bluuebunny/crossref_metadata_2025 huggingface dataset:
Meta-analyses of the Effectiveness of Intravenous Immune Globulin for Prevention and Treatment of Neonatal Sepsis
Authors: Jenson Hal B. , Pollock Brad H.
Published: August 2004

Objective. To determine the effectiveness of intravenous immune globulin (IVIG) in the prevention and treatment of neonatal sepsis.

Design. All published studies of IVIG for the prevention or treatment of neonatal sepsis were reviewed. Peer-reviewed, prospective, randomized trials with high merit were analyzed by two meta-analyses. The effect of prophylactic IVIG was evaluated by comparison of the numbers of cases of sepsis (bacteremia in the presence of systemic manifestations of sepsis), and of therapeutic IVIG by comparison of the numbers of deaths resulting from early-onset sepsis.

Results. Meta-analysis of 4933 evaluable newborns in 12 studies of IVIG prophylaxis showed a statistically significant negative association with the incidence of sepsis in premature low birth weight newborns given IVIG shortly after birth (P = .0193, two-sided). The heterogeneity across these studies precluded estimation of a common odds ratio. Meta-analysis of 110 evaluable cases of neonatal sepsis in three studies of IVIG treatment of neonatal sepsis showed a significant decrease in the mortality rate for neonates with sepsis given IVIG (P = .007, two-sided). The common odds ratio was .173 (95% confidence interval = .031 to .735).

Conclusions. Using conservative and objective outcome rating criteria, the addition of IVIG to standard therapies is of minimal but demonstrable benefit in preventing sepsis when administered prophylactically to premature low birth weight newborns, and of unequivocal benefit in preventing death when administered therapeutically for early-onset neonatal sepsis. The likelihood of newborns with sepsis living past the neonatal period was improved nearly sixfold when IVIG was administered in addition to standard therapies. neonatal sepsis, immune globulin.
Osteogenesis Imperfecta in Childhood: Impairment and Disability
Authors: Engelbert R. H. H. , van der Graaf Y. , van Empelen R. , Beemer F. A. , Helders P. J. M.
Published: August 2004

Objective. To determine clinical characteristics in children with osteogenesis imperfecta (OI) regarding impairment (range of joint motion and muscle strength) and disability (functional skills) in relation to the different types of the disease, and to study the correlation between characteristics of impairment and disability.

Methods. In a cross-sectional study 54 children with OI (OI type I: 24; OI type III: 15; OI type IV: 15), the range of joint motion, muscle strength, and functional ability were measured in a standardized way and analyzed statistically.

Results. The range of joint motion in almost all joints differed significantly with respect to the different disease types. In OI type I patients, generalized hypermobility of the joints was present, without decrease in joint motion. In OI type III the extremities were severely maligned, especially the lower limbs. In type IV the upper and lower extremities were equally maligned. Muscle strength differed significantly with respect to the different types of OI. In type I patients, muscle strength was normal except for the periarticular hip muscles. In type III, especially in the lower extremities, muscle strength was severely decreased, with a muscular imbalance around the hip joint. In type IV, muscle strength was mainly decreased in the proximal muscles of the upper and lower extremities. In children ≤7.5 years of age, significant differences existed among the different disease types in functional skills regarding mobility. No significant difference was observed in self-care and social function, although the most severely affected children showed a tendency to score better with social function. Older children differed significantly concerning mobility and self-care items. In children ≤7.5 years old, a correlation was sometimes observed between impairment and disability items, although in older children a moderate to good correlation was always present (r > .6).

Conclusion. In OI, severity-related profiles exist, within the different subtypes of the disease, regarding range of joint motion, muscle strength, and functional skills. In younger children, impairment parameters do not sufficiently correlate for disability. Rehabilitation strategies in younger children should therefore focus on improvement of functional skills and not only on impairment parameters. osteogenesis imperfecta, pediatrics, muscle strength, range of joint motion, impairment, disability, functional outcome.
Screening for Developmental Dysplasia of the Hip: From Theory to Practice
Authors: Baronciani Dante , Atti Giuseppe , Andiloro Francesco , Bartesaghi Angelo , Gagliardi Luigi , Passamonti Contardo , Petrone Massimo ,   Collaborative Group DDH Project
Published: August 2004

Objective. To evaluate an organizational model for neonatal population screening for developmental dysplasia of the hip.

Methods. In 4648 neonates born in six hospitals of the Lombardy region, screening for developmental dysplasia of the hip was done using the Ortolani-Barlow maneuver and ultrasonography.

Results. The frequency of positive results of clinical and ultrasound examinations carried out in the hospitals varied considerably as a result of difficulties in the Ortolani-Barlow test reproducibility and in the low sensitivity of the clinical examination when compared to ultrasonography. Neonatal screening results implied a large number of subjects with a IIa hip, according to Graf’s system; as these subjects require follow-up, the cost of this type of screening is high. Ultrasound findings were normal at 69 days of life in 88% and 75% of subjects, respectively, with unilateral and bilateral type IIa hip.

