bluuebunny/crossref_metadata_2025 huggingface dataset:
Depressive Symptoms and Cigarette Smoking Among Teens
Authors: Goodman Elizabeth , Capitman John
Published: August 2004

Context.

Although several risk factors for tobacco use have been implicated in the development of depression, smoking progression has typically been viewed as a consequence of depression. The results of limited longitudinal studies are controversial.

Objective.

To assess the nature and direction of the relationship between cigarette smoking and depression among teens.

Design.

Prospective analysis of baseline and 1-year follow-up data from the National Longitudinal Study of Adolescent Health.

Setting.

In-home teen and parent interviews.

Participants.

Two samples were identified. For the first sample, 8704 adolescents who were not depressed at baseline based on CES-D scores were identified for analyses of the effects of cigarette smoking on development of high depressive symptomatology. Baseline smoking status, which could vary in this group, was the predictor of interest in these analyses. For the second sample, 6947 teens who had not smoked cigarettes in the 30 days before the baseline survey (noncurrent smokers) were identified for analyses on the effect of high depressive symptoms on subsequent moderate to heavy cigarette use at 1 year of follow-up. Baseline high depressive symptomatology based on CES-D score was the predictor of interest in this sample.

Main Outcome Measures.

Among the nondepressed, developing high depressive symptoms at 1 year of follow-up. Among noncurrent smokers, smoking at least 1 pack per week at 1 year of follow-up.

Results.

For the nondepressed, multivariate modeling revealed that current cigarette smoking was the strongest predictor of developing high depressive symptoms in all models (final model odds ratio [OR]: 3.90; 95% confidence interval [CI]: 1.85,8.20). For noncurrent smokers, although in bivariate analyses, baseline high depressive symptoms increased the risk of heavy smoking nearly threefold, multivariate modeling revealed that baseline high depressive symptoms were not predictive of heavy smoking when controlling for other determinants of smoking in teens. Previous experimentation with smoking was the strongest predictor of becoming a heavy smoker (OR: 3.04; 95% CI: 1.93,4.88).

Conclusions.

In contrast to common dictum, depression does not seem to be an antecedent to heavy cigarette use among teens. However, current cigarette use is a powerful determinant of developing high depressive symptoms.
The Tagum Study I: Analysis and Clinical Correlates of Mercury in Maternal and Cord Blood, Breast Milk, Meconium, and Infants' Hair
Authors: Ramirez Gloria B. , Cruz Ma. Cristina Vince , Pagulayan Olive , Ostrea Enrique , Dalisay Crispin
Published: August 2004

Objectives.

To compare the indicators and levels of mercury (Hg) exposure in the mother with those in the fetal compartments, and determine its effects on the newborn.

Methods.

Hg levels using atomic absorption spectrophotometry were determined in maternal blood, breast milk, cord blood, infants' hair, and meconium of 78 consecutive mother-infant pairs in a community with high Hg pollution. The prevalence and levels of Hg both in meconium and in cord blood were correlated with maternal and infant risk factors.

Results.

The prevalence of Hg in the fetal compartments was higher than in the maternal fluid compartments. Hg was present in 6.4% of maternal blood and 6.4% of breast milk, as compared with 16.7% of cord blood, 31.6% of infants' hair, and 46.1% of meconium. Forty-six percent of infants with Hg in cord blood had none in meconium, whereas 80.6% with Hg in meconium had none in cord blood. Hg was not present in the maternal blood of all infants (n = 36) with Hg in their meconium. Among those with detectable Hg, the mean levels were: mothers' blood 24 parts per billion ± 5.47, cord blood 53.3 parts per billion ± 37.49, and meconium 48.6 ± 43.48. Quantitative measurement in hair was not done because of insufficient sample. Paired comparisons were all significant between Hg levels in the mothers' blood and meconium, mothers' blood and cord blood, and cord blood and meconium. Regression analysis showed Hg levels in meconium to be correlated with prevalence of Hg in infants' hair, length of stay in Tagum, and meconium-stained amniotic fluid. Fisher's Exact probability test showed that the prevalence of Hg in meconium was significantly related to the prevalence of Hg in the mothers' blood and length of stay in Tagum.

The prevalence of Hg in cord blood was significantly related to the prevalence in the mothers' blood. Regression analysis of levels of Hg in cord blood showed a significant relation to levels in mothers' blood (.0001), prevalence in infants' hair (.0126), gestational age (GA) (.0091), and head circumference (HC) (.0469). By quadrant analysis of weight against HC in 66 full-term infants all of 4 infants weighing an average of >3000 g at birth and with HCs lower than the fifth percentile had Hg in meconium.

Conclusion.

The higher prevalence and levels of Hg in the fetal compartments reflect the ease of placental transfer with fetal trapping. Hg determinations in the mothers' blood underestimate the degree and extent of fetal exposure. There is a significant difference in each compartment's ability to reflect Hg exposure of the fetus. A small HC may be associated with the presence of Hg in meconium. Hg in meconium should be measured in addition to cord blood to determine the load of fetal Hg.
Patterns of Alcohol and Drug Use in Adolescents Can Be Predicted by Parental Substance Use Disorders
Authors: Biederman Joseph , Faraone Stephen V. , Monuteaux Michael C. , Feighner Jennifer A.
Published: August 2004

Objective.

