bluuebunny/crossref_metadata_2025 huggingface dataset:
Fulminant Late-Onset Sepsis in a Neonatal Intensive Care Unit, 1988–1997, and the Impact of Avoiding Empiric Vancomycin Therapy
Authors: Karlowicz M. Gary , Buescher E. Stephen , Surka Aqil E.
Published: August 2004

Objective.

To determine the pathogens associated with fulminant (lethal within 48 hours) late-onset sepsis (occurring after 3 days of age) in a neonatal intensive care unit (NICU) and the frequency of fulminant late-onset sepsis for the most common pathogens.

Methods.

A retrospective study was conducted of sepsis in infants in a NICU over a 10-year period (1988–1997).

Results.

There were 825 episodes of late-onset sepsis occurring in 536 infants. Thirty-four of 49 (69%; 95% confidence interval [CI]: 55%–82%) cases of fulminant late-onset sepsis were caused by Gram-negative organisms, including Pseudomonassp., 20 (42%); Escherichia coli, 5 (10%);Enterobacter sp., 4 (8%); and Klebsiellasp., 4 (8%). The frequency of fulminant sepsis was highest forPseudomonas sp., 20 of 36 (56%; 95% CI: 38%–72%) and lowest for coagulase-negative staphylococci, 4 of 277 (1%; 95%CI: 0%–4%). The very low frequency of fulminant sepsis caused by coagulase-negative staphylococci did not increase during the period when oxacillin was used instead of vancomycin as the empiric antibiotic for Gram-positive organisms.

Conclusions.

These data suggest that empiric antibiotics selected for treatment of suspected sepsis in infants >3 days old need to effectively treat Gram-negative pathogens, particularlyPseudomonas sp., because these organisms, although less frequent, are strongly associated with fulminant late-onset sepsis in the NICU. Avoiding empiric vancomycin therapy seemed to be a reasonable approach to late-onset sepsis, because of the very low frequency of fulminant sepsis caused by coagulase-negative staphylococci.
Pediatric Office Emergencies and Emergency Preparedness in a Small Rural State
Authors: Heath Barry W. , Coffey Jean S. , Malone Patrick , Courtney James
Published: August 2004

Objective.

Although the frequency of pediatric office medical emergencies has been investigated in a retrospective manner, there have been no prospective studies. We examined how often pediatricians in a small rural state encountered medical emergencies in the office setting. This study included an in-office educational program and the donation of resuscitation equipment to study participants.

Design and Intervention.

Thirty-eight of the 40 active primary care pediatric practices in the state of Vermont participated in this study. Thirty-seven sites were surveyed retrospectively regarding office preparedness for emergencies and frequency of office emergencies. At each practice site, an educational session was provided and an office resuscitation kit was donated. Thirty-seven sites were followed prospectively for a 12-month period evaluating the incidence of office medical emergencies and the adequacy of the donated resuscitation kit.

Results.

Three hundred twenty-seven individuals from 38 Vermont pediatric practice sites participated. Forty-nine percent had basic life support training and 26% had pediatric advanced life support training. Sixty-seven percent of practices had a plan for office medical emergencies. Forty-six percent of practices had called local emergency medical services providers to their offices in the past year. Emergency preparedness ranged from a high of 95% of sites with oxygen to a low of 27% of sites with intraosseous needles. The estimate of the frequency of medical emergencies was .9 (standard deviation = .8) per office in the previous 12 months. In the 12-month study, there were 28 medical emergencies reported, averaging .8 (standard deviation = 1.5) emergencies per office per year. Sixty-five percent of participating sites had no emergencies in the study. Of the emergencies reported, 75% were respiratory in origin. The donated resuscitation kits proved sufficient for all of the emergencies reported.

Conclusions.

Serious medical emergencies are rare events in the primary care pediatric office, occurring less than once per office per year. The most common emergency situations encountered are respiratory. All of the emergencies in this study were managed effectively using a simple and relatively inexpensive resuscitation kit. We provided an emergency preparedness program for pediatric practices in a small rural state.
Longitudinal Neurologic Follow-Up in Neonatal Intensive Care Unit Survivors With Various Neonatal Morbidities
Authors: McGrath Margaret M. , Sullivan Mary C. , Lester Barry M. , Oh William
Published: August 2004

Objective.

The purpose of this prospective longitudinal study was to examine neurocognitive and school performance outcomes of low birth weight infants with reference to neonatal morbidity and socioeconomic status. We further evaluated the cognition and school performance based on their neurologic status at the time of assessment.

Methods.

One hundred eighty-eight children (39 healthy full-term and 149 preterm infants) were classified into 4 subgroups based on their neonatal medical status: healthy, sick (without neurologic complications), small for gestational age, and neurologically compromised infants. Neurologic status was classified as normal, suspect, or abnormal at hospital discharge, 18 months, 30 months, 4 years, and 8 years of age. Socioeconomic status, cognitive, and school performances were assessed.

Results.

Neurologically, both full-term and healthy preterm groups did well during the 8-year period. There were significant fluctuations between suspect and abnormal neurologic classifications among the 3 preterm groups with neonatal complications. Preterms with neurologic abnormality during the neonatal period did the poorest with 45% of the group remaining abnormal at 8 years of age. Children who were neurologically normal had higher cognitive scores at ages 4 and 8 than those categorized as suspect or abnormal. Preterm infants with neurologic abnormality required significantly more academic resources in the school. Reading and math achievement scores were the lowest for the preterm groups classified as neurologically suspect or abnormal.