Conclusion. This study evaluated various organizational models for screening (for different time periods and for selected populations) in relation to the cost-benefit ratio and demonstrated the different problems that still impede identification of a correct screening model. congenital dislocation of the hip, developmental dysplasia of the hip, clinical screening, newborn, reliability, ultrasonography.
Chorioamnionitis, Cortisol, and Acute Lung Disease in Very Low Birth Weight Infants
Authors: Watterberg Kristi L. , Scott Susan M. , Naeye Richard L.
Published: August 2004

Objective. To explore the relationship between chorioamnionitis, postnatal cortisol concentrations, and acute respiratory distress in very low birth weight infants.

Methods. Appropriate for gestational age infants weighing between 501 to 1500 g at birth were enrolled into this prospective, observational study, and data regarding respiratory distress on the first day of life were recorded. Serum cortisol concentrations were measured on (a) day 2, (b) day 3 or 4, and (c) day 5, 6, or 7 of life. On day (b) or (c), 3.5 μg/kg of cosyntropin (an adrenocorticotrophic hormone analog) was given, and a repeat specimen was drawn 30 minutes later. Chorioamnionitis was diagnosed by placental examination by one author (R.L.N.).

Results. Forty-two infants exposed to chorioamnionitis and 37 infants not exposed were enrolled. Chorioamnionitis correlated inversely with gestational age, and was associated with decreased measures of acute respiratory support (exogenous surfactant, fraction of inspired oxygen, and ventilator support at 12 and 24 hours). Infants with chorioamnionitis had higher cortisol concentrations, both basal and stimulated. Gestational age was not significantly related to basal cortisol, but did correlate positively with stimulated values. Cortisol values from the 16 infants exposed to prenatal glucocorticoid therapy were excluded from these analyses.

Conclusions. These results provide evidence that prenatal inflammation leads to adrenal stimulation, resulting in increased cortisol secretion and accelerated lung maturation. The enhanced response to cosyntropin stimulation seen in these infants may reflect an increased adrenal capacity to respond to postnatal stressors. Because of the apparent magnitude of the effect of chorioamnionitis on cortisol measures, this factor should be included in future investigations of adrenal function in very low birth weight newborns. chorioamnionitis, very low birth weight infants, respiratory distress syndrome, cortisol, adrenocorticotrophic hormone, adrenal gland, lung maturation.
Hepatitis B Vaccination and Hepatocellular Carcinoma in Taiwan
Authors: Lee Cheng-Liang , Ko Ying-Chin
Published: August 2004

Objective. In 1984, Taiwan started a large-scale hepatitis B vaccination program, enabling us to test the hypothesis that prevention of hepatitis B virus infection eventually decreases the incidence of hepatocellular carcinoma.

Methods. Groups aged 0 to 9 years and 10 to 100 years in each calendar year were defined as the study group and the reference group, respectively. The percentage of children vaccinated in the study group increased during recent years. The study group and the reference group were divided into 5-year age strata (0 to 4, 5 to 9, … , 80 to 84, and 85 and over). Poisson regression was used to estimate age- and gender-adjusted liver carcinoma mortality rate ratios for 1974 through 1993, relative to 1974.

Results. The adjusted mortality rate ratios of liver carcinoma in the study group decreased significantly for 1992 and 1993, whereas in the reference group it did not show the same result. A significantly declining trend of liver carcinoma mortality rate ratios was observed in the study group after 1984, whereas the same trend was not found in the reference group.

Conclusions. Our results support the hypothesis that hepatitis B vaccination can decrease the incidence of hepatocellular carcinoma.
Megestrol Acetate Treatment of Growth Failure in Children Infected With Human Immunodeficiency Virus
Authors: Clarick Robert H. , Hanekom Willem A. , Yogev Ram , Chadwick Ellen Gould
Published: August 2004

Objective. To evaluate the effect of megestrol acetate on weight gain and linear growth in human immunodeficiency virus-infected children with growth failure.

Methods. All human immunodeficiency virus-infected children with growth failure treated with megestrol acetate at our institution were evaluated retrospectively. Weight, height, and weight:height ratio were documented from 6 months before initiation of megestrol acetate until 6 months after treatment was discontinued. Measurements were corrected for age and sex by conversion toz-scores. Incremental growth was determined before, during, and after treatment. The potential effects of CD4+ T-lymphocyte count and percentage, antiretroviral therapy, and intercurrent illnesses on growth were evaluated.

Results. Nineteen patients were treated with a total of 27 courses of megestrol acetate. The median duration of therapy was 7 months (range, 3 to 11 months), and the median megestrol acetate dose was 7.91 mg/kg/day (range, 4.06 to 8.56 mg/kg/day). From 6 months and 3 months before treatment to the onset of therapy, median changes in weight z-scores were −.27 and −.15, respectively. During megestrol acetate treatment, median changes in weightz-scores were +.29 after 1 month of therapy, +.40 after 3 months, and +.57 after 6 months. After megestrol acetate therapy was discontinued, poor weight gain and weight loss resumed. Median 6-month growth velocities for weight were less than the 10th percentile before megestrol acetate, greater than the 97th percentile during treatment, and less than the 3rd percentile after treatment was discontinued. Megestrol acetate therapy was not associated with changes in linear growth. Antiretroviral therapy, CD4+ T-lymphocyte count or percentage, or intercurrent illnesses were not associated with statistically significant differences in response to megestrol acetate therapy.