To examine the specificity of risk for alcohol or drug abuse or dependence (substance use disorders [SUDs]) in offspring exposed to particular subtypes of parental SUDs.

Methods.

The original sample was derived from 2 groups of index children: 140 attention-deficit/hyperactivity disorder (ADHD) probands and 120 non-ADHD comparison probands. These groups had 174 and 129 biological siblings and 279 and 240 parents, respectively.

Results.

Independent of familial risk, exposure to parental SUDs predicted SUDs in the offspring. Controlling for duration of exposure, we found that adolescence was a critical developmental period for exposure to parental SUDs. Because all our analyses controlled for social class, ADHD status, and parental lifetime history of SUDs, these results show that exposure to parental SUDs predicts offspring SUDs independently of these risk factors.

Conclusions.

These results support the critical importance of familial environmental risk factors for the development of SUDs in youth in general and particularly in those at high risk for these disorders. These results highlight adolescence as a critical period for the deleterious effects of exposure to parental SUDs, supporting the need to develop preventive and early intervention strategies targeted at adolescents at high risk for SUDs.
Verve and Jolt: Deadly New Internet Drugs
Authors: Winickoff Jonathan P. , Houck Constance S. , Rothman Ellen L. , Bauchner Howard
Published: August 2004

As regulatory agencies have increased restrictions on the sale and marketing of γ-hydroxybutyrate (GHB), they have been frustrated by the appearance of precursor molecules such as γ-butyrolactone (GBL) that have become widely available over the Internet. These dangerous precursors are vigorously marketed to adolescents and young adults as dietary supplements that increase muscle mass and enhance sexual performance with seductive names such as Verve and Jolt, both easily recognizable teen icons. We present the case of an adolescent who ingested both of these GBL products 2 weeks apart, resulting in life-threatening respiratory depression and emergent intubation on both occasions. The GBL toxidrome, necessary acute interventions, and public health implications are reviewed. We urge all health care providers to report similar cases immediately to the FDA MedWatch system.γ-butyrolactone, γ-hydroxybutyrate, respiratory insufficiency, central nervous system depressants, substance abuse.
Role of Naloxone in Newborn Resuscitation
Authors: Herschel Marguerite , Khoshnood Babak , Lass Nancy A.
Published: August 2004

Objective.

Because of questions about the basis for the use of naloxone in resuscitation of the newborn, we wished to evaluate the use of naloxone at our institution and an affiliated hospital.

Methodology.

Evaluation of the actual use of naloxone at a university hospital and a community hospital: we document naloxone use by daily survey for a month in one; in the other, we perform a retrospective record review of 1 year's use.

Results.

The university hospital had 240 births during February, 1998. Naloxone was given twice: once, 7 minutes before delivery to a woman at term who had received opiates about 2 hours previously; and once, intramuscularly, to a premature infant for apnea, before being intubated. The community hospital had 2044 births during fiscal 1998. Twenty-six neonates were identified as having received naloxone. Of the 26, 13 received naloxone without needing ventilatory support; all 13 with respiratory depression had a predisposing perinatal complication.

Conclusion.

The use of naloxone in practice may not conform to the American Academy of Pediatrics' guidelines for use in resuscitation of the newborn. The use of naloxone in resuscitation of the newborn should be reevaluated.
The Role of the Pediatrician in Transitioning Children and Adolescents With Developmental Disabilities and Chronic Illnesses From School to Work or College
Authors:   Committee on Children With Disabilities
Published: August 2004

This Policy Statement was retired May 2011.

The role of the pediatrician in transitioning children with disabilities and chronic illnesses from school to work or college is to provide anticipatory guidance and to promote self-advocacy and self-determination. Knowledge of the provisions of the key federal laws affecting vocational education is essential for the pediatrician's successful advocacy for patients.
Children in Pickup Trucks
Authors:   Committee on Injury and Poison Prevention
Published: August 2004

Pickup trucks have become increasingly popular in the United States. A recent study found that in crashes involving fatalities, cargo area passengers were 3 times more likely to die than were occupants in the cab. Compared with restrained cab occupants, the risk of death for those in the cargo area was 8 times higher. Furthermore, the increased use of extended-cab pickup trucks and air bag-equipped front passenger compartments creates concerns about the safe transport of children. The most effective preventive strategies are the legislative prohibition of travel in the cargo area and requirements for age-appropriate restraint use and seat selection in the cab. Parents should select vehicles that are appropriate for the safe transportation needs of the family. Physicians have an important role in counseling families and advocating public policy measures to reduce the number of deaths and injuries to occupants of pickup trucks.
Primary Care Treatment of Pediatric Psychosocial Problems: A Study From Pediatric Research in Office Settings and Ambulatory Sentinel Practice Network
Authors: Gardner William , Kelleher Kelly J. , Wasserman Richard , Childs George , Nutting Paul , Lillienfeld Harris , Pajer Kathleen
Published: August 2004

Objective.

Psychosocial problems cause much of the morbidity among children, and their frequency of presentation in primary care is growing. How is primary care treatment of children's psychosocial problems affected by child symptoms, physician training, practice structure, insurance, physician/patient relationship, and family demographics?