Conclusions.

Neonatal morbidities exert a significant impact in neurologic outcomes among preterm children during the 8 years of assessment. Compromised neurologic status adversely affects cognitive and school performances. Neonatal medical status is an important variable indicating neurocognitive and school performance outcomes in low birth weight infants.
Predictors of Asthma Three Years After Hospital Admission for Wheezing in Infancy
Authors: Reijonen Tiina Marjaana , Kotaniemi-Syrjänen Anne , Korhonen Kaj , Korppi Matti
Published: August 2004

Objective.

To evaluate the influence of early antiinflammatory therapy in the development of asthma 3 years after hospitalization for wheezing in infancy. In addition, the effects of allergic sensitization and respiratory syncytial virus (RSV) infection on the development of asthma were investigated.

Design and Setting.

A randomized, controlled follow-up study in a university hospital that provides primary hospital care for all pediatric patients in a defined area.

Patients.

Eighty-nine infants under 2 years of age who had been hospitalized for infection associated with wheezing and followed up for 3 years.

Intervention.

Early antiinflammatory therapy was given for 16 weeks; 29 patients received cromolyn sodium and 31 received budesonide. Twenty-nine control patients received no therapy.

Outcome Measures.

Clinical diagnosis of current asthma, defined as having at least 3 episodes of physician-diagnosed wheezing and either a wheezing episode during the preceding year or ongoing antiinflammatory medication for asthma.

Results.

Fourteen (48%) patients in the former cromolyn group, 15 (48%) in the former budesonide group, and 16 (55%) in the control group had current asthma. The significant predictors of asthma were age over 12 months (risk ratio [RR] 4.1; 95% confidence interval [CI] = 1.59–10.35), history of wheezing (RR 6.8; CI = 1.35–34.43), and atopic dermatitis on study entry (RR 3.4; CI = 1.17–9.39). Skin prick test positivity at the age of 16 months significantly predicted asthma (RR 9.5; CI = 2.45–36.72). In addition, all of the 18 (20%) children sensitized with furred pet developed asthma. RSV identification (RR 0.3; CI = 0.08–0.80) and early furred pet contact at home (RR 0.3; CI 0.10–0.79) were associated with the decreased occurrence of asthma.

Conclusions.

Antiinflammatory therapy for 4 months has no influence on the occurrence of asthma 3 years after wheezing in infancy. Early sensitization to indoor allergens, especially to pets, and atopic dermatitis predict subsequent development of asthma. RSV infection in wheezing infants may have a better outcome than other infections.
Trends in Intussusception-Associated Hospitalizations and Deaths Among US Infants
Authors: Parashar Umesh D. , Holman Robert C. , Cummings Kate C. , Staggs N. Wayne , Curns Aaron T. , Zimmerman Christopher M. , Kaufman Stephen F. , Lewis Jon E. , Vugia Duc J. , Powell Kenneth E. , Glass Roger I.
Published: August 2004

Context.

The newly licensed tetravalent rhesus-human reassortant rotavirus vaccine has been withdrawn following reports of intussusception among vaccinated infants.

Objective.

To describe the epidemiology of intussusception-associated hospitalizations and deaths among US infants.

Design.

This retrospective cohort study examined hospital discharge data from the National Hospital Discharge Survey for 1988–1997, Indian Health Service (IHS) for 1980–1997, California for 1990–1997, Indiana for 1994–1998, Georgia for 1997–1998, and MarketScan for 1993–1996, and mortality data from the national multiple cause-of-death data for 1979–1997 and linked birth/infant death data for 1995–1997.

Patients.

Infants (<1 year old) with anInternational Classification of Diseases, Ninth Revision, Clinical Modification code for intussusception (560.0) listed on their hospital discharge or mortality record, respectively.

Results.

During 1994–1996, annual rates for intussusception-associated infant hospitalization varied among the data sets, being lowest for the IHS (18 per 100 000; 95% confidence interval [CI] = 9–35 per 100 000) and greatest for the National Hospital Discharge Survey (56 per 100 000; 95% CI = 33–79 per 100 000) data sets. Rates among IHS infants declined from 87 per 100 000 during 1980–1982 to 12 per 100 000 during 1995–1997 (relative risk =7.6, 95% CI = 3.2–18.2). Intussusception-associated hospitalizations were uncommon in the first 2 months of life, peaked from 5 to 7 months old, and showed no consistent seasonality. Intussusception-associated infant mortality rates declined from 6.4 per 1 000 000 live births during 1979–1981 to 2.3 per 1 000 000 live births during 1995–1997 (relative risk = 2.8, 95% CI = 1.8–4.3). Infants whose mothers were <20 years old, nonwhite, unmarried, and had an education level below grade 12 years were at an increased risk for intussusception-associated death.

Conclusions.

Intussusception-associated hospitalization rates varied among the data sets and decreased substantially over time in the IHS data. Although intussusception-associated infant deaths in the United States have declined substantially over the past 2 decades, some deaths seem to be related to reduced access to, or delays in seeking, health care and are potentially preventable.intussusception, hospitalizations, deaths, risk factors, infants.
Improving Preschoolers' Self-Regulation of Energy Intake
Authors: Johnson Susan L.
Published: August 2004

Background.