Conclusions. Megestrol acetate treatment of growth failure in pediatric human immunodeficiency virus disease is associated with weight gain, without affecting linear growth.
Treatment of Pyogenic Granuloma in Children With the Flashlamp-pumped Pulsed Dye Laser
Authors: Tay Yong-Kwang , Weston William L. , Morelli Joseph G.
Published: August 2004

Objective. Pyogenic granuloma is a common, acquired, vascular tumor of the skin in children, often ulcerates or bleeds, and is commonly localized to the face. The treatment of choice has been surgical removal, either by excision or shave, followed by electrocautery. The site, young age of the patient, and the inherent nature of surgical removal or electrocautery often make this procedure a traumatic experience. Also, surgical treatment usually leads to permanent scarring. Owing to the pulsed dye laser's ability to cause selective destruction of superficial capillary-sized cutaneous blood vessels, its ease of operation, and its lack of scarring, we evaluated its use in the treatment of pyogenic granuloma in children.

Methods. Twenty-two children with solitary pyogenic granulomas were treated with a vascular-specific (585 nm), pulsed (450 microseconds) dye laser using a 5-mm spot size with a laser energy of 6 to 7 J/cm2 without anesthesia. Retreatments were administered every 2 weeks if necessary until the lesion cleared. Posttreatment care consisted of twice-a-day application of bacitracin ointment.

Results. In 20 patients (91%), laser treatment was successful. Five patients (25%) required one treatment for resolution, eight patients (40%) required two treatments, and six patients (30%) required three treatments for clearing. One patient required six treatments before the lesion resolved. There was no correlation with the duration, or site of the lesion, with respect to the number of laser treatments required. Lesions in all 20 children healed without scarring and with excellent cosmetic results. In two patients (9%), laser treatment failed in that there was no response to the initial laser treatment on follow-up 2 weeks later. Both had large pyogenic granulomas (1 cm and .5 cm in diameter, respectively) which were elevated over .5 cm above the surface of the skin. These lesions were surgically removed. None of the patients had a recurrence during the follow-up period of 6 months to 3 years.

Conclusion. Pulsed dye lasers are effective and safe for the treatment of small pyogenic granulomas in children and should be considered a treatment option.
Epidemiology of Biliary Atresia: A Population-based Study
Authors: Yoon Paula W. , Bresee Joseph S. , Olney Richard S. , James Levy M. , Khoury Muin J.
Published: August 2004

Objective. Biliary atresia is the leading cause of extrahepatic obstructive jaundice in the newborn and is the single most frequent indication for liver transplantation in children. The cause of biliary atresia is unknown, although several mechanisms have been postulated to explain the inflammatory process that obliterates the bile ducts. Most interest has been directed toward viral infections. Information about the epidemiologic characteristics of biliary atresia in well-defined populations is lacking but is essential for developing and addressing hypotheses of causation for the disease.

Methods. Infants with biliary atresia were identified in metropolitan Atlanta from 1968 through 1993 by a population-based birth defects surveillance system that ascertains infants with serious birth defects in the first year of life using active case ascertainment. Birth prevalence rates were analyzed for spatial and temporal clustering and effects attributable to county of residence, sex, race, maternal age, parity, and birth weight. Logistic regression was used to study the independent effects of the risk factors and to look for interactions.

Results. Fifty-seven infants with biliary atresia were identified, for a rate of 0.73 per 10 000 live births. There was significant seasonal clustering of the disease, with rates three times higher from December through March compared with rates from April through July. Rates were significantly higher among nonwhite infants compared with white infants (0.96 vs 0.44 per 10 000 live births) and infants born at term with low birth weights (<2500 g) compared with infants born at term with normal birth weights (≥2500 g) (2.62 vs 0.75 per 10 000 live births).

Conclusions. Our study is the first in the United States to describe the epidemiologic characteristics of biliary atresia using a population-based approach. The demonstration of significant seasonal clustering provides support for theories that biliary atresia may be caused by environmental exposure (consistent with a viral cause) during the perinatal period.
Additive Impact of In-hospital Cardiac Arrest on the Functioning of Children With Heart Disease
Authors: Bloom Audrey A. , Wright Jean A. , Morris Robin D. , Campbell Robert M. , Krawiecki Nicolas S.
Published: August 2004

Objective. This study examined the impact of a sudden cardiac arrest (CA) on the neurodevelopmental and adaptive functioning of young children with congenital heart disease (CHD).

Methodology. Sixteen children with CHD who had sustained an in-hospital CA were compared with a medically similar group of children with CHD who had not incurred a CA. The contribution of CA, disease severity, and family socioeconomic status on the prediction of developmental outcome variables was evaluated.