Design.

Questionnaire study of treatment of psychosocial problems during office visits by children.

Settings.

At total of 401 primary care offices from 44 US states, Puerto Rico, and Canada.

Patients.

From 21 150 children seen in office visits, we selected children with an identified psychosocial problem but who were not already receiving specialty mental health services (n = 2618 children).

Outcome Measures.

Clinicians' decisions to counsel families, to refer children to mental health specialists, or to prescribe medication.

Results.

The treatment choices of primary care clinicians (PCCs) were generally independent of patients' demographics or insurance status. Clinicians' training, beliefs about mental health, and practice structure had no effect on treatment choices. However, clinicians seeing their own patients were more likely to prescribe medications for attention problems. The clinician's perception about whether the parent agreed with the treatment choice was important for every treatment modality. Counseling and referral were more common and medication was less common when a problem was newly recognized at the visit.

Conclusions.

Structural factors such as practice type, insurance coverage, and physician training were less important for treatment than were process factors, such as whether the visit was a psychosocial problem visit, whether the problem was newly or previously recognized, and whether the family and clinician were familiar with each other and in accord about treatment.
Time for a New Paradigm in Pediatric Medical Education: Teaching Neonatal Resuscitation in a Simulated Delivery Room Environment
Authors: Halamek Louis P. , Kaegi David M. , Gaba David M. , Sowb Yasser A. , Smith Bradford C. , Smith Brian E. , Howard Steven K.
Published: August 2004

Objectives.

Acquisition and maintenance of the skills necessary for successful resuscitation of the neonate are typically accomplished by a combination of completion of standardized training courses using textbooks, videotape, and manikins together with active participation in the resuscitation of human neonates in the real delivery room. We developed a simulation-based training program in neonatal resuscitation (NeoSim) to bridge the gap between textbook and real life and to assess trainee satisfaction with the elements of this program.

Methods.

Thirty-eight subjects (physicians and nurses) participated in 1 of 9 full-day NeoSim programs combining didactic instruction with active, hands-on participation in intensive scenarios involving life-like neonatal and maternal manikins and real medical equipment. Subjects were asked to complete an extensive evaluation of all elements of the program on its conclusion.

Results.

The subjects expressed high levels of satisfaction with nearly all aspects of this novel program. Responses to open-ended questions were especially enthusiastic in describing the realistic nature of simulation-based training. The major limitation of the program was the lack of fidelity of the neonatal manikin to a human neonate.

Conclusion.

Realistic simulation-based training in neonatal resuscitation is possible using current technology, is well received by trainees, and offers benefits not inherent in traditional paradigms of medical education.
Television Commercial Violence During Nonviolent Programming: The 1998 Major League Baseball Playoffs
Authors: Anderson Charles R.
Published: August 2004

Objectives.

To identify the frequency of violent commercials during the major league baseball playoffs in 1998 and to compare it with the 1996 playoffs.

Design and Setting.

All 4 World Series games televised on the Fox Television Network (Fox), all 6 National League Championship Series (NLCS) televised by Fox, and 5 of 6 American League Championship Series (ALCS) playoff games televised by the National Broadcasting Company (NBC) were videotaped in October 1998. The results were compared with a similar study that analyzed the 1996 playoffs.

Results.

Forty-four commercials (11.0 per game) that included violent interactions were noted during the World Series, 53 violent commercials (8.8 per game) during the NLCS, and 40 (8.0 per game) during the ALCS for a total of 137. Of these 137 violent commercials, 78 contained at least 1 violent act, 126 contained at least 1 violent threat, and 12 contained evidence of at least 1 violent consequence. One hundred five of the 137 violent commercials (76.6%) were television promotions and 23 (16.8%) were for big-screen movie promotions. Twenty-three of 35 big-screen movie promotions (65.7%) were violent. Ten of the 137 violent commercials (7.3%) contained obvious blood, of which 9 were televised by NBC. There were, however, an additional 20 commercials televised by Fox that contained visible blood if the videotape was slowed or paused. Sixty-three of the 137 violent commercials (46.0%) used fire and explosions, of which 53 were televised by Fox and 10 by NBC. Guns were involved in 86 of 137 violent commercials (62.8%), with Fox accounting for 64 (6.4 per game) and NBC accounting for 22 (4.4 per game). Knives were used in 1 violent commercial on both Fox and NBC. Comparisons that can be made to 1996 include the following: 1) violent commercials during the World Series (both televised by Fox) increased from 10.1 to 11.0 per game; and 2) violent commercials during the ALCS (both televised by NBC) increased from 6.0 to 8.0 per game.

Conclusion.

Commercials during the 1998 major league playoffs were similar in violent content, compared with 1996. The violent commercials continue to consist primarily of promotions for television programs and big-screen movies. It continues to be counterintuitive to find such commercials in family-oriented programming and makes it difficult for parents to avoid exposing their children to this form of violence.
Long-Term Effect of Dust Control on Blood Lead Concentrations
Authors: Lanphear Bruce P. , Eberly Shirley , Howard Cynthia R.
Published: August 2004

Background.

Dust control is recommended to prevent children's exposure to residential lead hazards, but the long-term effect of dust control on children's exposure to environmental lead is unknown.

