are alternatives to long-acting β-agonists as complementary treatment to inhaled corticosteroids in pediatric asthma management because they provide bronchodilation and bronchoprotection without development of tolerance, and complement the antiinflammatory activity unchecked by steroids. In addition, the Cys-LTRA montelukast has been shown to ameliorate asthmatic symptoms and provide bronchoprotection in asthmatic preschool children from 2 years of age, which is of particular importance in this difficult-to-manage group of asthmatics. Given their efficacy, antiinflammatory activity, oral administration, and safety, LT modifiers will play an important role in the treatment of asthmatic children.
Maternal Phenylketonuria
Authors:   Committee on Genetics
Published: August 2004

Elevated maternal phenylalanine levels during pregnancy are teratogenic and may result in growth retardation, significant psychomotor handicaps, and birth defects in the offspring of unmonitored and untreated pregnancies. Women of childbearing age with all forms of phenylketonuria, including mild variants such as hyperphenylalaninemia, should receive counseling concerning their risks for adverse fetal effects optimally before conceiving. The best outcomes occur when strict control of maternal phenylalanine levels is achieved before conception and continued throughout the pregnancy.
Health Supervision for Children With Down Syndrome
Authors:   Committee on Genetics
Published: August 2004

These guidelines are designed to assist the pediatrician in caring for the child in whom the diagnosis of Down syndrome has been confirmed by karyotype. Although the pediatrician's initial contact with the child is usually during infancy, occasionally the pregnant woman who has been given the prenatal diagnosis of Down syndrome will be referred for counseling. Therefore, these guidelines offer advice for this situation as well.
Congenital Epulis
Authors: Lapid Oren , Shaco-Levy Ruthy , Krieger Yuval , Kachko Leonid , Sagi Amiram
Published: August 2004

Epulis is a rare tumor of the newborn, also known as granular cell tumor of the newborn or Neumann's tumor. This tumor arises from the mucosa of the gingiva, most commonly from the anterior part of the maxillary alveolar ridge, and is typically seen as a mass protruding out of the newborn child's mouth, which may interfere with respiration or feeding. Epulis is seen only in the newborn and is a different entity from other granular cell tumors. The tumor has a marked female preponderance of 8:1. The recommended treatment is prompt surgical resection. Recurrences of the tumor and damage to future dentition have not been reported, suggesting that radical excision is not warranted.

A newborn female with such a mass is described. The tumor was resected using a carbon dioxide laser; the postoperative course was uneventful. On histologic examination, it was composed of diffuse sheets and clusters of polygonal cells containing small round to oval nuclei and abundant coarsely granular cytoplasm. The tumor cells stained positive for vimentin, and negative for S100-protein, actin, desmin, laminin, keratin, estrogen, and progesterone receptors. Electron microscopic examination showed granular cells containing heterogeneous electron-dense granules, lysosomes, and cytoplasmic lipid droplets. The clinical and microscopic features of such tumors are reviewed.
Reactogenicity and Immunogenicity at Preschool Age of a Booster Dose of Two Three-Component Diphtheria-Tetanus-Acellular Pertussis Vaccines in Children Primed in Infancy With Acellular Vaccines
Authors: Tozzi Alberto Eugenio , Anemona Alessandra , Stat D. , Stefanelli Paola , Biol D. , Salmaso Stefania , Biol D. , Atti Marta Luisa Ciofi degli , Mastrantonio Paola , Giammanco Anna ,   the Progetto Pertosse Study Group
Published: August 2004

Objectives.

To determine the reactogenicity and immunogenicity of a fourth dose of 2 three-component acellular pertussis vaccines combined with diphtheria-tetanus-acellular pertussis (DTaP) when administered at preschool age to children primed in infancy with 3 doses of the same DTaP and who had received a diphtheria-tetanus (DT) dose at the age of 12 months.

Setting.

Local health units of 4 Italian regions.

Study Design.

Three thousand five hundred twenty-two children, who had been randomized in the first year of life to be immunized with a DTaP vaccine by either SmithKline Beecham or Chiron Biocine, were offered a booster of the same vaccine or, if refusing, a DT vaccine at the age of 5 to 6 years. Families of children were aware of the vaccine administered. The occurrence of adverse events was compared between the children who received a DTaP booster and those boosted with a DT only. Antibody titers to pertussis vaccine components (pertussis toxin, filamentous hemoagglutinin, and pertactin) were determined on 558 paired sera taken before and 30 days after the DTaP booster administration.

Results.