Results. Children in the CA group displayed more impairments in general cognitive, motor, and adaptive behavior functioning as well as greater disease severity as measured by a cumulative medical risk index. With respect to all children in the study, a higher socioeconomic status was related to higher scores on cognitive functioning, lower levels of child maladjustment, and lower levels of stress within the parent-child relationship. Although the occurrence of a CA alone did not contribute to the prediction of outcome measures, a significant interactional effect between CA and cumulative medical risk index was found. Specifically, among children who had incurred a CA, as disease severity increased, decrements in abilities were observed. Few significant correlations between specific CA-related variables (eg, length of CA) and outcome indices were found.

Conclusions. Results from this study indicate that the impact of cardiac arrest on neuropsychological functioning may be mediated by the child's overall disease severity. These findings have implications for the identification of CA survivors at greatest risk for developmental difficulties.
Iguanas and Salmonella Marina Infection in Children: A Reflection of the Increasing Incidence of Reptile-associated Salmonellosis in the United States
Authors: Mermin Jonathan , Hoar Bruce , Angulo Frederick J.
Published: August 2004

Objective. To investigate clinical aspects and risk factors for Salmonella serotype Marina infection in the United States.

Methods. We identified all isolates of SMarina reported in 1994 to the NationalSalmonella Surveillance System. Patients were interviewed about demographic information, clinical course, diet, travel history, and contact with reptiles before illness.

Results. Twenty-six (81%) of 32 patients were infants (<1 year of age) and 24 (75%) were male. This differs from otherSalmonella isolates reported to the Centers for Disease Control and Prevention in 1994, of which 14% were from infants and 49% from male patients. Eleven patients (34%) were hospitalized for a median of 3.5 days (range: 2 to 21 days), and 1 died. Of 28 patients (88%) with reported iguana exposure, only 4 (14%) touched the reptile, and only 12 respondents (43%) realized that it might have been the source of infection. Seven (32%) of 22 families who owned an iguana at the time of illness continued to own an iguana when contacted a median of 28 weeks later. Persons who thought that the iguana was the source of infection were more likely to have given away or sold the pet than those who did not. Four isolates (13%) were from blood. Bacteremia was associated with taking antibiotics during the 30 days before S Marina infection (odds ratio: 24; 95% confidence interval: 1.2–1309).

Conclusion. S Marina infection is a potentially serious illness associated with iguana exposure, and it reflects the larger problem of reptile-associated salmonellosis. Many parents do not know that owning an iguana puts their children at risk forSalmonella infection. Pediatricians, veterinarians, and pet store owners should inform their patients and customers of the potential risks of owning reptiles and provide appropriate preventive education.
Epidural Analgesia, Intrapartum Fever, and Neonatal Sepsis Evaluation
Authors: Lieberman Ellice , Lang Janet M. , Frigoletto Fredric , Richardson Douglas K. , Ringer Steven A. , Cohen Amy
Published: August 2004

Objective. Although several studies have documented an increase in maternal temperature associated with use of epidural analgesia during labor, none have investigated the impact of epidural use on the rate of intrapartum fever or the consequences for the fetus and newborn of this elevated maternal temperature. This study evaluates the impact of epidural analgesia use during labor on the rate of intrapartum fever and the performance of neonatal sepsis evaluations and treatment with antibiotics.

Methods. We studied 1657 nulliparous women with term pregnancies and singleton vertex fetuses who were afebrile at admission for delivery. The rates of maternal intrapartum fever >100.4°F, neonatal sepsis evaluation, and neonatal antibiotic treatment according to use of epidural analgesia during labor were determined. Rate ratios and 95% confidence intervals (CI) were calculated. Multiple logistic regression was used to examine associations while controlling for confounding factors.

Results. Intrapartum fever >100.4°F occurred in 14.5% of women receiving an epidural but only 1.0% of women not receiving an epidural (adjusted odds ratio (OR) = 14.5, 95% CI = 6.3, 33.2). Without epidural, the rate of fever remained low regardless of length of labor; with epidural, the rate of fever increased from 7% for labors ≤6 hours to 36% for labors >18 hours. Neonates whose mothers received epidurals were more often evaluated for sepsis (34.0% vs 9.8%; adjusted OR = 4.3, 95% CI = 3.2, 5.9) and treated with antibiotics (15.4% vs 3.8%; adjusted OR = 3.9, 95% CI = 2.1, 6.1). Although 63% of women received epidurals, 96.2% of intrapartum fevers, 85.6% of neonatal sepsis evaluations, and 87.5% of neonatal antibiotic treatment occurred in the epidural group.

Conclusions. Use of epidural analgesia during labor is strongly associated with the occurrence of maternal intrapartum fever, neonatal sepsis evaluations, and neonatal antibiotic treatment.
Secular Increases in Relative Weight and Adiposity Among Children Over Two Decades: The Bogalusa Heart Study
Authors: Freedman David S. , Srinivasan Sathanur R. , Valdez Rodolfo A. , Williamson David F. , Berenson Gerald S.
Published: August 2004

Objective. To examine trends in relative weight and obesity among 5- to 24-year-olds between 1973 and 1994.