Children exhibit individual differences in their ability to self-regulate energy intake. Feeding strategies that focus on external signals, like the time of day or amount of food left on a plate, tend to diminish children's ability to respond to internal cues of hunger and fullness.

Objectives.

We investigated whether children could be taught to focus on internal cues of hunger and satiety, and consequently improve their self-regulation of energy intake. We explored whether parents' eating behaviors and adiposity were related to their children's self-regulation skills and adiposity.

Design.

In a pretest and posttest design, preschoolers participated in single-meal protocols to assess their individual ability to self-regulate food intake. During a 6-week intervention period, children took part in individual and group activities designed to help them recognize internal cues. Parents completed questionnaires regarding adult dietary restraint and disinhibition.

Results.

At baseline, we found a large individual variability in children's regulation: some children overate, some regulated accurately, and others underate. At baseline, children's eating related to their adiposity and to mothers' disinhibition: heavier children and children whose mothers' reported difficulty controlling food intake showed less evidence of self-regulation. Both overeaters and undereaters responded to the intervention, improving their ability to self-regulate, and children's eating was no longer significantly related to mother's eating.

Conclusions.

Children's disregulated energy intake is related to mothers' weight status and mothers' perceived control over eating. Cues can be provided that help children to focus on internal signals and improve their ability to self-regulate energy intake.
Do Obese Inner-City Children With Asthma Have More Symptoms Than Nonobese Children With Asthma?
Authors: Belamarich Peter F. , Luder Elisabeth , Kattan Meyer , Mitchell Herman , Islam Shaheen , Lynn Henry , Crain Ellen F.
Published: August 2004

Objective.

To test whether obesity is associated with decreased peak expiratory flow rates (PEFR), increased asthma symptoms, and increased health service use.

Design/Methods.

Secondary analysis of data from a cross-sectional convenience sample.

Setting.

Emergency departments (EDs) and primary care clinics in 8 inner-city areas in 7 cities.

Participants.

One thousand three hundred twenty-two children aged 4 to 9 years with asthma.

Measures.

Obesity was defined as a body mass index (BMI, weight/height2) >95th percentile. Nonobese children were those with a BMI between the 5th and 95th percentile. Underweight children with a BMI <5th percentile were eliminated from the study. Demographic and anthropometric data were obtained during a baseline interview with the primary caretaker and the child. Symptoms, health service use data and measurements of PEFR were obtained by parental report during the baseline interview and at 3-month intervals by telephone interview over the following 9-month period.

Results.

Obese (n = 249) and nonobese (n = 1073) children did not differ in terms of age, gender, family income, passive smoke exposure, caretaker's mental health, and skin test reactivity to indoor allergens. Obese children were more often Latino (28% vs 17%) and, in the 3 months before the baseline interview, were more likely to have used oral steroids (30% vs 24%). There were no differences between groups in terms of baseline PEFR scores. During the 9 months after baseline assessment, the obese group had a higher mean number of days of wheeze per 2-week period (4.0 vs 3.4), and a greater proportion of obese individuals had unscheduled ED visits (39% vs 31%). There were no differences between the groups in terms of frequency of hospitalization, or in nocturnal awakening.

Conclusions.

In our sample of inner-city children with asthma, obese children used more medicine, wheezed more, and a greater proportion had unscheduled ED visits than the nonobese children.
Bronchial Hyperresponsiveness Before and After the Diagnosis of Bronchial Asthma in Children
Authors: Mochizuki Hiroyuki , Shigeta Makoto , Arakawa Hirokazu , Kato Masahiko , Tokuyama Kenichi , Morikawa Akihiro
Published: August 2004

Objective.

To assess at what age bronchial hyperresponsiveness (BHR) is acquired in children with asthma.

Background.

A relationship between BHR and infantile wheezing diseases has been reported. Infants with a genetic predisposition to atopy are more likely to wheeze with respiratory viral infection or bronchiolitis, and it is suspected that the continued BHR after the first attack of asthma may be induced or triggered by some viral infections. Also, recent studies have reported the existence of atopic and BHR-related genes. However, whether BHR is congenital or acquired after asthma attacks, and when BHR in children with asthma is established or acquired remain unclear.

Methods.

We performed methacholine inhalation challenge using a transcutaneous oxygen pressure (tcPO2) monitoring system in 205 children without asthma from 6 months to 6 years of age. During follow-up, 18 of these participants were diagnosed with asthma (group N-A). This group and 15 age-matched children without asthma (group N-N) were tested twice using methacholine inhalation challenge. For comparison, 39 age-matched atopic-type asthmatic children (group A-A) were also given the inhalation challenge twice. Methacholine inhalation challenge using a tcPO2 monitoring system was performed while the participants were asleep in the supine position. Sequential doses of inhaled methacholine delivered by oxygen mask were doubled until a 10% decrease in tcPO2 from the baseline was reached. The cumulative dose of methacholine at the inflection point of tcPO2 (minimal dose of methacholine [Dmin]-PO2) was considered to represent BHR.

Results.