Four episodes of temperature ≥39.5°C, 2 in each DTaP group, were recorded. Fever ≥38°C occurred infrequently in both DTaP and DT recipients (DTaP range: 2.5%–2.8%; DT range: 0%–4.8%), as did irritability (DTaP range: 10.1%–11.7%; DT range: 7.4%–12.6%). The frequency of local reactions was significantly higher for DTaP recipients (range: 44.0%–52.8%), with respect to DT recipients (range: 29.5%–44.4%). Extensive local reactions were observed in 1.2% of DTaP recipients and in .5% of DT recipients. Both DTaP vaccines induced high antibody titers against pertussis toxin, filamentous hemoagglutinin, and pertactin, with an increase of >10 times the prebooster geometric mean titers.

Conclusions.

A booster dose of DTaP at preschool age in children primed with the same acellular pertussis vaccine is safe and immunogenic. However, the frequency of local reactions is higher compared with that following primary immunization and with that following booster with DT only, and parents should be informed of the potential for these reactions to occur.
Allergic Reactions to Measles-Mumps-Rubella Vaccination
Authors: Patja Annamari , Mäkinen-Kiljunen Soili , Davidkin Irja , Paunio Mikko , Peltola Heikki
Published: August 2004

Objective.

Immunization of egg-allergic children against measles, mumps, and rubella (MMR) is often deferred or even denied, although the safety of this vaccination has been clearly shown. Moreover, the majority of severe allergic reactions have occurred in egg-tolerant vaccinees. Other allergenic vaccine components have been sought, and gelatin has been suggested as one cause of allergic adverse events. The aim of this study was to further characterize the actual allergenic vaccine components.

Methods.

Serum samples from 36 recipients of MMR vaccine with anaphylaxis, urticaria with or without angioedema, asthmatic symptoms, or Henoch-Schönlein purpura were analyzed by CAP System radioallergosorbent test (RAST) and immunospot methods to detect the allergenic vaccine component. To evaluate the correspondence between the findings in the CAP System RAST or the immunospot and clinical symptoms, histories of allergies and present hypersensitivity symptoms were assessed.

Results.

Of the 36 participants, 10 were demonstrated to be allergic to gelatin. Seven of them had persistent allergic symptoms, possibly attributable to foods containing gelatin or cross-reactive allergens. The results of the immunospot suggested concomitant allergy to gelatin and egg, chicken, and feathers, as well as cow's milk, or they reflected allergen cross-reactivity.

Conclusions.

Although severe allergic adverse events attributable to MMR vaccination are extremely rare, all serious allergic reactions should be further assessed to detect the likely causative vaccine component, including gelatin. The current recommendation for immunization of egg-allergic persons according to standard MMR vaccination schedules is reinforced. measles, mumps, and rubella vaccine, immunization, adverse effects, allergic reactions, gelatin allergy, CAP System, radioallergosorbent test, immunospot, immunoglobulin E.
Microstructural Brain Development After Perinatal Cerebral White Matter Injury Assessed by Diffusion Tensor Magnetic Resonance Imaging
Authors: Hüppi Petra S. , Murphy Brendan , Maier Stephan E. , Zientara Gary P. , Inder Terrie E. , Barnes Patrick D. , Kikinis Ron , Jolesz Ferenc A. , Volpe Joseph J.
Published: August 2004

Objective.

Brain injury in premature infants is characterized predominantly by perinatally acquired lesions in the cerebral white matter (WM). The impact of such injury on the subsequent development of cerebral WM is not clear. This study uses diffusion tensor magnetic resonance imaging (MRI) to evaluate the effects of cerebral WM injury on subsequent microstructural brain development in different WM areas of the brain.

Methods.

Twenty premature infants (gestational age: 29.1 ± 1.9 weeks) were studied by conventional MRI within the first 3 weeks of life and again at term, with the addition at the latter time of diffusion tensor MRI. Ten of the preterm infants had cerebral WM injury identified by the early MRI and were matched with 10 premature infants of similar gestational age and neonatal course but with normal neonatal MRI scans. Diffusion tensor MRI at term was acquired in coronal and axial planes and used to determine the apparent diffusion coefficient, a measure of overall restriction to water diffusion, and the relative anisotropy (RA), a measure of preferred directionality of diffusion, in central WM, anterior frontal WM, occipital WM, temporal WM, and the posterior limb of the internal capsule. Diffusion vector maps were generated from the diffusion tensor analysis to define the microstructural architecture of the cerebral WM regions.

Results.

At term, the diffusion tensor MRI revealed no difference in apparent diffusion coefficient among preterm infants with or without perinatal WM lesions. By contrast, RA, the measure of preferred directionality of diffusion and thereby dependent on development of axonal fibers and oligodendroglia, was 25% lower in central WM, the principal site of the original WM injury. However, RA was unaffected in relatively uninjured WM areas, such as temporal, anterior frontal, and occipital regions. Notably, RA values in the internal capsule, which contains fibers that descend from the injured cerebral WM, were 20% lower in the infants with WM injury versus those without. Diffusion vector maps showed striking alterations in the size, orientation, and organization of fiber tracts in central WM and in those descending to the internal capsule.