Design. A panel design consisting of seven cross-sectional surveys of schoolchildren and three surveys of post-high-school subjects. Anthropometric measurements included height, weight, and subscapular and triceps skinfolds.

Study Population. All schoolchildren residing in Ward 4 of Washington Parish, Louisiana, a biracial community, were considered eligible; participation rates were >80%. Young adults were eligible if they had participated previously as schoolchildren. A total of 26 371 examinations were performed on 11 564 persons.

Results. During the study period, substantial increases in mean levels of weight (0.2 kg/y) and skinfold thickness (0.15 mm/y) were observed; these changes were independent of height, age, and other covariates. The prevalence of overweight, defined by the 85th percentile of weight-for-height in 1973 to 1974, increased approximately twofold by 1994. Although secular increases were seen both among boys and girls and among blacks and whites, the largest increases were seen among 19- to 24-year-olds. Furthermore, the yearly increases in relative weight and obesity during the latter part of the study period (1983 through 1994) were ∼50% greater than those between 1973 and 1982.

Conclusions. The increasing prevalence of obesity in early life indicates a need for primary prevention. Additional study is needed to determine whether these trends are continuing to accelerate and to examine possible explanations, such as diet and physical activity, for these changes.
Efficacy and Safety of Intravenous Midazolam and Ketamine as Sedation for Therapeutic and Diagnostic Procedures in Children
Authors: Parker Robert I. , Mahan Rosemary A. , Giugliano Debra , Parker Margaret M.
Published: August 2004

Objective. We have used the combination of midazolam, a short-acting benzodiazepine, and ketamine, a “dissociative anesthetic,” to provide conscious sedation for invasive or lengthy procedures.

Methods. A total of 350 procedures (74 lumbar punctures, 97 bone marrow aspirations or biopsies, 84 radiotherapy sessions, and 95 imaging studies) were performed on 68 children, 4 months to 17 years of age, in both inpatient and ambulatory settings. All patients had an intravenous line in place and were monitored for heart rate and O2 saturation by pulse oximetry for the duration of the procedure and recovery time. Blood pressure was monitored periodically (every 5 to 30 minutes). Oxygen and suction equipment was available during the procedure. In addition to the individual performing the procedure, a second staff member trained in airway management (eg, physician, nurse practitioner, or registered nurse) was present to monitor vital signs and respiratory status. Patients were sedated initially with midazolam (0.05 to 0.1 mg/kg intravenously; maximum single dose of 2 mg, maximum total dose of 4 mg), followed by ketamine (1 to 2 mg/kg intravenously). During lengthy procedures, additional doses of ketamine (0.5 to 1 mg/kg) were given as necessary. Effectiveness of the sedation, recovery time, and adverse events associated with the sedative regimen were documented.

Results. All patients were effectively sedated with this regimen. Four patients experienced transient decrease in O2saturation (<85%) requiring temporary interruption of the procedure and oxygen by blow-by; the procedure was subsequently completed without incident in each case. Two patients experienced significant agitation during recovery from sedation. This side effect resolved spontaneously after 5 to 10 minutes in one patient and was effectively treated with diphenhydramine hydrochloride in the other. Twenty-four lumbar punctures were associated with transient decrease in O2saturation (88% to 92%), which improved by relief of neck flexion and/or blow-by oxygen. No hypotension, bradycardia, or respiratory depression requiring respiratory support or reversal of sedation was noted. Anesthesia recovery time ranged from <15 minutes to 120 minutes with >70% of patients recovering within 30 minutes. Most patients demonstrated an increase in oral secretions requiring occasional suctioning. Transient sleep disturbances were reported in only two patients.

Conclusions. This sedative regimen of intravenous midazolam and ketamine was found to be safe and effective. Its use has greatly reduced patient and parent anxiety for diagnostic and therapeutic procedures.
Do Oral Antibiotics Prevent Meningitis and Serious Bacterial Infections in Children WithStreptococcus pneumoniaeOccult Bacteremia? A Meta-analysis
Authors: Rothrock Steven G. , Harper Marvin B. , Green Steven M , Clark Mark C. , Bachur Richard , McIlmail Daniel P. , Giordano Philip A. , Falk Jay L.
Published: August 2004

Objective. To determine whether oral antibiotics prevent meningitis and serious bacterial infections in children with Streptococcus pneumoniae occult bacteremia.

Data Sources. Using the Medline database, the English-language literature was searched for all publications concerning bacteremia, fever, or S pneumoniae from 1966 to April 1996.

Study Selection. All studies that included a series of children with S pneumoniae occult bacteremia containing orally treated and untreated groups. Children were excluded from individual studies if they were immunocompromised, had a serious bacterial infection, underwent a lumbar puncture, or received parenteral antibiotics.

Data Extraction. Three authors independently reviewed each article to determine the number of eligible children and the outcome of children meeting entry criteria.

Data Synthesis. Eleven of 21 studies were excluded, leaving 10 evaluable studies with 656 total cases of S pneumoniae occult bacteremia identified. Patients who received oral antibiotics had fewer serious bacterial infections than untreated patients (3.3% vs 9.7%; pooled odds ratio, 0.35; 95% confidence interval, 0.17 to 0.73). Meningitis developed in 3 (0.8%) of 399 children in the oral antibiotic group and 7 (2.7%) of 257 untreated children (pooled odds ratio, 0.51; 95% confidence interval, 0.12 to 2.09).