Objective.

To determine the effect of dust control on children's exposure to lead, as measured by blood lead concentration at 48 months of age.

Design.

A randomized, controlled trial.

Setting.

Rochester, New York.

Participants.

A total of 275 urban children were randomized at 6 months of age; 189 (69%) were available for the 48-month follow-up blood test.

Intervention.

Children and their families were randomly assigned to an intervention group that received cleaning equipment and up to 8 visits by a trained lead hazard control advisor or to a control group. The intervention was terminated when the children were 24 months of age.

Outcome Measures.

Geometric mean blood lead concentration and prevalence of elevated blood lead concentration (ie, ≥10 μg/dL, ≥15 μg/dL, and ≥20 μg/dL), by group assignment.

Results.

For children with 48-month blood tests, baseline geometric mean blood lead concentrations were 2.8 μg/dL (95% confidence interval [CI]: 2.6,3.0); there were no significant differences in baseline characteristics or lead exposure by group assignment. At 48 months of age, the geometric mean blood lead was 5.9 μg/dL (95% CI: 5.3,6.7) for the intervention group and 6.1 μg/dL (95% CI: 5.5,6.9) for the control group. The percentage of children with a 48-month blood lead ≥10 μg/dL, ≥15 μg/dL, and ≥20 μg/dL was 19% versus 19%, 2% versus 9%, and 1% versus 2% in the intervention and control groups, respectively.

Conclusions.

We conclude that dust control, as performed by families and in the absence of lead hazard controls to reduce ongoing contamination from lead-based paint, was not effective in preventing children's exposure to residential lead hazards.
Interferon-α and Ribavirin in Treating Children and Young Adults With Chronic Hepatitis C After Malignancy
Authors: Lackner Herwig , Moser Andrea , Deutsch Johann , Kessler Harald H. , Benesch Martin , Kerbl Reinhold , Schwinger Wolfgang , Dornbusch Hans-Jürgen , Preisegger Karl-Heinz , Urban Christian
Published: August 2004

Objective.

Chronic hepatitis C is a major long-term problem for children who survive cancer. Interferon (IFN)-α has been shown to be effective in treating patients with chronic hepatitis C; however, the rate of sustained response is low. Combining IFN-α and ribavirin (RBV) has been shown to significantly improve the response in adult patients with chronic hepatitis C. The aim of this pilot study was to evaluate the efficacy and safety of a combined virostatic treatment with IFN-α and RBV in a small cohort of children and adolescents with chronic hepatitis C and previous malignancy.

Methods.

Twelve patients with a history of a hematooncologic disease (median follow-up: 13.5 years; range: 7–14.7 years) and chronic hepatitis C were treated with recombinant IFN-α-2a (6 megaunits/m2 body surface area, 3 times a week, subcutaneously) combined with RBV (15 mg/kg body weight/day, orally) for 12 months. They were tested monthly for blood counts and liver function, and for serum virus concentrations (hepatitis C virus RNA by polymerase chain reaction) every 3 months.

Results.

At the end of the treatment, hepatitis C virus RNA could not be detected in the serum of 8 of the 12 patients; 2 of these patients relapsed soon after therapy withdrawal, whereas 6 patients maintained in sustained virologic and biochemical remission (follow-up: 12 months). Treatment-induced toxicity was moderate and reversible with influenza-like symptoms and a decrease in blood counts in all 12 patients, alopecia in 5 of the 12, hemolysis in 4 of the 12, and weight loss of >10% in 2 of the 12.

Conclusions.

As demonstrated in adults with chronic hepatitis C, treatment with IFN-α and RBV also seems to be an effective and safe therapeutic option for children and adolescents with chronic hepatitis C after malignancy.
Effectiveness of a Clinical Pathway for Inpatient Asthma Management
Authors: Johnson Kevin B. , Blaisdell Carol J. , Walker Allen , Eggleston Peyton
Published: August 2004

Background.

Clinical pathways for asthma are tools that have the potential to improve compliance with nationally recognized management guidelines, but their effect on patient outcomes has not been documented.

Objectives.

To determine the effect of an asthma clinical pathway on patients' length of stay, use of nebulized β-agonist therapy while hospitalized, and use of acute care clinics for 2 weeks after discharge.

Design/Methods.

The study was a randomized, controlled trial. Patients between the ages of 2 and 18 years admitted with an asthma exacerbation and not under the care of an asthma specialist were eligible for the study. Patients were randomized either to a conventional ward (control group) or to a ward using the clinical pathway (intervention group). For 2 weeks after discharge, we collected data to determine whether patients visited a health care provider for worsening asthma.

Results.

One hundred ten patients (26%) were enrolled. Control and intervention groups had similar demographic and asthma severity profiles. The intervention group had an average length of stay 13 hours shorter than did the control group. In addition, at every dosing interval, the intervention group received less nebulized β-agonist therapy. There were no deaths in either group.

Conclusion.

A clinical pathway for inpatient asthma decreased the length of stay and β-agonist medication use with no adverse outcomes or increased acute-care encounters through 2 weeks after discharge.
Respiratory Symptoms in Mothers of Young Children
Authors: d'Arcy Hannah , Gillespie Brenda , Foxman Betsy
Published: August 2004

Objectives.