Conclusions.

Perinatal cerebral WM injury seems to have major deleterious effects on subsequent development of fiber tracts both in the cerebral WM and more distally. The ultimate impact of brain injury in the newborn should be considered as a function not only of tissue destruction, but also of impaired subsequent brain development.
Residential Exposures Associated With Asthma in US Children
Authors: Lanphear Bruce P. , Aligne C. Andrew , Auinger Peggy , Weitzman Michael , Byrd Robert S.
Published: August 2004

Objective.

Residential exposures are recognized risk factors for childhood asthma, but the relative contribution of specific risk factors and the overall contribution of housing to asthma in US children is unknown. The objective of this study was to identify risk factors and estimate the population attributable risk of residential exposures for doctor-diagnosed asthma for US children.

Methods.

A cross-sectional survey was conducted from 1988 to 1994. Survey participants were 8257 children who were <6 years old and who participated in the Third National Health and Nutrition Examination Survey, a survey of the health and nutritional status of children and adults in the United States. The main outcome measure was doctor-diagnosed asthma, as reported by the parent.

Results.

Six percent of children had doctor-diagnosed asthma. The prevalence of asthma was higher among boys (6.7%) than girls (5.1%) and was higher among black children (8.9%) than white children (5.2%). Risk factors for doctor-diagnosed asthma included a family history of atopy (odds ratio [OR]: 2.2; 95% confidence interval [CI]: 1.5, 3.1), child's history of allergy to a pet (OR: 24.2; 95% CI: 8.4, 69.5), exposure to environmental tobacco smoke (OR: 1.8; 95% CI: 1.2–2.6), use of a gas stove or oven for heat (OR: 1.8; 95% CI: 1.02–3.2), and presence of a dog in the household (OR: 1.6; 95% CI: 1.1, 2.3). The population attributable risk of ≥1 residential exposure for doctor-diagnosed asthma in US children <6 years old was 39.2%, or an estimated 533 000 excess cases, whereas having a family history of atopy accounted for 300 000. The attributable cost of asthma as a result of residential exposures for children <6 years old was $402 million (95% CI: $296–$507 million) annually.

Conclusions.

The elimination of identified residential risk factors, if causally associated with asthma, would result in a 39% decline in doctor-diagnosed asthma among US children <6 years old.
Sudden Infant Death Syndrome, Bedsharing, Parental Weight, and Age at Death
Authors: Carroll-Pankhurst Cindie , Mortimer Edward A.
Published: August 2004

Objective.

To assess the role of parental bedsharing in sudden infant death syndrome (SIDS)-like deaths, this study examines the hypothesis that, compared with other SIDS cases, the age distribution of deaths associated with bedsharing should be lower in younger, less vigorous infants.

Methods.

For 84 SIDS cases in Cleveland, Ohio, 1992 to 1996, age at death, maternal weight, and other risk factors for SIDS were compared for cases grouped according to bedsharing status.

Results.

Mean ages at death were 9.1 weeks for 30 bedsharing and 12.7 for 54 nonbedsharing cases, counting 10 with missing information as nonbedsharing. Mean pregravid weights of bedsharing mothers exceeded those of nonbedsharing mothers (84.1 vs 67.0 kg). Mean ages at death for nonbedsharing infants, bedsharing infants of smaller mothers, and bedsharing infants of larger mothers were 12.7, 10.3, and 7.6 weeks, respectively. Large maternal size did not affect age at death in the absence of bedsharing.

Conclusions.

By demonstrating that among an urban population at high risk for SIDS, bedsharing is strongly associated with a younger age at death, independent of any other factors, this study provides evidence of a relationship between some SIDS-like deaths and parent-infant bedsharing, particularly if the parent is large.
International Experience With Trisomy 21 Infants Placed on Extracorporeal Membrane Oxygenation
Authors: Southgate W. Michael , Annibale David J. , Hulsey Thomas C. , Purohit Dilip M.
Published: August 2004

Objective.

To characterize the international experience concerning neonates with trisomy 21 (T21) managed with extracorporeal membrane oxygenation (ECMO), and to compare and contrast this group of patients to the neonatal ECMO population as a whole.

Methods.

Data from the Extracorporeal Life Support Organization for newborn infants placed on ECMO between January 1984 and June 1999 were analyzed. Infants with T21 were compared with the group of infants without T21.

Results.