In groups N-N and A-A, there was no difference in Dmin-PO2 between the first and second challenge. However, the Dmin-PO2 in group N-A significantly decreased from the first challenge to the second challenge. There was no significant difference between the Dmin-PO2 in group N-N and the first Dmin-PO2 in group N-A; or between the Dmin-PO2in group A-A and the second Dmin-PO2 in group N-A.

Conclusions.

These data suggest that BHR in many infants with asthma is acquired after several asthma attacks.bronchial hyperresponsiveness, childhood asthma, methacholine inhalation challenge, transcutaneous oxygen pressure.
Fomepizole Treatment of Ethylene Glycol Poisoning in an Infant
Authors: Baum Carl R. , Langman Craig B. , Oker Elif E. , Goldstein Craig A. , Aviles Sandra R. , Makar Jasmin K.
Published: August 2004

The enzyme alcohol dehydrogenase metabolizes ingested ethylene glycol (EG) to the toxic compounds glycolic and oxalic acids. Renal failure, acidosis, hypocalcemia, and death may follow. Traditional treatment of EG poisoning may require ethanol, a competitive substrate of alcohol dehydrogenase, and hemodialysis, that removes both EG and its toxic metabolites. A new alcohol dehydrogenase inhibitor, fomepizole (4-methylpyrazole), was approved in 1997 for patients at least 12 years old with suspected or confirmed EG poisoning.

Fomepizole has not been studied adequately in the pediatric population. We present a case of an 8-month-old male infant who drank up to 120 mL of EG and developed acidosis and oxalate crystalluria. He was treated with fomepizole and hemodialysis. Even after the completion of hemodialysis, fomepizole appeared to effectively block the production of EG toxic metabolites and to allow the resolution of acidosis; the patient recovered within 48 hours. This is the first report of fomepizole treatment of EG poisoning in an infant.4-methylpyrazole, fomepizole, poisoning, ethylene glycol, hemodialysis, infant, child, pediatrics.
Pediatricians' Liability During Disasters
Authors:   Committee on Pediatric Emergency Medicine and Committee on Medical Liability
Published: August 2004

This Policy Statement was revised. See https://doi.org/10.1542/peds.2015-3112.

This statement addresses the need for professional liability insurance coverage for pediatricians during disasters and suggests measures to ensure adequate coverage.
Missed Opportunities for Preventing Tuberculosis Among Children Younger Than Five Years of Age
Authors: Lobato Mark N. , Mohle-Boetani Janet C. , Royce Sarah E.
Published: August 2004

Objectives.

Childhood tuberculosis (TB) is an important indicator of public health success in interrupting and preventing TB transmission. To determine the frequency and types of missed opportunities for preventing TB among children <5 years of age.

Methods.

We collected data from the public health records of child TB cases and their adult source cases. These children were from health jurisdictions where TB case rates in children were higher than the California average for this age group.

Results.

We reviewed the records for 165 children reported with TB (20% confirmed by culture). These children were evaluated for TB because of signs or symptoms of illness (32%), a contact investigation (26%), screening (22%), a source case investigation (4%), and unknown reasons (16%). Excluding 4 children infected byMycobacterium bovis, only 59 of 161 children (37%) had a source case found. Children found in a contact investigation, born in the United States, <1 year of age, or who were black were more likely to have a source case found than children who did not have one of these characteristics. Of 43 children found in a contact investigation, improvements in contact investigations may have prevented TB in 17 of these children (40%). Among the 43 adult source cases, factors that may have facilitated transmission include delayed reporting in 23%, a delayed contact investigation in 21%, and delayed or nondocumented bacteriologic sputum conversion in 42% of culture-positive cases.

Conclusions.

Important missed opportunities to prevent TB in children include the failure to find and appropriately manage adult source cases and failure to completely evaluate and properly treat children exposed to TB. Improvements in case detection, case management, and contact investigations are necessary to eliminate TB in children.
Elevated Blood Lead Levels and Blood Lead Screening Among US Children Aged One to Five Years: 1988–1994
Authors: Kaufmann Rachel B. , Clouse Timothy L. , Olson David R. , Matte Thomas D.
Published: August 2004

Objectives.

To estimate the proportion of children 1 to 5 years of age who received blood lead testing during 1988–1994 and to assess whether predictors of testing coincided with predictors of elevated blood lead levels.

Design.

Cross-sectional analysis of data from the Third National Health and Nutrition Examination Survey.

Participants.

US children 1 to 5 years of age.

Outcome Measures.

Prevalence of blood lead testing and elevated blood lead levels among children 1 to 5 years of age and odds ratios for factors predicting blood lead testing and elevated blood lead levels.

Results.

Overall, 6.3% had elevated blood lead levels and 10.2% had undergone previous blood lead tests. Being of minority race/ethnicity, living in an older home, residing in the Northeast or Midwest regions of the United States, being on Medicaid, having a head of household with <12 years of education, and having a history of anemia were significant factors in both models. Additional independent risk factors for an elevated blood lead level included being sampled in phase 1 of the survey, being 1 to 2 years of age, not having a regular doctor, and being sampled during the summer months. Additional independent correlates of a previous blood lead test included having moved less than twice in one's lifetime, having a female head of household, and having parents whose home language was English. Of an estimated 564 000 children 1 to 5 years of age who had elevated blood lead levels and no previous screening test in 1993, 62% were receiving Medicaid, 40% lived in homes built before 1946, and 34% were black, non-Hispanic.

