bluuebunny/crossref_metadata_2025 huggingface dataset:
Studies on the dehydrogenative polymerization of monolignol β-glycosides: Part 5. UV spectroscopic monitoring of horseradish peroxidase-catalyzed polymerization of monolignol glycosides
Authors: Tobimatsu Yuki , Takano Toshiyuki , Kamitakahara Hiroshi , Nakatsubo Fumiaki
Published: July 2008

Horseradish peroxidase (HRP)-initiated dehydrogenative polymerizations of guaiacyl (G) and syringyl (S)-type monolignol γ-O-glucosides, isoconiferin (iso-G) and isosyringin (iso-S), which contain a hydrophilic glucosyl unit on γ-position of coniferyl alcohol (G-alc) and sinapyl alcohol (S-alc), respectively, were monitored by UV spectroscopy to study the formation of dehydrogenation polymer (DHP, lignin polymer model) in a homogeneous aqueous phase. During homopolymerization of iso-S, a new absorbance band at 325 nm (A
325) rapidly increased in intensity and then gradually disappeared, whereas such stable changes in absorbance were not observed during homopolymerization of iso-G. During polymerization of iso-S, A
325 rapidly disappeared when an acid, nucleophile or reductant was added to the reaction mixture, indicating that A
325 can be attributed to S-type quinone methide intermediates (QMs). Similar to iso-S polymerization, temporary absorbance at 328 nm was observed during conventional polymerization of S-alc. We interpret this observation as follows: S-type QMs accumulated in the reaction mixture and the progress of subsequent DHP formation during oxidative polymerization of iso-S or S-alc was hindered. UV monitoring of iso-G and iso-S copolymerization revealed that the presence of iso-G promoted the disappearance of A
325. Furthermore, S-type QMs generated in situ by iso-S polymerization disappeared more rapidly after guaiacol addition than after 2,6-dimethoxyphenol addition. The following mechanism for copolymerization of iso-G and iso-S can be proposed: G-type precursors with phenolic hydroxyl groups react readily by nucleophilic addition with the α-C of S-type QMs, and the molecular chains of DHPs increase via non-cyclic α-aryl ether bonds.
Ruiz de Burton's Emotional Landscape: Property and Feeling in The Squatter and the Don
Authors: Dawson Melanie V.
Published: July 2008

This essay argues that María Amparo Ruiz de Burton's 1885 novel The Squatter and the Don combines elements of realism and sentimentalism, articulating a realist mode of sympathy that is directed toward the novel's Californio characters. As U.S. citizens who are dispossessed of property and citizenship rights in the wake of the Mexican American War, the Californios register various forms of personal and material loss, albeit analytically and self-consciously. Through the invocation of hybrid emotions, which carry the cultural inflections of both Anglo and Californio traditions, Ruiz de Burton's novel enriches a critical understanding of realism's intervention in a contentious late-nineteenth-century debate about difference in relation to U.S. national and racial identities. Moreover, the novel undercuts a mode of realism devoted to scenic (and, hence, material) detail. By presenting emotional rather than scenic vistas and by highlighting familial and communal bonds in contrast to an exaggerated, capitalist attachment to property (amply demonstrated by the novel's squatter characters), The Squatter and the Don presents affect as a means of understanding the structures of citizenship neglected by U.S. corporations, land commissions, and citizens who colonize California and claim it on behalf of a capitalist nation.
Advances in Genetic Testing and Applications in Newborn Medicine
Authors: Goodin Kara , Chen Margaret , Lose Edward , Mikhail Fady M. , Korf Bruce R.
Published: July 2008

Because genetic conditions can alter the health of neonates, it is important for neonatologists to become familiar with the indications for testing and major issues in the interpretation of results. The two primary molecular cytogenetic techniques are fluorescence in situ hybridization and array comparative genomic hybridization, which allow detection of deletions, duplications, and rearrangements of small regions within the chromosome. Direct mutation analysis of DNA can be targeted to a specific variant known to be associated with disease. Epigenetic factors can affect gene expression without altering the genotype. For example, genomic imprinting (differential expression of a gene) causes several genetic disorders. Most molecular genetic testing performed in the newborn nursery is for purposes of diagnosis. Important differences in analytic validity, clinical validity, and clinical utility distinguish genetic testing from more traditional laboratory testing, and the implications of these differences must be considered when ordering such tests.
Testing Strategy for Inborn Errors of Metabolism in the Neonate
Authors: Dagli Aditi I. , Zori Roberto T. , Heese Bryce A.
Published: July 2008