Fifteen thousand nine hundred forty-six infants, including 91 (n = 91) with the diagnosis of T21, were placed on ECMO for neonatal respiratory failure during the 14.5-year period. T21 infants were overrepresented in the ECMO population by several-fold when compared with the incidence of T21 in the general population. Eighty-seven of the 91 T21 infants were placed on ECMO after 1989. The distribution of primary diagnoses leading to ECMO differed between the groups (T21 vs non-T21): primary persistent pulmonary hypertension, 47.3% versus 13%; meconium aspiration syndrome, 23.1% versus 32.9%; sepsis, 7.7% versus 13.2%; congenital diaphragmatic hernia, 7.7% versus 19.9%; and respiratory distress syndrome, 3.3% versus 7.9%. Although survival to discontinuation of ECMO was similar in the 2 groups, likelihood of survival to discharge was decreased for T21 infants (65.9% vs 75.6%) because of increased post-ECMO mortality.

Conclusions.

Extracorporeal Life Support Organization registry data suggests that T21 infants are at a significantly higher risk of being placed on ECMO for neonatal respiratory failure than the general population, perhaps as a result of delayed extrauterine pulmonary vascular adaptation, as manifested in the high rate of primary persistent pulmonary hypertension as the primary diagnosis. There may have been a shift in attitude regarding the use of ECMO in the T21 patient after 1989. Although most T21 patients placed on ECMO will survive, the prognosis is more guarded in this population when compared with all infants so managed. The long-term neurodevelopmental outcome of this group of T21 ECMO survivors is currently unknown.
Continuous Infusion of Glucagon Induces Severe Hyponatremia and Thrombocytopenia in a Premature Neonate
Authors: Belik Jaques , Musey Judy , Trussell Rebecca A.
Published: August 2004

We report on a 35-week gestation infant who developed severe hyponatremia and thrombocytopenia after continuous infusion of glucagon for the treatment of intractable hypoglycemia. Given these serious side effects, glucagon infusion should be avoided in the treatment of premature infants.hypoglycemia, glucose, small for gestational age.
Technical Report: Alternative Dispute Resolution in Medical Malpractice
Authors: Fraser John J. ,   the Committee on Medical Liability
Published: August 2004

This Technical Report was retired January 2011.

The purpose of this technical report is to provide pediatricians with an understanding of past crises within the professional liability insurance industry, the difficulties of the tort system, and alternative strategies for resolving malpractice disputes that have been applied to medical malpractice actions. Through this report, pediatricians will gain a technical understanding of common alternative dispute resolution (ADR) strategies. The report explains the distinctions between various ADR methods in terms of process and outcome, risks and benefits, appropriateness to the nature of the dispute, and long-term ramifications. By knowing these concepts, pediatricians faced with malpractice claims will be better-equipped to participate in the decision-making with legal counsel on whether to settle, litigate, or explore ADR options.
Head Lice Infestation: Single Drug Versus Combination Therapy With One Percent Permethrin and Trimethoprim/Sulfamethoxazole
Authors: Hipolito Ronaldo B. , Mallorca Florinda G. , Zuniga-Macaraig Zoraya O. , Apolinario Patricia C. , Wheeler-Sherman Jan
Published: August 2004

Background.

Head lice infestation (HLI) is a vexing problem for pediatricians and families because lice are becoming resistant to approved antipediculosis agents.

Objective.

This study compared the efficacy of 3 different treatments for HLI and determined whether combination therapy reduced treatment failures.

Design and Setting.

A randomized, clinical trial performed in 3 private practices.

Participants.

The population was children ranging in age from 2 to 13 years.

Methods.

HLI was diagnosed by direct inspection of the hair and scalp. Children were assigned to 1 of 3 groups: 1) 1% permethrin creme rinse (1% PER; n = 39); 2) oral administration of trimethoprim/sulfamethoxazole (TMP/SMX;n = 36); and 3) a combination of 1% PER and TMP/SMX (n = 40). Follow-up visits were done 2 and 4 weeks later, and parents or caregivers of those who did not return were interviewed by telephone. If HLI was present at the 2-week follow-up, the child was retreated per their protocol. We defined successful treatment as the absence of adult lice and nymphal stage or eggs (nits). The presence of nits alone was not considered a treatment failure.

Results.

At the 2-week follow-up visit, successful treatment for groups 1, 2, and 3 was 79.5%, 83%, and 95%, respectively. At the 4-week follow-up, successful treatment was 72%, 78%, and 92.5% for groups 1, 2, and 3, respectively. The absolute risk reduction for recurrence comparing group 1 versus group 2 was 6%, group 2 versus group 3 was 14%, and group 1 versus group 3 was 20%. No major adverse complications were seen in any treatment group.

Conclusion.