Conclusions.

Lead screening was more frequent among children with risk factors for lead exposure. However, among children with elevated blood lead levels, only one third had been tested previously. In 1993 an estimated 564 000 children 1 to 5 years of age had elevated blood lead levels but were never screened. Physicians should screen Medicaid-eligible children and should follow state or local health department recommendations about identifying and screening other at-risk children. In areas where no health department guidelines exist, physicians should screen all children or screen based on known risk factors.
Attitudes Toward Secondhand Smoke, Smoking, and Quitting Among Young People
Authors: Glantz Stanton A. , Jamieson Patrick
Published: August 2004

Objective.

To assess the impact of attitudes toward secondhand smoke among young people.

Methods.

Three hundred nonsmokers and 300 smokers (smoked a cigarette in last 30 days) 14 through 22 years of age in the United States were surveyed with random-digit dialing. The results of this cross-sectional survey were analyzed using logistic regression to determine predictors of nonsmoking and intent to stop among current smokers.

Results.

Controlling for age, ethnicity, and education, nonsmokers were more likely to consider smoking risky than smokers (odds ratio [OR] = 3.46). Nonsmokers were twice as likely to consider secondhand smoke dangerous than smokers (OR = 1.47). Among the variables in our model, the only statistically significant predictor of planning to stop smoking or having actually stopped was believing that secondhand smoke harmed nonsmokers, which more than doubled the chances of planning to stop or having stopped smoking (relative risk = 2.17).

Conclusions.

Educating young people about the dangers of secondhand smoke and empowering nonsmokers to speak out should be a strong element of any tobacco control program.
Effects of Cisapride on Corrected QT Interval, Heart Rate, and Rhythm in Infants Undergoing Polysomnography
Authors: Benatar Avram , Feenstra Arjen , Decraene Tine , Vandenplas Yvan
Published: August 2004

Objective.

To evaluate the effects of cisapride, a prokinetic gastrointestinal drug, on the electrocardiographic QT interval, heart rate, and rhythm in infants during routine 8-hour polysomnography. Reported electrocardiogram (ECG) and rhythm disturbances in a small number of patients with the use of cisapride provided the impetus for this prospective study.

Study Design.

Two hundred fifty-two infants born at term were enrolled. Of these, 134 were on cisapride therapy for suspected gastroesophageal reflux and 118 were not on cisapride and served as controls. Cisapride-treated and control infants were from the outset divided into 3 age groups; group 1: under 3 months of age; group 2: between 3 and 6 months of age; and group 3: >6 months of age. Continuous ECG bipolar limb lead I recording, saturation monitoring, and electroencephalography were conducted. QT intervals and heart rate were measured at hourly intervals.

Results.

Cisapride doses were: group 1 mean, 0.80 mg/kg/day (range: 0.38–1.55); group 2 mean, 0.80 mg/kg/day (range: 0.23–1.38); and group 3 mean, 0.72 mg/kg/day (range: 0.32–1.41). Heart rate was higher in the younger infants, with a gradual decrease with age. No difference in heart rate was detected between the cisapride and control groups. The QTc interval in patients in group 1 was statistically longer than the controls, when applying both Bazett's and Hodges' formulae for QT correction. The other age groups did not differ. No arrhythmia or atrioventricular conduction abnormalities were observed.

Conclusion.

Infants under 3 months of age on cisapride treatment had significantly longer QTc intervals (with Bazett's formula, the 98th percentile was 504 ms in the cisapride group vs 447 ms in controls). The clinical significance and risk of the increased QTc interval in these infants are unclear and need further evaluation and risk stratification. Meanwhile, cisapride should be judiciously prescribed in infants <3 months of age.
Circumstances Leading to a Change to Prone Sleeping in Sudden Infant Death Syndrome Victims
Authors: Côté Aurore , Gerez Teresa , Brouillette Robert T. , Laplante Séverine
Published: August 2004

Context.

In addition to usual prone sleeping, unaccustomed prone sleeping represents a significant risk factor for sudden infant death syndrome (SIDS). However, little information is available regarding the circumstances leading caretakers to change the infant's sleep position to prone position in SIDS victims.

Objective.

To determine, in a population of SIDS victims, the timing of a change to prone sleeping and the reason for that change in infants who were originally nonprone sleepers.

Design and Setting.

Case series analysis from a questionnaire administered between 1991 and 1997 to parents and other caretakers of SIDS victims in the province of Quebec (Canada).

Subjects.

One hundred fifty-seven SIDS cases occurring in the province during the study.

Results.

Of the 157 SIDS cases studied, 139 were found in the prone position, although only 93 infants usually slept prone. Of the 64 nonprone sleepers, 34 had been changed to prone by the parents or another caretaker before death, and 18 had apparently turned to prone for the first time. In the 34 cases changed to prone, the change occurred <1 week before death for 21 infants; for 16 of those infants, death occurred the first or second time that they slept prone. In 56% of the cases changed from a nonprone to prone sleeping position, a caretaker other than the parents had precipitated the change.

Conclusions.