Early detection and management of inborn errors of metabolism (IEMs) can improve the affected infant's prognosis. Initial screening tests can provide a general overview of the infant's metabolic status and suggest potential IEMs. Among the clinical findings seen in many IEMs are encephalopathy, hypoglycemia, jaundice and liver disease, cardiac arrhythmias, cardiomyopathy, hypotonia, dysmorphic features, and nonimmune hydrops. Confirmatory testing (enzyme analysis or molecular DNA testing) are required to make the diagnosis. Clinicians should be aware of specific requirements for such testing to obtain the desired results.
Neonatal Presentations of CHARGE Syndrome and VATER/VACTERL Association
Authors: Kaplan Julie , Hudgins Louanne
Published: July 2008

Neonatologists often care for newborns who have multiple congenital anomalies. The specific diagnosis has implications for the infant's clinical management. In this article, we examine the neonatal presentations of CHARGE syndrome and VATER/VACTERL association. Once the features of these two entities are recognized clinically, the appropriate diagnostic evaluations can be initiated.
Neonatal Graves Disease Caused by Transplacental Antibodies
Authors: Hernandez Maria Isabel , Lee Kuk-Wha
Published: July 2008

Autoimmune thyroid disease is common in pregnancy. Graves disease is present in about 0.2% of pregnancies, and clinical hyperthyroidism occurs in approximately 1% of neonates born to women who have Graves disease. Antibodies to the thyroid-stimulating hormone receptor (TSH-R) (stimulating or blocking) freely cross the placenta and can act in the fetal thyroid gland during the second half of pregnancy. A few cases of fetal hyperthyroidism or hypothyroidism related to maternal TSH-R antibodies (TRAbs) have been reported. Neonatal hyperthyroidism or thyrotoxicosis is usually apparent by 10 days after birth. Such states should be considered emergencies and treated promptly to prevent damage in the newborn.
Financial Burden in Families of Children With Special Health Care Needs: Variability Among States
Authors: Shattuck Paul T. , Parish Susan L.
Published: July 2008

OBJECTIVE. The main objective of this study was to examine variability among states for 3 indicators of the family financial burden related to caring for children with special health care needs.

METHODS. Data were from a 2001 national survey of households with children (<18 years of age) with special health care needs, with a representative sample from each state. The outcomes examined included whether a family had any out-of-pocket expenditures during the previous 12 months related to the child's special health care needs, the amount of expenditure (absolute burden), and the amount of expenditure per $1000 of family income (relative burden). We used multilevel regression to examine state-level variability in financial burden, controlling for individual-level factors. We also examined the association between state median family income and state mean financial burden.

RESULTS. Overall, 82.5% of families reported expenditures of more than $0. Among these families, the mean unadjusted absolute burden was $752 and the relative burden was $19.6 per $1000. Adjusted state means ranged from $562 to $972 for absolute burden and from $14.5 to $32.3 per $1000 for relative burden. Families living in states with higher median family incomes had lower financial burdens across all 3 measures.

CONCLUSIONS. Families that are similar with respect to household demographic characteristics and the nature of their children's special health care needs have different out-of-pocket health expenditures depending on the state in which they live. Documenting and understanding this variability moves the field closer to the goal of establishing evidence-based, state policy recommendations aimed at reducing the financial burden of these vulnerable families.
Message Framing and Perinatal Decisions
Authors: Haward Marlyse F. , Murphy Ryan O. , Lorenz John M.
Published: July 2008

OBJECTIVES. The purpose of this study was to explore the effect of information framing on parental decisions about resuscitation of extremely premature infants. Secondary outcomes focused on elucidating the impact of other variables on treatment choices and determining whether those effects would take precedence over any framing effects.