Our findings indicate that a combination of 1% PER and TMP/SMX is an effective alternative therapy for HLI. We recommend that the dual therapy with 1% PER and oral TMP/SMX be used and reserved in cases of multiple treatment failures or suspected cases of lice-related resistance to therapy.
Racial and Temporal Variations in the Prevalence of Heart Defects
Authors: Botto Lorenzo D. , Correa Adolfo , Erickson J. David
Published: August 2004

Background.

Documenting the prevalence and trends of congenital heart defects provides useful data for pediatric practice, health-care planning, and causal research. Yet, most population-based studies use data from the 1970s and 1980s. We sought to extend into more recent years the study of temporal and racial variations of heart defects occurrence in a well-defined population.

Methods.

We used data from the Metropolitan Atlanta Congenital Defects Program, a population-based registry with active case ascertainment from multiple sources. Heart defects were identified among liveborn infants up to 1 year old, among stillborn infants, and among pregnancy terminations to mothers residing in metropolitan Atlanta.

Results.

From 1968 through 1997, the registry ascertained 5813 major congenital heart defects among 937 195 infants, for a prevalence of 6.2 per 1000. The prevalence increased to 9.0 per 1000 births in 1995 through 1997. The prevalence of ventricular septal defects, tetralogy of Fallot, atrioventricular septal defects, and pulmonary stenosis increased, whereas that of transposition of the great arteries decreased. For some defects, prevalence and trends varied by race.

Conclusions.

The prevalence of congenital heart defects is increasing. Whereas most findings likely result from improved case ascertainment and reporting, others might be because of changes in the distribution of risk factors in the population. The basis of the racial variations is incompletely understood.
Incidence and Remission of Asthma in Schoolchildren: Report From the Obstructive Lung Disease in Northern Sweden Studies
Authors: Rönmark Eva , Jönsson Elsy , Platts-Mills Thomas , Lundbäck Bo
Published: August 2004

Objective.

An increasing prevalence of asthma has been reported worldwide as well as in Sweden. In 1996, the prevalence of asthma and type 1 allergy was investigated in a cohort of 3525 children 7 and 8 years old in 3 areas of northern Sweden. The aim of the present study was to estimate the incidence of asthma and to identify risk factors for incident cases over 1 year.

Methods.

The study started with a parental questionnaire, the International Study of Asthma and Allergies in Childhood questionnaire with additional questions, a skin prick test, and a validation study. The cohort was followed up after 1 year with the same questions. The response rate to the questionnaire was 97% in 1996, and 3339 children (97%) participated both in 1996 and 1997.

Results.

The incidence of physician-diagnosed asthma was 0.9/100/year; of wheezing, 3.8/100/year; and of new frequent or daily users of asthma medicines, 1.1/100/year. There was no difference by sex. The risk factor pattern based on incident cases of asthma was different from that based on prevalent cases. Significant risk factors for incident asthma were a positive skin test (odds ratio [OR]: 9.3; 95% confidence interval [CI]: 3.8–22.7); low birth weight (OR: 7.4; 95% CI: 2.2–24.5); and family history of asthma (OR: 2.6; 95% CI: 1.1–6.3). Having or having had pets at home was associated with a decreased risk for asthma and wheezing based on prevalent cases, although it was associated with an increased risk for incidence of wheezing (OR: 2.9; 95% CI: 1.3–6.2). Remission of asthma, which was reported by 10% of the children with current asthma during 1 year, was associated with a negative skin test.

Conclusion.

The incidence of asthma at the age of 8 years was high, but remission was also common. Important risk factors for the development of asthma at this age were type 1 allergy, low birth weight, and family history of asthma. Furthermore, the results suggest that in a region where sensitivity to domestic animals is a strong risk factor for asthma, the presence of pets in the home may have different effects in early childhood compared with later in childhood.
Incidence of Congenital Rubella Syndrome at a Hospital Serving a Predominantly Hispanic Population, El Paso, Texas
Authors: Zimmerman Laura , Reef Susan E.
Published: August 2004

Objective.

The current epidemiology of rubella reveals an increase in the number of cases among adult Hispanics and an increase in the number of congenital rubella syndrome (CRS) cases among infants of Hispanic mothers. Recent rubella outbreaks have occurred primarily among adult Hispanics, many of whom are foreign-born natives of countries where rubella vaccination is not routine or has only recently been implemented. The objective of this study was to estimate the incidence of CRS in a hospital serving a predominantly Hispanic population.

Methods.