Children receiving child care outside the home are at greater risk of upper respiratory infection, but whether parents of those children are also at increased risk is undocumented. We describe the incidence of 2 or more respiratory symptoms in the previous 2 weeks among 185 mothers of children 3 years of age or younger by child care use.

Methods.

Mothers in Michigan and Nebraska were interviewed by phone regarding respiratory symptoms, use of outside child care (for an index child), sleeping habits, and demographic information.

Results.

Nearly one half (46.5%) reported 2 or more symptoms during the past 2 weeks; 15.1% had contacted a health care provider and 13.0% spent 1 or more days in bed because of their symptoms, which lasted an average of 5.5 days. Prevalence of symptoms was invariant to sociodemographic characteristics. Mothers using outside child care (74.6%) were twice as likely as those without outside care to have been ill in the past 2 weeks (odds ratio: 2.26; 95% confidence interval [CI]: 1.12,4.54). Most mothers (69.2%) reported having their sleep interrupted by their children at least once in the last 2 weeks or sharing a bed with a child part or all of the night (61.1%); 25.4% slept 6 hours or less nightly. Women reporting that they rarely or never felt rested (26.5%) were 2.65 times more likely to be ill (95% CI: 1.26,5.55), compared with those reporting that they frequently or always felt rested (46.5%), after adjusting for any outside child care.

Conclusions.

Future studies should focus on risk factors that can be modified to reduce illness among both children and their parents.
Care to Underserved Children: Residents' Attitudes and Experiences
Authors: Weitzman Carol Cohen , Freudigman Kimberly , Schonfeld David J. , Leventhal John M.
Published: August 2004

Objectives.

To examine: 1) the relationship between residents' responses toward caring for underserved children and families during residency and their perceptions of their continuity clinic experience; and 2) which characteristics are related to continuing to care for the underserved after completion of training.

Design.

Cross-sectional descriptive study.

Methods.

A 49-item questionnaire was mailed to 210 third-year pediatric residents at 12 urban training programs in the Northeast in May 1995. Information was collected about residents' emotional responses toward caring for underserved families, their assessments of clinic operations, their sense of effectiveness in caring for underserved patients in continuity clinic, preresidency experiences with the underserved, and their intent to care for the underserved after training.

Results.

Of 210 surveys mailed, 71% were returned. Thirty-six percent of residents planned to pursue a career in primary care, 53% did not, and 11% did not answer or were planning a year as chief resident. Fifty-seven percent of all residents planned to devote a portion of their practice toward caring for the underserved after training.

Residents whose emotional responses toward caring for the underserved included: 1) not worrying that they had become numb to children's psychosocial difficulties, 2) not feeling angry with how families cared for their children, and 3) feeling more empathy with the underserved had significantly higher mean scores on both their assessment of clinic operations and their sense of effectiveness. The only demographic characteristic associated with a greater sense of effectiveness was being black.

To better characterize which residents planned to care for the underserved after training, we examined a subsample of 46 residents who recalled an interest in caring for the underserved during residency training and who were pursuing a career in primary care. Residents that did not recall an interest in caring for the underserved at the onset of residency training were unlikely to have plans to care for the underserved after the completion of training. Within this group residents who planned to care for the underserved after training differed significantly from residents who did not plan to continue this work by feeling a greater sense of effectiveness in clinic, feeling less worried about becoming numb, and having greater empathy for underserved families.

Conclusions.

There are a number of identifiable emotional responses residents develop toward caring for the underserved that relate to their perceptions of continuity clinic and whether a resident chooses to continue to care for the underserved after training.
Cisapride and QTc Interval in Children
Authors: Ramı́rez-Mayans Jaime , Garrido-Garcı́a Luis Martı́n , Huerta-Tecanhuey Andrea , Gutierrez-Castrellón Pedro , Cervantes-Bustamante Roberto , Mata-Rivera Norberto , Zárate-Mondragón Flora
Published: August 2004

Background.

Recent reports about cisapride have raised some concerns about the safety and efficacy of this medication in children. The aim of this study was to identify electrocardiographic changes and a predisposition to develop arrhythmias in children.

Methods.

Patients were divided in 2 groups: 1) 63 children (mean age: 29 months) who received cisapride (0.2 mg/kg/dose 3 times/day), and 2) 57 children (mean age: 27 months) who did not receive cisapride (they served as controls). Both groups did not have any associated disease. Electrocardiogram (EKG) was performed to children when they were included in the study. The QT interval was corrected using Bazett's formula. Twenty-four-hour Holter recording was performed in children with prolonged QT interval (PQTI). When PQTI was identified in group 1, cisapride was discontinued and a new EKG was performed.

Results.

Five children from group 1 and 6 from group 2 had PQTI. In 3 children with PQTI, the QTc interval returned to normal values when cisapride was discontinued. In children under 4 months of age, a statistical difference was found, with QTc interval being longer in group 2 (without cisapride) than in group 1. Holter recordings were normal in all children with PQTI.

Conclusion.

PQTI can be found in normal children with or without cisapride. In our study PQTI was not associated with any life-threatening event.
Can Epinephrine Inhalations Be Substituted for Epinephrine Injection in Children at Risk for Systemic Anaphylaxis?
Authors: Simons F. Estelle R. , Gu Xiaochen , Johnston Lana M. , Simons Keith J.
Published: August 2004

Background.