Conclusion. Although oral antibiotics modestly decreased the risk of serious bacterial infections in children with S pneumoniae occult bacteremia, there was insufficient evidence to conclude that oral antibiotics prevent meningitis. Published recommendations that oral antibiotics be administered to prevent serious bacterial infections in children with possible S pneumoniae occult bacteremia should be reevaluated in light of the lower risk of sequelae from S pneumoniae occult bacteremia and newer data concerning side effects from treatment.
Increasing Prevalence of Recurrent Otitis Media Among Children in the United States
Authors: Lanphear Bruce P. , Byrd Robert S. , Auinger Peggy , Hall Caroline B.
Published: August 2004

Background. The number of visits for otitis media, the most common diagnosis among preschool children, has increased during the past decade. This study was undertaken to determine whether there has been a concurrent increase in the prevalence of recurrent otitis media among children in the United States and to identify risk factors or demographic changes to explain the increase.

Methods. Secondary analyses of cross-sectional data from the Child Health Supplement to the 1981 and 1988 National Health Interview Surveys (n = 5189 [1981] and n = 6209 [1988]) were done to identify temporal changes in the prevalence and any associated risk factors of recurrent otitis media among children <6 years of age.

Results. Recurrent otitis among preschool children increased from 18.7% in 1981 to 26% in 1988 (odds ratio [OR] = 1.6, 95% confidence interval [CI] = 1.4, 1.7). Although the prevalence of recurrent otitis increased with age, the greatest increase in recurrent otitis media occurred in infants (OR = 1.9, CI = 1.3, 2.9). Factors independently associated with recurrent otitis were any allergic condition (OR = 1.9, CI = 1.7, 2.2); survey year (OR = 1.7, CI = 1.5, 1.9); Black race (OR = .6, CI = .5, .7); Hispanic ethnicity (OR = .8, CI = .6, .9); day care (OR = 1.5, CI = 1.3, 1.7); out-of-home care by an unrelated sitter (OR = 1.3, CI = 1.1, 1.6); and male gender (OR = 1.2, CI = 1.1, 1.3). From 1981 to 1988, there were significant increases in some risk factors associated with recurrent otitis media, including day care (11% vs 21%) and allergic conditions (14% vs 18%).

Conclusions. We conclude that there has been a significant increase in the prevalence of recurrent otitis media among children in the United States, particularly in infants. The increased prevalence of recurrent otitis media was associated with an increase in the use of child care and a higher prevalence of allergic conditions among children. otitis media, recurrent otitis media, day care, child care, infection, otitis, children, allergies, infants, National Health Interview Survey, Child Health Supplement.
Circulating Neutrophils in Septic Preterm Neonates: Comparison of Two Reference Ranges
Authors: Engle William D. , Rosenfeld Charles R. , Mouzinho Anna , Risser Richard C. , Zeray Fiker , Sanchez Pablo J.
Published: August 2004

Objective. To study the effect of sepsis on circulating neutrophils in very low birth weight neonates and to assess the usefulness of recently revised reference ranges for circulating neutrophils in the diagnosis of sepsis in this population by comparison with previously reported reference ranges.

Methods. Neutrophil parameters (absolute total neutrophils, absolute total immature neutrophils, and the immature:total neutrophil proportion) were analyzed retrospectively in 202 sepsis episodes in 192 neonates (birth weight = 1055 ± 246 g, X ± SD; estimated gestational age = 29 ± 2 weeks) between birth and 30 days of age. The percentage of values lying outside the reference ranges reported recently by Mouzinho et al32 and previously by Manroe et al24 were compared. To more accurately assess possible differences in specificity between the two reference ranges, neonates with early-onset group B streptococcal infection (n = 19) were compared with a matched control group (n = 51) using conditional logistic regression.

Results. Greater sensitivity was observed using the previous reference ranges of Manroe et al24 over the entire study period (0 to 720 hours) both for the initial and the second complete blood count (CBC). The previous reference ranges also were more sensitive than the revised ranges for the initial CBC at 0 to 72 and at 73 to 720 hours and for infections attributable to coagulase-negative staphylococci. However, specificity in neonates without group B streptococcal infection was significantly greater with the revised reference ranges compared with those of Manroe et al24 (initial CBC, 73% vs 45%; serial CBCs, 59% vs 10%).

Conclusion. The observed differences in sensitivities may be of limited clinical significance because very low birth weight infants often are begun on antibiotic therapy regardless of laboratory values. However, the striking differences in specificity using the revised reference ranges suggest that these ranges may be clinically useful in determining length of antimicrobial therapy in infants in whom cultures remain sterile. sepsis, very low birth weight neonate, neutrophils.
The Questionnaire for Identifying Children with Chronic Conditions: A Measure Based on a Noncategorical Approach
Authors: Stein Ruth E. K. , Westbrook Lauren E. , Bauman Laurie J.
Published: August 2004

Objective. To report on the development of the Questionnaire for Identifying Children with Chronic Conditions (QuICCC). This new instrument identifies children and adolescents who have chronic health conditions based on the noncategorical conceptual framework outlined in our earlier work. It uses the consequences of conditions as a method for identifying children with chronic health conditions and is completely independent of diagnosis.