Hospital charts of infants <1 year old discharged between January 1, 1994 and December 31, 1996 withInternational Classification of Diseases, Ninth Revision(ICD-9) discharge codes consistent with CRS were reviewed; we looked for cataracts, deafness, congenital heart defects, dermal erythropoiesis, microcephaly, meningoencephalitis, and other defects associated with CRS. We abstracted data on maternal and infant ethnicity, maternal age, gestational age, infants' birth weight, infants' clinical characteristics, and laboratory evaluation. Cases were categorized according to the Council of State and Territorial Epidemiologists' case classification for CRS.

Results.

Of the 182 infants with 1 or more ICD-9 codes consistent with CRS, 6 (3.3%) met either the confirmed or probable case definition for CRS. Two infants met the definition for confirmed CRS. Although laboratory tests for rubella immunoglobulin M antibodies were positive for both of these infants, only 1 of the cases had been reported to the state health department. Four other infants had clinical presentations that met the definition for a probable case. One of these had been tested for rubella immunoglobulin M antibodies, and the test was negative. The other 3 had not been tested. The rate of infants meeting the definition of confirmed and probable CRS was 3.1 per 10 000 hospital births. All confirmed and probable cases were among infants born to Hispanic mothers. Maternal country of origin was Mexico for the 2 confirmed cases and 1 of the probable cases, and unknown for the remaining 3 probable cases.

Conclusions.

The rate of confirmed and probable CRS among infants in this predominantly Hispanic population is higher than the reported rate in the United States in the vaccine era, which has been reported to range from approximately 0.01–0.08 per 10 000 live births. These findings indicate a need for heightened awareness of CRS among physicians who serve populations at risk for rubella. Physicians should report all confirmed and probable CRS cases to the state health department. The lack of appropriate laboratory testing in 3 infants with probable CRS indicates that physicians should consider a diagnosis of CRS in infants with some signs consistent with CRS, particularly in areas serving high numbers of individuals at risk for rubella.
Prevalence and Assessment of Attention-Deficit/Hyperactivity Disorder in Primary Care Settings
Authors: Brown Ronald T. , Freeman Wendy S. , Perrin James M. , Stein Martin T. , Amler Robert W. , Feldman Heidi M. , Pierce Karen , Wolraich Mark L.
Published: August 2004

Research literature relating to the prevalence of attention-deficit/hyperactivity disorder (ADHD) and co-occurring conditions in children from primary care settings and the general population is reviewed as the basis of the American Academy of Pediatrics clinical practice guideline for the assessment and diagnosis of ADHD. Epidemiologic studies revealed prevalence rates generally ranging from 4% to 12% in the general population of 6 to 12 year olds. Similar or slightly lower rates of ADHD were revealed in pediatric primary care settings. Other behavioral, emotional, and learning problems significantly co-occurred with ADHD. Also reviewed were rating scales and medical tests that could be employed in evaluating ADHD. The utility of using both parent- and teacher-completed rating scales that specifically assess symptoms of ADHD in the diagnostic process was supported. Recommendations were made regarding the assessment of children with suspected ADHD in the pediatric primary care setting.
A Randomized, Placebo-Controlled Trial of Antimicrobial Treatment for Children With Clinically Diagnosed Acute Sinusitis
Authors: Garbutt Jane M. , Goldstein Marion , Gellman Elliot , Shannon William , Littenberg Benjamin
Published: August 2004

Objective.

Although antimicrobial treatment for children with acute sinusitis is used commonly, it is unclear whether it offers significant clinical benefit. The purpose of this study was to evaluate the effectiveness of antimicrobial treatments for acute sinusitis as they are used in community pediatric practice.

Methods.

We conducted a randomized, placebo-controlled trial in 3 community pediatric practices in St Louis, Missouri. A total of 188 patients who were between the ages of 1 and 18 years and who had had 10 to 28 days of persistent sinus symptoms and a clinical diagnosis of acute sinusitis were randomized to receive 14 days of amoxicillin (40 mg/kg/d in 3 daily doses), amoxicillin-clavulanate (amoxicillin 45 mg/kg/d in 2 daily doses), or placebo. Change in sinus symptoms was assessed both by a quantitative symptom score (the S5 score) and subjectively by the parent. Secondary outcomes included adverse effects of treatment and recurrence or relapse of sinus symptoms. Outcomes were assessed by telephone interviews over a 2-month period.

Results.

Of the 161 patients who were included in the analysis, 58 received amoxicillin, 48 received amoxicillin-clavulanate, and 55 received placebo. Day 14 improvement rates were 79%, 81%, and 79%, respectively. There were no differences in the 14-day change in S5 score among treatment groups. The rates of adverse events (amoxicillin, 19%; amoxicillin-clavulanate, 11%; placebo, 10%), relapse (amoxicillin, 12%; amoxicillin-clavulanate, 13%; placebo, 13%), and recurrence (amoxicillin, 9%; amoxicillin-clavulanate, 13%; placebo, 13%) of sinus symptoms were similar among treatment groups.