For out-of-hospital treatment of anaphylaxis, inhalation of epinephrine from a pressurized metered-dose inhaler is sometimes recommended as a noninvasive, user-friendly alternative to an epinephrine injection.

Objective.

To determine the feasibility of administering an adequate epinephrine dose from a metered-dose inhaler in children at risk for anaphylaxis by assessing the rate and extent of epinephrine absorption after inhalation.

Methods.

We performed a prospective, randomized, observer-blind, placebo-controlled, parallel-group study in 19 asymptomatic children with a history of anaphylaxis. Based on the child's weight, 10, 15, or 20 carefully supervised epinephrine or placebo inhalations were attempted. Before dosing, and at intervals from 5 to 180 minutes after dosing, we monitored plasma epinephrine concentrations, blood glucose, heart rate, blood pressure, and adverse effects.

Results.

Eleven children (mean ± standard error of the mean: 9 ± 1 years and 33 ± 3 kg) in the epinephrine group were able to inhale 11 ± 2 (range: 3–20) puffs, equivalent to 74% ± 7% of the precalculated dose or 0.078 ± 0.009 mg/kg. They achieved a mean peak plasma epinephrine concentration of 1822 ± 413 (range: 230-4518) pg/mL at 32.7 ± 6.2 minutes. Eight children (10 ± 1 years of age and 33 ± 5 kg) in the placebo group were able to inhale 12 ± 2 (range: 8–20) puffs, 89% ± 3% of the precalculated dose, and had a peak endogenous plasma epinephrine concentration of 1316 ± 247 (range: 522-2687) pg/mL at 44.4 ± 16.7 minutes. In the children receiving epinephrine compared with those receiving placebo, mean plasma epinephrine concentrations were not significantly higher at any time, mean blood glucose concentrations were significantly higher from 10 to 30 minutes, mean heart rate was not significantly different at any time, and mean systolic and diastolic blood pressures were not significantly increased at most times. After the inhalations of epinephrine or placebo, the children complained of bad taste and many experienced cough or dizziness. After inhaling epinephrine, 1 child developed nausea, pallor, and muscle twitching.

Conclusions.

Despite expert coaching, because of the number of epinephrine inhalations required and the bad taste of the inhalations, most children were unable to inhale sufficient epinephrine to increase their plasma epinephrine concentrations promptly and significantly. Therefore, we urge caution in recommending epinephrine inhalation as a substitute for epinephrine injection for out-of-hospital treatment of anaphylaxis symptoms in children.
The Child-Friendly Healthcare Initiative (CFHI): Healthcare Provision in Accordance With the UN Convention on the Rights of the Child
Authors:   Implemented by Child Advocacy International with the technical support of the Department of Child and Adolescent Health and Development of the World Health Organization (WHO) the Royal College of Nursing (UK) the Royal College of Paediatrics and Child Health (UK) in collaboration with the United Nations Children's Fund (UNICEF)., Southall David P. , Burr Sue , Smith Robert D. , Bull David N. , Radford Andrew , Williams Anthony , Nicholson Sue
Published: August 2004

Objective.

Although modern medical technology and treatment regimens in well-resourced countries have improved the survival of sick or injured children, most of the world's families do not have access to adequate health care. Many hospitals in poorly resourced countries do not have basic water and sanitation, a reliable electricity supply, or even minimal security. The staff, both clinical and nonclinical, are often underpaid and sometimes undervalued by their communities. In many countries there continues to be minimal, if any, pain control, and the indiscriminate use of powerful antibiotics leads to a proliferation of multiresistant pathogens. Even in well-resourced countries, advances in health care have not always been accompanied by commensurate attention to the child's wider well-being and sufficient concerns about their anxieties, fears, and suffering.

In accordance with the United Nations Convention on the Rights of the Child,1 the proposals set out in this article aim to develop a system of care that will focus on the physical, psychological, and emotional well-being of children attending health care facilities, particularly as inpatients.

Design of the Program.

To develop in consultation with local health care professionals and international organizations, globally applicable standards that will help to ensure that practices in hospitals and health centers everywhere respect children's rights, not only to survival and avoidance of morbidity, but also to their protection from unnecessary suffering and their informed participation in treatment.

Child Advocacy International will liase closely with the Department of Child and Adolescent Health and Development of the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) in the implementation of the pilot scheme in 6 countries. In hospitals providing maternity and newborn infant care, the program will be closely linked with the Baby Friendly Hospital Initiative of WHO/UNICEF that aims to strengthen support for breastfeeding. United Nations Children's Fund, United Nations Convention on the Rights of the Child, child protection, breastfeeding, pain control, palliative care, child abuse.
Blood–Brain Phenylalanine Relationships in Persons With Phenylketonuria
Authors: Koch Richard , Moats Rex , Guttler Flemming , Guldberg Per , Nelson Marvin
Published: August 2004

Objectives.