METHODS. This confidential survey study was administered to adult volunteers via the Internet. The surveys depicted a hypothetical vignette of a threatened delivery at gestational age of 23 weeks, with prognostic outcome information framed as either survival with lack of disability (positive frame) or chance of dying and likelihood of disability among survivors (negative frame). Participants were randomly assigned to receive either the positively or negatively framed vignette. They were then asked to choose whether they would prefer resuscitation or comfort care. After completing the survey vignette, participants were directed to a questionnaire designed to test the secondary hypothesis and to explore possible factors associated with treatment decisions.

RESULTS. A total of 146 subjects received prognostic information framed as survival data and 146 subjects received prognostic information framed as mortality data. Overall, 24% of the sample population chose comfort care and 76% chose resuscitation. A strong trend was detected toward a framing effect on treatment preference; respondents for whom prognosis was framed as survival data were more likely to elect resuscitation. This framing effect was significant in a multivariate analysis controlling for religiousness, parental status, and beliefs regarding the sanctity of life. Of these covariates, only religiousness modified susceptibility to framing; participants who were not highly religious were significantly more likely to be influenced to opt for resuscitation by the positive frame than were participants who were highly religious.

CONCLUSIONS. Framing bias may compromise efforts to approach prenatal counseling in a nondirective manner. This is especially true for subsets of participants who are not highly religious.
Outcomes in a Population of Healthy Term and Near-Term Infants With Serum Bilirubin Levels of ≥325 μmol/L (≥19 mg/dL) Who Were Born in Nova Scotia, Canada, Between 1994 and 2000
Authors: Jangaard Krista A. , Fell Deshayne B. , Dodds Linda , Allen Alexander C.
Published: July 2008

OBJECTIVE. The goal was to study the incidence of kernicterus, developmental delay, autism, cerebral palsy, and hearing loss in infants with peak total serum bilirubin levels of ≥325 μmol/L (≥19 mg/dL), compared with infants with less-severe or no hyperbilirubinemia, in a population of healthy term and late preterm infants.

METHODS. Prospectively gathered, standardized, maternal and neonatal data for infants at ≥35 weeks of gestation who were born between January 1, 1994, and December 31, 2000, were extracted from the Nova Scotia Atlee Perinatal Database. Infants with Rh factor isoimmunization, significant congenital or chromosomal abnormalities, or severe peripartum asphyxia were excluded. Comparisons were made on the basis of peak total serum bilirubin levels. Diagnoses were obtained through data linkage with the Medical Services Insurance Database for office visits and the Canadian Institute for Health Information Database for hospital admissions. The registration file provided information allowing calculation of follow-up times, which were determined for each separate outcome. Follow-up periods ranged from 2 to 9 years, with the end point being the first time the diagnostic code was encountered in either database. Cox proportional-hazards regression analyses were used to examine the relationships between outcomes and total serum bilirubin levels.

RESULTS. Of 61238 infants included in the study cohort, 4010 (6.7%) did not have linkage data, which left 56019 infants for analysis. There were no cases of kernicterus and no significant differences in rates of cerebral palsy, deafness, developmental delay, or visual abnormalities between the groups. There were suggestions of associations with attention-deficit disorder in the severe hyperbilirubinemia group and with autism in the combined moderate and severe hyperbilirubinemia group.

CONCLUSIONS. There was no increase in adverse effects reported previously to be associated with bilirubin toxicity. Associations with developmental delay, attention-deficit disorder, and autism were observed.
Surfactant Status in Preterm Neonates Recovering From Respiratory Distress Syndrome
Authors: Verlato Giovanna , Cogo Paola Elisa , Balzani Marco , Gucciardi Antonina , Burattini Ilaria , De Benedictis Fernando , Martiri Giovanna , Carnielli Virgilio Paolo
Published: July 2008

OBJECTIVE. The goal was to establish whether reduced amounts of pulmonary surfactant contribute to postextubation respiratory failure in preterm infants recovering from respiratory distress syndrome.