Conclusion.

Neither amoxicillin nor amoxicillin-clavulanate offered any clinical benefit compared with placebo for children with clinically diagnosed acute sinusitis.
Resuscitation With Room Air Instead of 100% Oxygen Prevents Oxidative Stress in Moderately Asphyxiated Term Neonates
Authors: Vento Máximo , Asensi Miguel , Sastre Juan , Garcı́a-Sala Fernando , Pallardó Federico V. , Viña José
Published: August 2004

Background.

Traditionally, asphyxiated newborn infants have been ventilated using 100% oxygen. However, a recent multinational trial has shown that the use of room air was just as efficient as pure oxygen in securing the survival of severely asphyxiated newborn infants. Oxidative stress markers in moderately asphyxiated term newborn infants resuscitated with either 100% oxygen or room air have been studied for the first time in this work.

Methods.

Eligible term neonates with perinatal asphyxia were randomly resuscitated with either room air or 100% oxygen. The clinical parameters recorded were those of the Apgar score at 1, 5, and 10 minutes, the time of onset of the first cry, and the time of onset of the sustained pattern of respiration. In addition, reduced and oxidized glutathione concentrations and antioxidant enzyme activities (superoxide dismutase, catalase, and glutathione peroxidase) were determined in blood from the umbilical artery during delivery and in peripheral blood at 72 hours and at 4 weeks' postnatal age.

Results.

Our results show that the room-air resuscitated (RAR) group needed significantly less time to first cry than the group resuscitated with 100% oxygen (1.2 ± 0.6 minutes vs 1.7 ± 0.5). Moreover, the RAR group needed less time undergoing ventilation to achieve a sustained respiratory pattern than the group resuscitated with pure oxygen (4.6 ± 0.7 vs 7.5 ± 1.8 minutes). The reduced-to-oxidized-glutathione ratio, which is an accurate index of oxidative stress, of the RAR group (53 ± 9) at 28 days of postnatal life showed no differences with the control nonasphyxiated group (50 ± 12). However, the reduced-to-oxidized-glutathione ratio of the 100% oxygen-resuscitated group (OxR) (15 ± 5) was significantly lower and revealed protracted oxidative stress. Furthermore, the activities of superoxide dismutase and catalase in erythrocytes were 69% and 78% higher, respectively, in the OxR group than in the control group at 28 days of postnatal life. Thus, this shows that these antioxidant enzymes, although higher than in controls, could not cope with the ongoing generation of free radicals in the OxR group. However, there were no differences in antioxidant enzyme activities between the RAR group and the control group at this stage.

Conclusions.

There are no apparent clinical disadvantages in using room air for ventilation of asphyxiated neonates rather than 100% oxygen. Furthermore, RAR infants recover more quickly as assessed by Apgar scores, time to the first cry, and the sustained pattern of respiration. In addition, neonates resuscitated with 100% oxygen exhibit biochemical findings reflecting prolonged oxidative stress present even after 4 weeks of postnatal life, which do not appear in the RAR group. Thus, the current accepted recommendations for using 100% oxygen in the resuscitation of asphyxiated newborn infants should be further discussed and investigated.
Effect of Caffeine on Oxygen Consumption and Metabolic Rate in Very Low Birth Weight Infants With Idiopathic Apnea
Authors: Bauer Jacqueline , Maier Kathrin , Linderkamp Otwin , Hentschel Roland
Published: August 2004

Objective.

Methylxanthines are among the most commonly prescribed drugs in neonatal intensive care. This study evaluates the effect of caffeine on oxygen consumption and metabolic rate in premature infants with idiopathic apnea.

Methods.

Eighteen preterm infants at gestational ages from 28 to 33 weeks and birth weights of 890 to 1680 g were enrolled in the study. Nine preterm infants received caffeine therapy, and 9 served as a control group. Oxygen consumption and energy expenditure were examined before, during, and after caffeine treatment.

Results.

Oxygen consumption increased significantly from 7.0 ± 0.9 before caffeine to 8.8 ± 0.7 mL/kg/min after 48 hours of caffeine therapy, and energy expenditure increased from 2.1 ± 0.3 to 3.0 ± 0.2 kcal/kg/hour. During the observation period of 4 weeks of caffeine treatment, oxygen consumption increased significantly in the caffeine group compared with the control patients. In the caffeine group, a lower environmental temperature was sufficient to maintain a normal body temperature. With similar caloric intake in both groups during the study period, daily weight gain in the control group was significantly higher (21 ± 4 vs 42 ± 2 g/d). None of the other parameters recorded changed during caffeine therapy.