Ongoing campaigns to decrease the risk of SIDS should emphasize the risk of unaccustomed prone sleeping to both parents and secondary caretakers.
Technical Report: Perinatal Human Immunodeficiency Virus Testing and Prevention of Transmission
Authors: Mofenson Lynne M. ,   the Committee on Pediatric AIDS
Published: August 2004

In 1994, the US Public Health Service published guidelines for the use of zidovudine to decrease the risk of perinatal transmission of human immunodeficiency virus (HIV). In 1995, the American Academy of Pediatrics and the US Public Health Service recommended documented, routine HIV education and testing with consent for all pregnant women in the United States. Widespread incorporation of these guidelines into clinical practice has resulted in a dramatic decrease in the rate of perinatal HIV transmission and has contributed to more than a 75% decrease in reported cases of pediatric acquired immunodeficiency syndrome (AIDS) since 1992. Substantial advances have been made in the treatment and monitoring of HIV infection; combination antiretroviral regimens that maximally suppress virus replication are now available. These regimens are recommended for pregnant and nonpregnant individuals who require treatment. Risk factors associated with perinatal HIV transmission are now better understood, and recent results from trials to decrease the rate of mother-to-child HIV transmission have contributed new strategies with established efficacy. However, perinatal HIV transmission still occurs; the Centers for Disease Control and Prevention estimates that 300 to 400 infected infants are born annually. Full implementation of recommendations for universal, routine prenatal HIV testing and evaluation of missed prevention opportunities will be critical to further decrease the incidence of pediatric HIV infection in the United States. This technical report summarizes recent advances in the prevention of perinatal transmission of HIV relevant to screening of pregnant women and their infants.
In Utero Exposure to Coumarins and Cognition at 8 to 14 Years Old
Authors: van Driel Dieneke , Wesseling Judit , Sauer Pieter J. J. , van der Veer Eveline , Touwen Bert C. L. , Smrkovsky Mila
Published: August 2004

Objective.

To assess the cognitive abilities in school-aged children who have been exposed to coumarins in utero.

Background.

Coumarin derivatives are an effective option for anticoagulant therapy in pregnant women. However, case reports describe anomalies of the fetal central nervous system after in utero exposure to coumarins. It is unclear whether prenatal exposure has an effect on cognitive functioning later in childhood.

Methods.

The exposed cohort consisted of 291 children from mothers who were prospectively registered because of coumarin treatment during pregnancy. The nonexposed cohort included 253 age-matched peers. An IQ was estimated using subtests of the Weschler Intelligence Scale for Children-Revised. Educational achievement was examined with tests for reading, spelling, and arithmetic. In addition, schoolteachers were asked to judge performance on language and arithmetic. The observers were not aware of the exposure status of the child.

Results.

No differences in mean IQ were found between the exposed and nonexposed cohort (mean difference: −1.1; 95% confidence interval [CI]: −3.2–1.1), but an IQ score below 80 was found in 11 children in the exposed compared with 3 children in the nonexposed cohort (odds ratio [OR] = 3.1; CI: 0.8–11.6). Regarding the tests for educational achievement, exposed children as a group performed as well as nonexposed controls. Exposed boys, in comparison with nonexposed boys, showed a higher frequency of poor performance on reading (OR = 2.9; CI: 1.1–7.4) and spelling (OR = 2.5; CI: 1.0–6.0).

Conclusion.

Cognitive functioning in coumarin-exposed children does not differ from nonexposed controls, but a minority of children seem to be prone to the potential negative effects of coumarins during pregnancy.
The Impact of a Clinic-Based Literacy Intervention on Language Development in Inner-City Preschool Children
Authors: Mendelsohn Alan L. , Mogilner Leora N. , Dreyer Benard P. , Forman Joel A. , Weinstein Stacey C. , Broderick Monica , Cheng Karyn J. , Magloire Tamara , Moore Taska , Napier Camille
Published: August 2004

Objective.

To determine the effect of a clinic-based literacy intervention on the language development of preschool children.

Methods.

A convenience sample of families presenting to 2 urban pediatric clinics for well-child care met the following criteria: the family was Latino or black and English- or Spanish-speaking; the child was 2 to 5.9 years old, with no neurodevelopmental disability, at a gestational age of 34 weeks or more, and not attending kindergarten. Participants at the first clinic (intervention group) were exposed to a literacy support program, based on Reach Out and Read (ROR), during the previous 3 years. At the second clinic (comparison group), a similar program started 3 months before the study. Parent-child reading activities were measured using the READ Subscale of the StimQ. Language development was measured using the One-Word Expressive and Receptive Picture Vocabulary Tests, and was performed in the child's primary language.

Results.

A total of 122 study participants (49 interventions and 73 comparisons) met inclusion criteria and completed all measures. Intervention and comparison families were similar for most sociodemographic variables. Intervention families reported reading together with their children approximately 1 more day per week. Intensity of exposure to ROR (measured by total number of contacts with the program) was associated with increased parent-child reading activities, as measured by the StimQ-Read Subscale (r = 0.20). Intervention children had higher receptive language (mean: 94.5 vs 84.8) and expressive language (mean: 84.3 vs 81.6). After adjusting for potential confounders in a multiple regression analysis, intervention status was associated with an 8.6-point increase (95% confidence interval [CI]: 3.3, 14.0) in receptive language (semipartial correlation [SR]coefficient = 0.27), and a 4.3-point increase (95% CI: 0.04, 8.6) in expressive language (SR = 0.17). In a similar multiple regression, each contact with ROR was associated with an adjusted mean 0.4-point increase (95% CI: 0.1, 0.6) in receptive score, and an adjusted mean 0.21-point increase (95% CI: 0.02, 0.4) in expressive score.