Clinicians caring for persons with phenylketonuria (PKU) have been perplexed by the occasional normal individual with the classical biochemical profile consistent with the diagnosis of PKU. Usually untreated subjects with the biochemical profile of blood phenylalanine (Phe) levels >1200 μmol/L are severely mentally retarded and may have neurological findings. Preliminary reports have recently appeared suggesting that low brain Phe levels, in comparison with elevated blood Phe levels, account for the occurrence of these occasional unaffected individuals with the biochemical profile consistent with PKU.

Method.

Magnetic resonance imaging/magnetic resonance spectroscopy was used to measure brain Phe content compared with simultaneously obtained blood Phe levels determined on the amino acid analyzer. This comparison was obtained in 5 normal non-PKU persons, 4 carriers of the gene causing PKU, and in 29 individuals with the proven form of the disorder.

Results.

Blood–brain measurements in 5 normal persons ranged from .051 to .081 mmol/L, with a mean of .058 mmol/L. Their simultaneously measured brain levels of Phe ranged from .002 to .15 mmol/L, with a mean of .09 mmol/L. Similar measurements were obtained in 4 carriers of the gene causing PKU. Their blood levels varied between .068 and .109 mmol/L, with a mean of .091 mmol/L and simultaneously obtained brain levels of Phe varied between .06 and .21 mmol/L, with a mean of .11 mmol/L. Twenty subjects with a mean IQ of 104 exhibited a mean blood level of 1.428 mmol/L and a simultaneous mean brain level of .23 mmol/L, whereas 9 persons with a mean IQ of 98.7 exhibited a mean blood Phe level of 1.424 and a mean brain Phe level of .64 mmol/L. The correlation between blood and brain levels was not significant.

Conclusion.

In usual cases, intellectually normal persons who have never been treated but who have a biochemical profile consistent with classical PKU exhibit lower brain levels of Phe. Such individuals are exceptional and may not need the vigorous restriction of their blood Phe levels that is required by the majority of persons with PKU.
Snowmobiling Hazards
Authors:   Committee on Injury and Poison Prevention
Published: August 2004

Snowmobiles continue to pose a significant risk to children younger than 15 years and adolescents and young adults 15 through 24 years of age. Head injuries remain the leading cause of mortality and serious morbidity, arising largely from snowmobilers colliding, falling, or overturning during operation. Children also were injured while being towed in a variety of conveyances by snowmobiles. No uniform code of state laws governs the use of snowmobiles by children and youth. Because evidence is lacking to support the effectiveness of operator safety certification and because many children and adolescents do not have the required strength and skills to operate a snowmobile safely, the recreational operation of snowmobiles by persons younger than 16 years is not recommended. Snowmobiles should not be used to tow persons on a tube, tire, sled, or saucer. Furthermore, a graduated licensing program is advised for snowmobilers 16 years and older. Both active and passive snowmobile injury prevention strategies are suggested, as well as recommendations for manufacturers to make safer equipment for snowmobilers of all ages.
Developmental Issues for Young Children in Foster Care
Authors:   Committee on Early Childhood, Adoption and Dependent Care
Published: August 2004

Greater numbers of young children with complicated, serious physical health, mental health, or developmental problems are entering foster care during the early years when brain growth is most active. Every effort should be made to make foster care a positive experience and a healing process for the child. Threats to a child's development from abuse and neglect should be understood by all participants in the child welfare system. Pediatricians have an important role in assessing the child's needs, providing comprehensive services, and advocating on the child's behalf.

The developmental issues important for young children in foster care are reviewed, including: 1) the implications and consequences of abuse, neglect, and placement in foster care on early brain development; 2) the importance and challenges of establishing a child's attachment to caregivers; 3) the importance of considering a child's changing sense of time in all aspects of the foster care experience; and 4) the child's response to stress. Additional topics addressed relate to parental roles and kinship care, parent-child contact, permanency decision-making, and the components of comprehensive assessment and treatment of a child's development and mental health needs.
Home, Hospital, and Other Non–School-based Instruction for Children and Adolescents Who Are Medically Unable to Attend School
Authors:   Committee on School Health
Published: August 2004

The American Academy of Pediatrics recommends that school-aged children and adolescents obtain their education in school in the least restrictive setting, that is, the setting most conducive to learning for the particular student. However, at times, acute illness or injury and chronic medical conditions preclude school attendance. This statement is meant to assist evaluation and planning for children to receive non–school-based instruction and to return to school at the earliest possible date.
Technical Report: Transmissible Spongiform Encephalopathies: A Review for Pediatricians
Authors: Whitley Richard J. , MacDonald Noni , Asher David M. ,   the Committee on Infectious Diseases
Published: August 2004

This Technical Report was retired May 2009.

Transmissible spongiform encephalopathies (TSEs) are a family of rare, slowly progressive, and universally fatal neurodegenerative syndromes affecting animals and humans. Until recently, TSEs were of little interest to pediatricians. However, since the outbreak in adolescents and the association of TSEs with new-variant Creutzfeldt-Jakob disease (nvCJD), interest among pediatricians and the general public has increased. Even before bovine spongiform encephalopathy and nvCJD were linked, the recognition that iatrogenic Creutzfeldt-Jakob disease (CJD) had been acquired from administration of cadaveric human growth and gonadotropic hormones and from corneal and dura mater transplants prompted medical vigilance. Furthermore, recent concern about the potential for transmission of CJD by blood and blood products has raised awareness among public health and regulatory agencies, pediatricians, and the public, although no epidemiologic data support this concern. Because of worldwide concern (although no cases have been reported in North America), this review focuses on the potential impact of TSEs, particularly CJD and nvCJD, on the pediatric population.
A Randomized, Double-Blind, Placebo-Controlled Study of Sumatriptan Nasal Spray in the Treatment of Acute Migraine in Adolescents
Authors: Winner Paul , Rothner A. David , Saper Joel , Nett Robert , Asgharnejad Mahnaz , Laurenza Antonio , Austin Randall , Peykamian Margaret
Published: August 2004

Objective.