Conclusion.

Long-term administration of caffeine in preterm infants is associated with an increase in oxygen consumption and with a reduction of weight gain. This may have implications for clinical practice as nutritional regimens need to be adjusted during this therapy.
Continuation of the Decline in Prevalence of Anemia in Low-Income Infants and Children in Five States
Authors: Sherry Bettylou , Mei Zuguo , Yip Ray
Published: August 2004

Objective.

To examine whether there is a continuation of the decline in prevalence of anemia among low-income infants and children 6.0 to 59.9 months old from the early 1980s to the mid-1990s.

Study Design.

Cross-sectional trend analysis of data from the Centers for Disease Control and Prevention's Pediatric Nutrition Surveillance System from the 5 states (Colorado, New Mexico, Oklahoma, Utah, and Vermont) that have been using the same laboratory method for anemia screening since 1984 or earlier.

Results.

The overall prevalence of anemia decreased substantially in each state from the early 1980s to the mid-1990s as follows: Colorado by 52%; New Mexico by 75%; Oklahoma by 67%; Utah by 57%; and Vermont by 48%. In each state, the prevalence of anemia declined for children of different age groups, birth weights, genders, type of pediatric care visit (screening or follow-up), and most race/ethnic groups.

Conclusions.

The decline in the prevalence of anemia initially observed in the 1980s continued well into the 1990s. This decline is likely attributable to better iron nutrition related to greater usage of iron-fortified products and possibly better iron bioavailability in some of the food products.
Growth of Preterm Infants Fed Nutrient-Enriched or Term Formula After Hospital Discharge
Authors: Carver Jane D. , Wu Paul Y. K. , Hall Robert T. , Ziegler Ekhard E. , Sosa Roberto , Jacobs Joan , Baggs Geraldine , Auestad Nancy , Lloyd Beate
Published: August 2004

Objective.

At hospital discharge, preterm infants may have low body stores of nutrients, deficient bone mineralization, and an accumulated energy deficit. This double-blind, randomized study evaluated the growth of premature infants with birth weights <1800 g who were fed a 22 kcal/fl oz nutrient-enriched postdischarge formula (PDF) or a 20 kcal/fl oz term-infant formula (TF) from hospital discharge to 12 months' corrected age (CA).

Methods.

Infants were randomized to PDF or TF a few days before hospital discharge with stratification by gender and birth weight (<1250 g or ≥1250 g). The formulas were fed to 12 months' CA. Growth was evaluated using analysis of variance controlling for site, feeding, gender, and birth weight group. Interaction effects were also assessed. Secondary analyses included a repeated measures analysis and growth modeling.

Results.

One hundred twenty-five infants were randomized; 74 completed to 6 months' CA and 53 to 12 months' CA. PDF-fed infants weighed more than TF-fed infants at 1 and 2 months' CA, gained more weight from study day 1 to 1 and 2 months' CA, and were longer at 3 months' CA. There were significant interactions between feeding and birth weight group—among infants with birth weights <1250 g, those fed PDF weighed more at 6 months' CA, were longer at 6 months' CA, had larger head circumferences at term 1, 3, 6, and 12 months' CA, and gained more in head circumference from study day 1 to term and to 1 month CA. The repeated measures and growth modeling analyses confirmed the analysis of variance results. The PDF formula seemed to be of particular benefit for the growth of male infants. Infants fed the PDF consumed less formula and had higher protein intakes at several time points. Energy intakes, however, were not different.

Conclusions.

Growth was improved in preterm infants fed a nutrient-enriched postdischarge formula after hospital discharge to 12 months' CA. Beneficial effects were most evident among infants with birth weights <1250 g, particularly for head circumference measurements.
Thermal Stress in Sudden Infant Death: Is There an Ambiguity With the Rebreathing Hypothesis?
Authors: Guntheroth Warren G. , Spiers Philip S.
Published: August 2004

Objective.

To assess the role of thermal stress in the cause of sudden infant death syndrome (SIDS), and to compare risk factors with those of rebreathing.

Methodology.

Analysis of publications concerning the epidemiology and physiology of thermal stress in SIDS.

Results.

A strong association between thermal regulation and ventilatory control was found, specifically for prolonged apnea. Infections, excessive room heat and insulation, and prone sleeping produce significantly increased odds ratios for SIDS. Although some of the risk factors for rebreathing could be explained by the effects of thermal stress, several factors for thermal stress could not reasonably be explained by the rebreathing hypothesis.

Conclusions.

Although the risk of thermal stress is widely accepted abroad, it has received relatively little attention in the United States. The incidence of SIDS in the United States can likely be further reduced by educating the public against the dangers of overheating, as an integral part of the back-to-sleep campaign.