Conclusions.

ROR is an important intervention, promoting parental literacy support and enhancing language development in impoverished preschool children. Integration of literacy promoting interventions such as these into routine pediatric health care for underserved populations can be recommended.
An Observational Study of Object Mouthing Behavior by Young Children
Authors: Juberg Daland R. , Alfano Kathleen , Coughlin Robert J. , Thompson Kimberly M.
Published: August 2004

Objective.

Mouthing behavior in infants and young children <3 years old is a poorly quantified yet normal part of early childhood development. Increasingly, safety and risk assessments involving materials that may be mouthed depend on accurate estimates of oral contact time. This study reports the results of an observational study performed to investigate and obtain data on mouthing behavior of objects for children up to 3 years old.

Methodology.

The study used a standard diary form with instructions for participating parents to observe their child in a normal environment (primarily home), and to document both the type and duration of each item mouthed. Phase I (pilot) consisted of 30 children each observed for 1 day, divided equally between the ages of 0 to 18 months (n = 15) and 19 to 36 months (n = 15), whereas Phase II included more participants (n = 92 aged 0–18 months;n = 95 aged 19–36 months). Phase III included observations for 5 nonconsecutive days over a 2-month period on 168 children between the ages of 3 to 18 months (at study initiation), and focused on total mouthing time of objects, exclusive of pacifiers.

Results.

The data collected during the first 2 phases were pooled and analyzed together. For all participants between the ages of 0 and 18 months (n = 107), the average daily duration of mouthing objects included: pacifiers (108 minutes), plastic toys (17 minutes), teethers (6 minutes), and other objects (9 minutes). The results for children 19 to 36 months old (n = 110) included: pacifiers (126 minutes), plastic toys (2 minutes), teethers (0 minutes), and other objects (2 minutes). Although no significant difference existed between the 2 age ranges for pacifier mouthing duration, a statistically significant difference was observed for nonpacifier objects. For Phase III, the average daily mouthing time for all objects (excluding pacifiers), based on 5 nonconsecutive days of observation for 168 children, was 36 minutes (n= 793 valid child observation days).

Conclusions.

Results of this study indicate that mouthing behavior is dependent on age and the types of items that are mouthed. Duration of mouthing varies among children, with some consistently not mouthing any objects and with a very small number mouthing objects for >2 hours a day. The study also revealed wide variability in the types of objects mouthed, including many nontoy objects. Children mouth pacifiers significantly longer than other objects, regardless of age. Significantly increased mouthing time of all nonpacifier objects is reported for children in the 0- to 18-month range compared with the 19- to 36-month range.
A Report Card on Quality Improvement for Children's Health Care
Authors: Ferris Timothy G. , Dougherty Denise , Blumenthal David , Perrin James M.
Published: August 2004

Objective.

Improving the quality of health care is a national priority. Nonetheless, no systematic effort has assessed the status of quality improvement (QI) initiatives for children or reviewed past research in child health care QI. This assessment is necessary to establish priorities for QI programs and research.

Methods.

To assess the status of QI initiatives and research, we reviewed the literature and interviewed experts experienced in QI for child health services. We defined QI as activities intended to close the gap between desired processes and outcomes of care and what is actually delivered. We classified reports published between 1985 and 1997 by publication characteristics, study design, clinical problem addressed, site of intervention, the QI method(s) used, and explicit association with a continuous quality improvement program.

Results.

We reviewed 68 reports meeting our definition of QI. More than half (48) were published after 1994. The reviewed reports included controlled evaluations in 36% of all identified interventions, and 3% of the reports were associated with continuous quality improvement. QI methods demonstrating some effectiveness included reminder systems for office-based preventive services and inpatient pathways for complex care. Reportedly successful QI initiatives more commonly described improvement in administrative measures such as rate of hospitalization or length of stay rather than functional status or quality of life. Interviews found that barriers to QI for children were similar to those for adults, but were compounded by difficulties in measuring child health outcomes, limited resources among public organizations and small provider groups, and relative lack of competition for pediatric tertiary care providers. Research and dissemination of QI for children were seen as less well developed than for adults.

Conclusions.

Attempts to improve the quality of child health services have been increasing, and the evidence we reviewed suggests that it is possible to improve the quality of care for children. Nonetheless, numerous gaps remain in the understanding of QI for children, and widespread improvement in the quality of health services for children faces significant barriers.
Carbamazepine Overdose Recognized by a Tricyclic Antidepressant Assay
Authors: Fleischman Amy , Chiang Vincent W.
Published: August 2004

Altered mental status in an adolescent presents a diagnostic challenge, and the clinician depends on clinical evaluation and laboratory studies to determine therapy and prognosis. We report the case of an adolescent with altered consciousness caused by carbamazepine overdose with a positive tricyclic antidepressant level to alert clinicians to the cross-reactivity of carbamazepine with a toxicology screen for tricyclic antidepressants.
Complete Spontaneous Resolution of Childhood Chiari I Malformation and Associated Syringomyelia
Authors: Sun Peter P. , Harrop James , Sutton Leslie N. , Younkin Donald
Published: August 2004