Method. Through a combination of techniques, we developed and piloted items and created 39 brief question sequences that were designed to be administered to a parent or guardian of children <18 years of age. The prototype was field tested extensively and refined using data from local hospital-based samples representing 318 households and 666 children. The instrument was then administered to two large representative samples (local: 657 households, 1275 children; national: 712 households, 1388 children) to establish validity and reliability.

Results. Content, convergent, construct, and criterion validity each have been demonstrated. The QuICCC has good test-retest reliability. Parents find the questions easy to answer. It took 7 to 8 minutes on average to obtain information about all the children in a family. The QuICCC successfully identified children with a wide range of different conditions that are usually considered chronic, and excluded those with acute illnesses and those with conditions but no current consequences.

Conclusions. The Questionnaire for Identifying Children with Chronic Conditions is a practical instrument that can be used for epidemiological purposes. It offers considerable flexibility and has many potential applications in health care delivery research.
Parents' Concerns About Children's Development: Prescreening Technique or Screening Test?
Authors: Glascoe Frances Page
Published: August 2004

Objective. Due to the limitations of previous studies, parents' concerns have been recommended as a prescreening technique, a brief method for identifying a subset of children in need of more in-depth developmental screening. The purpose of this study was to assess whether parents' concerns could: (1) serve instead as a screening measure; (2) aid in making focused referral decisions; and (3) help pediatricians target families for developmental promotion and in-office counseling. An additional goal was to determine why most parents' concerns are accurate although some are not.

Design Survey/Setting. Public schools and day care centers in four diverse geographic sites representing the northern, central, southern and western United States.

Patients and Other Participants. A total of 408 children between 21 and 84 months of age and their parents, whose socioeconomic and demographic characteristics reflect proportions in the 1990 United States Census.

Main Outcome Measures. Licensed psychological examiners and educational diagnosticians elicited parents' concerns about children's development and measured children's development with a broad battery including measures of intelligence, language, motor, and school skills.

Results. Certain concerns, ie, motor, language, global/cognitive, and school (in children 4 years and older) had high levels of sensitivity and identified 79% of the 56 children with disabilities. Accurate referrals could be made for 70% of the 56 children. The absence of concerns or concerns in other areas, ie, socialization, self-help, or behavior, had reasonable specificity and identified 72% (N = 255) of the 352 typically developing children. Of the remaining 28% (N = 97) of parents with significant concerns but whose children did not have disabilities, most had children with substantially lower performance in almost all developmental areas than the children of the 255 parents without significant concerns. Further, more than half of the 97 children could be distinguished by a single concern (usually about expressive language) whereas the majority of accurately concerned parents had multiple concerns. A significant proportion of the 12 parents of disabled children who did not raise concerns could be identified by difficulties communicating in either English or Spanish.

Conclusion. If systematically elicited, parents' concerns approach standards for screening tests and can be used to make reasonably accurate referral decisions. Over-referrals can be significantly reduced by administered screening tests to the small group of children (16%) whose parents have a single significant concern. Those who pass screening or whose parents have nonsignificant concerns can be targeted for developmental promotion and in-office counseling. Under-referrals can be minimized by administering screening tests (with the help of an interpreter as needed) to children whose parents have communication difficulties.
Single Rope Tree Swing Injuries Among Children
Authors: Albanese Craig T. , Gardner Mary J. , Adkins Michael A. , Schall Laura , Lynch James M.
Published: August 2004

Objective. To examine the scope and severity of injuries sustained from falls from single rope tree swings among children.

Methods. Twenty-six children formed the basis of this retrospective study. Patients were divided into three groups based on the estimated distance of their fall (one, two, or three stories). Data were analyzed with respect to mechanism of injury, age, gender, length of hospital stay, injury severity score, number and type of injuries, and mortality.

Results. Eighteen patients fell from ropes, and 8 from vines (all onto packed dirt). Fourteen falls occurred from one story or less, 8 from two stories, and 4 from three stories. One death occurred from intracranial injury following a two-story fall. No difference in age, gender, injury severity score, or length of hospital stay with respect to the height of the fall was observed. Falls from lower heights resulted in equally severe injuries as falls from higher heights. Overall, head trauma was the most common injury (58%) followed by long bone fractures (42%), axial skeletal fractures (23%), and intra-abdominal visceral injuries (8%).