To compare the efficacy and tolerability of sumatriptan nasal spray (NS; 5 mg, 10 mg, and 20 mg) with placebo for the treatment of acute migraine in adolescents.

Methods.

A randomized, double-blind, placebo-controlled, single-attack study was conducted in 653 US adolescents (12–17 years of age). Patients with at least a 6-month history of migraine, who met International Headache Society criteria for migraine (with or without aura) were eligible for participation. Headache relief 2 hours postdose, complete relief, presence or absence of associated symptoms, headache recurrence, and use of rescue medications were recorded. The primary efficacy endpoint was headache relief 2 hours postdose sumatriptan NS (20 mg) versus placebo. Safety and tolerability were assessed by examining adverse events, changes in electrocardiograms, vital signs, physical examinations, and clinical laboratory tests.

Results.

Headache relief 1 hour postdose was significantly greater for patients using 10 mg (56%) and 20 mg (56%) of sumatriptan NS compared with placebo (41%). Headache relief 2 hours postdose was significantly greater for patients using 5 mg of sumatriptan NS (66%) compared with placebo (53%), and approached statistical significance for 20 mg (63%) compared with placebo (53%). Complete relief 2 hours postdose was significantly greater for patients using 20 mg of sumatriptan NS compared with placebo (36% vs 25%, respectively). Each dose of sumatriptan (5 mg, 10 mg, and 20 mg) was superior to placebo with respect to the cumulative percentages of patients first reporting headache relief within 2 hours of dosing (Kaplan-Meier). The sumatriptan 20-mg dose was superior to placebo with respect to the cumulative percentages of patients first reporting complete relief within 2 hours of dosing (Kaplan-Meier). Photophobia and phonophobia were significantly reduced 2 hours postdose for sumatriptan NS (20 mg), compared with placebo (36% vs 48% and 25% vs 44%, respectively). Taste disturbance was the most commonly reported adverse event (2%, 19%, 30%, and 26% for placebo, 5 mg, 10 mg, and 20 mg, respectively). No drug-related serious adverse events or clinically relevant changes in laboratory parameters, electrocardiograms, or vital signs were reported.

Conclusions.

Sumatriptan NS is effective and well-tolerated for the treatment of acute migraine in adolescents, with the 20-mg dose providing the best overall efficacy and tolerability profiles.
Severity of Neonatal Retinopathy of Prematurity Is Predictive of Neurodevelopmental Functional Outcome at Age 5.5 Years
Authors: Msall Michael E. , Phelps Dale L. , DiGaudio Kathleen M. , Dobson Velma , Tung Betty , McClead Richard E. , Quinn Graham E. , Reynolds James D. , Hardy Robert J. , Palmer Earl A. ,   on Behalf of the Cryotherapy for Retinopathy of Prematurity Cooperative Group
Published: August 2004

Objective.

The purpose of this study was to assess the relation between neonatal retinopathy of prematurity (ROP) in very low birth weight infants and neurodevelopmental function at age 5.5 years.

Methods.

Longitudinal follow-up of children occurred in 2 cohorts of the Multicenter Cryotherapy for Retinopathy of Prematurity Study. The extended natural history cohort followed 1199 survivors of <1251 g birth weight from 5 centers. The threshold randomized cohort (ThRz) followed 255 infants <1251 g from 23 centers who developed threshold ROP and who consented to cryotherapy to not more than 1 eye. At 5.5 years both cohorts had ophthalmic and acuity testing and neurodevelopmental functional status determined with the Functional Independence Measure for Children (WeeFIM).

Results.

Evaluations were completed on 88.7% of the extended natural history cohort; 87% had globally normal functional skills (WeeFIM: >95). As ROP severity increased, rates of severe disability increased from 3.7% among those with no ROP, to 19.7% of those with threshold ROP. Multiple logistic regression analysis demonstrated that better functional status was associated with favorable visual acuity, favorable 2-year neurological score, absence of threshold ROP, having private health insurance, and black race.

Evaluations were completed on 87.4% of the ThRz children. In each functional domain, the 134 children with favorable acuity in their better eye had fewer disabilities than did the 82 children with unfavorable acuity: self-care disability 25.4% versus 76.8%, continency disability 4.5% versus 50.0%, motor disability 5.2% versus 42.7%, and communicative-social cognitive disability 22.4% versus 65.9%, respectively.

Conclusion.

Severity of neonatal ROP seems to be a marker for functional disability at age 5.5 years among very low birth weight survivors. High rates of functional limitations in multiple domains occur in children who had threshold ROP, particularly if they have unfavorable visual acuity.