The diagnosis of Chiari I malformation and associated syringomyelia is often made in childhood. Since the advent of magnetic resonance imaging, these abnormalities are increasingly detected incidentally. Despite incomplete understanding of the natural history of asymptomatic Chiari I malformations, the current recommendation is to consider prophylactic surgical intervention in those with an associated syringomyelia. This case report presents a complete spontaneous resolution of a Chiari I malformation and syringomyelia in a child. It illustrates the possibility that asymptomatic children with Chiari I malformations and syringomyelia may be followed conservatively.
Perinatal Renal Ischemia Resulting in Hypertensive Cardiomyopathy
Authors: Saland Jeffrey M , Mahony Lynn , Baum Michel
Published: August 2004

Three neonates presented with malignant hypertension during the first week of life; 2 of them had congestive heart failure. Although none had indwelling umbilical artery catheters, unilateral renovascular lesions were diagnosed by nuclear perfusion scans. Angiotensin-converting enzyme inhibitor therapy produced rapid recovery. Hypertension must be included in the differential diagnosis of infants presenting with congestive heart failure and acidosis. Ultrasonography is not sensitive enough to exclude renovascular lesions. We emphasize the importance of early diagnosis and treatment.
Sexuality, Contraception, and the Media
Authors:   Committee on Public Education
Published: August 2004

This Policy Statement was retired July 2017.

Early sexual intercourse among American adolescents represents a major public health problem. Although early sexual activity may be caused by a variety of factors, the media are believed to play a significant role. In film, television, and music, sexual messages are becoming more explicit in dialogue, lyrics, and behavior. In addition, these messages contain unrealistic, inaccurate, and misleading information that young people accept as fact. Teens rank the media second only to school sex education programs as a leading source of information about sex. Recommendations are presented to help pediatricians address the effects of the media on sexual attitudes, beliefs, and behaviors of their patients.
School Health Centers and Other Integrated School Health Services
Authors:   Committee on School Health
Published: August 2004

This statement offers guidelines on the integration of expanded school health services, including school-based and school-linked health centers, into community-based health care systems. Expanded school health services should be integrated so that they enhance accessibility, provide high-quality health care, link children to a medical home, are financially sustainable, and address both long- and short-term needs of children and adolescents.
Institutional Ethics Committees
Authors:   Committee on Bioethics
Published: August 2004

This Policy Statement was revised: https://doi.org/10.1542/peds.2019-0659.

In hospitals throughout the United States, institutional ethics committees (IECs) have become a standard vehicle for the education of health professionals about biomedical ethics, for the drafting and review of hospital policy, and for clinical ethics case consultation. In addition, there is increasing interest in a role for the IEC in organizational ethics. Recommendations are made about the membership and structure of an IEC, and guidelines are provided for those serving on an ethics committee.
A Randomized, Double-Masked, Placebo-Controlled Trial of Recombinant Granulocyte Colony-Stimulating Factor Administration to Preterm Infants With the Clinical Diagnosis of Early-Onset Sepsis
Authors: Miura Ernani , Procianoy Renato S. , Bittar Cristina , Miura Clarissa S. , Miura Maurı́cio S. , Mello Cı́ntia , Christensen Robert D.
Published: August 2004

Objective.

We performed a randomized, double-masked, parallel-groups, placebo-controlled trial of recombinant granulocyte colony-stimulating factor (rG-CSF) administration to 44 preterm neonates who had blood cultures obtained and antibiotics begun because of the clinical diagnosis of early-onset sepsis. Two primary outcome variables were tested 1) mortality and 2) development of nosocomial infections over the 2-week period after dosing.

Design and Methods.

The treatment group (n = 22) received 10 μg/kg/day of intravenous rG-CSF once daily for 3 days and the placebo group (n = 22) received the same volume of a visually indistinguishable vehicle. Mortality and culture-proven nosocomial infections were recorded. Immediately before the first, second, and third doses, and again 10 days after the first dose, serum concentrations were determined for tumor necrosis factor-α, interleukin 6, granulocyte-macrophage colony stimulating factor, and G-CSF, and blood leukocyte counts, absolute neutrophil counts, immature/total neutrophil ratios, platelet counts, and hemoglobin concentrations were measured.

Results.

The treatment and placebo groups were of similar gestational age (29 ± 3 vs 31 ± 3 weeks) and birth weight (1376 ± 491 vs 1404 ± 508 g), and had similar Apgar scores and 24-hour Score for Neonatal Acute Physiology scores. The mortality rate was not different between treatment and placebo groups. However, the occurrence of a subsequent nosocomial infection was lower in the rG-CSF recipients (relative risk: .19; 95% confidence interval: .05–.78). rG-CSF treatment did not alter the serum concentrations of the cytokines measured (except for G-CSF). Serum G-CSF levels and blood neutrophil counts were higher in the treatment than in the placebo group 24 hours and 48 hours after dosing.

Conclusions.

Administration of 3 daily doses of rG-CSF (10 μg/kg/day) to premature neonates with the clinical diagnosis of early-onset sepsis did not improve mortality but was associated with acquiring fewer nosocomial infections over the subsequent 2 weeks.