Conclusions. The present study demonstrated that recreational single rope tree swing injuries among children resulted in significant morbidity regardless of the height of the fall. This activity carries a substantial risk for serious injury. The mechanism of injury, clinical data, and the importance of medical awareness and patient education are emphasized.
The Clinical Phenotype of Succinic Semialdehyde Dehydrogenase Deficiency (4-Hydroxybutyric Aciduria): Case Reports of 23 New Patients
Authors: Gibson K. Michael , Christensen Ernst , Jakobs Cornelis , Fowler Brian , Clarke Michael A. , Hammersen Gerhard , Raab Klaus , Kobori Joyce , Moosa Allie , Vollmer Brigitte , Rossier Eva , Iafolla A. Kimberly , Matern Dietrich , Brouwer Oebele F. , Finkelstein Janice , Aksu Fuat , Weber Hans-Peter , Bakkeren Jan A. J. M. , Gabreels Fons J. M. , Bluestone Daniel , Barron Todd F. , Beauvais Pierre , Rabier Daniel , Santos Cesar , Umansky Richard , Lehnert Willy
Published: August 2004

Objectives. To further define the clinical spectrum of the disease for pediatric and metabolic specialists, and to suggest that the general pediatrician and pediatric neurologist consider succinic semialdehyde dehydrogenase (SSADH) deficiency in the differential diagnosis of patients with (idiopathic) mental retardation and emphasize the need for accurate, quantitative organic acid analysis in such patients.

Patients. The clinical features of 23 patients (20 families) with SSADH deficiency (4-hydroxybutyric aciduria) are presented. The age at diagnosis ranged from 3 months to 25 years in the 11 male and 12 female patients; consanguinity was noted in 39% of families.

Outcome Measurements. The following abnormalities were observed (frequency in 23 patients): motor delay, including fine-motor skills, 78%; language delay, 78%; hypotonia, 74%; mental delay, 74%; seizures, 48%; decreased or absent reflexes, 39%; ataxia, 30%; behavioral problems, 30%; hyperkinesis, 30%; neonatal problems, 26%; and electroencephalographic abnormalities, 26%. Associated findings included psychoses, cranial magnetic resonance or computed tomographic abnormalities, and ocular problems in 22% or less of patients. Therapy with vigabatrin proved beneficial to varying degrees in 35% of the patients. Normal early development was noted in 30% of patients.

Conclusions. Our data imply that two groups of patients with SSADH deficiency exist, differentiated by the course of early development. Our recommendation would be that accurate, quantitative organic acid analysis in an appropriate specialist laboratory be requested for any patients presenting with two or more features of mental, motor, or language delay and hypotonia of unknown cause. Such analyses are the only definitive way to diagnose SSADH deficiency; the diagnosis can be confirmed by determination of enzyme activity in white cells from whole blood. We think that increased use of organic acid determination will lead to increased diagnosis of SSADH deficiency and a more accurate representation of disease frequency. As additional patients are identified, we should have a better understanding of both the metabolic and clinical profiles of SSADH deficiency.
Safety and Immunogenicity of Three Doses of a Five-Valent Pneumococcal Conjugate Vaccine in Children Younger Than Two Years With and Without Human Immunodeficiency Virus Infection
Authors: King James C. , Vink Peter E. , Farley John J. , Smilie Martha , Parks Marie , Lichenstein Richard
Published: August 2004

Objective. To assess the safety and immunogenicity of three doses of a five-valent (types 6B, 23F, 14, 18C, and 19F) pneumococcal conjugate vaccine (PCV) among children younger than 2 years who are and are not infected with human immunodeficiency virus (HIV).

Methods. A convenience sample of 18 HIV-infected children 2 years and younger (mean, 12.9 months) received three doses (each separated by 2 months) of PCV. An additional convenience sample of 33 non–HIV-infected children of virtually identical age, race, and sex as the HIV-infected group were randomized in a double-blind fashion to receive three doses of PCV or saline placebo. Safety data were collected for 72 hours after each vaccination. Sera were obtained before each and 1 month after the third vaccination to determine vaccine type-specific immunoglobulin G pneumococcal antibody titers by an enzyme-linked immunosorbent assay.

Results. Seventeen HIV- and 30 non–HIV-infected children completed the study. The PCV was well tolerated by both HIV- and non–HIV-infected children. No significant differences in local or systemic reactions were noted between HIV- and non–HIV-infected PCV or placebo recipients. Three doses of PCV were immunogenic, as evidenced by 16- to 659-fold increases in type-specific geometric mean antibody titers over prevaccination levels in HIV- and non–HIV-infected children. With respect to an arbitrary protective level, 78% of the antibody titers from HIV-infected children and 88% of the titers from non–HIV-infected children were 1.0 μg/mL or greater 1 month after the third PCV dose. HIV-infected children with milder disease (Centers for Disease Control and Prevention classes N1–2, A1–2, and B1) were more likely to have protective antibody titers after the first and second PCV doses than HIV-infected children with more advanced disease (Centers for Disease Control and Prevention classes N3, A3, B2–3, and C1–3). However, after the third PCV dose, these differences disappeared.

Conclusion. Three doses of PCV seem safe and immunogenic in both HIV- and non–HIV-infected children younger than 2 years. This type of vaccine should result in a marked reduction in systemic pneumococcal disease in both HIV- and non–HIV-infected children. Given the high incidence of invasive pneumococcal disease in HIV-infected children, this vaccine may markedly improve the quality of life for this unfortunate group of children.