METHODS. We prospectively recruited preterm infants who needed mechanical ventilation and exogenous surfactant for treatment of moderate/severe respiratory distress syndrome and could not be extubated before day 3 of life. 13C-labeled dipalmitoyl-phosphatidylcholine was administered endotracheally as tracer before extubation, for estimation of surfactant disaturated phosphatidylcholine pool size and half-life. Patients were retrospectively divided into 3 groups, that is, extubation failure if, after extubation, they needed reintubation or continuous positive airway pressure treatment of ≥6 cmH2O and fraction of inspired oxygen of >0.4, extubation success if they did not meet the failure criteria, and not extubated if they needed ongoing ventilation. Clinical and respiratory parameters were recorded hourly.

RESULTS. Reliable kinetic data could be obtained for 63 of the 88 enrolled neonates. Sixteen, 23, and 24 neonates were categorized in the extubation failure, extubation success, and not extubated groups, respectively. Clinical and demographic characteristics did not differ between the extubation failure and extubation success groups. Disaturated phosphatidylcholine pool size was smaller in the extubation failure group than in the extubation success group (25 ± 12 vs 43 ± 24 mg/kg) and was 37 ± 32 mg/kg in the not extubated group. Disaturated phosphatidylcholine half-life was 19 ± 7, 24 ± 12, and 28 ± 18 hours in the extubation failure, extubation success, and not extubated groups, respectively.

CONCLUSIONS. In a selected population of preterm infants with moderate/severe respiratory distress syndrome who could not be extubated in the first 3 days of life, infants who were reintubated or needed high continuous positive airway pressure settings after extubation had a smaller disaturated phosphatidylcholine pool size than did those who were successfully extubated or needed low continuous positive airway pressure settings.
Associations Between Maternal Age and Infant Health Outcomes Among Medicaid-Insured Infants in South Carolina: Mediating Effects of Socioeconomic Factors
Authors: Pittard William B. , Laditka James N. , Laditka Sarah B.
Published: July 2008

OBJECTIVE. The objective of this study was to investigate whether infants who are born to adolescent mothers are at greater risk for health problems than those who are born to older mothers.

METHODS. Data represent all health care encounters for infants who were born in South Carolina between 2000 and 2002 and were healthy at birth and continuously enrolled in fee-for-service Medicaid (n = 41696). We separately examined in the first and second years of life use of preventive care doctor visits, sick-infant doctor visits, emergency department visits, hospital admissions, and both emergency department visits and hospitalizations for ambulatory care–sensitive conditions. We compared these outcomes for infants of adolescent mothers (aged 11–17 years) and older mothers (aged 18–47 years), adjusting for individual characteristics of mothers and infants.

RESULTS. In unadjusted results, infants of adolescent mothers used more health care in 9 of 12 use categories. For example, in year 1, they had an average of 1.71 emergency department visits and 1.39 hospitalizations, compared with 1.26 and 1.18, respectively, for infants of older mothers. In results that were adjusted only for infant and delivery characteristics, they similarly used more services in most categories. After adjustment for either mothers' characteristics alone or those of both the infant/delivery and mothers, there was evidence that they had modestly more sick-infant doctor visits and hospital admissions in year 1 and notably more hospital admissions for ambulatory care–sensitive conditions.

CONCLUSIONS. Infants of adolescent mothers are more likely than infants of older mothers to use a variety of health care services that suggest poorer health. A considerable proportion of this greater use seems to be attributable to specific characteristics of mothers, such as socioeconomic characteristics, rather than to an inability that is common among adolescents to promote infant health or to use health care appropriately.
Universal Newborn Hearing Screening: Systematic Review to Update the 2001 US Preventive Services Task Force Recommendation
Authors: Nelson Heidi D. , Bougatsos Christina , Nygren Peggy
Published: July 2008

OBJECTIVE. This review is an update for the US Preventive Services Task Force on universal newborn hearing screening to detect moderate-to-severe permanent, bilateral congenital hearing loss. We focus on 3 key questions: (1) Among infants identified by universal screening who would not be identified by targeted screening, does initiating treatment before 6 months of age improve language and communication outcomes? (2) Compared with targeted screening, does universal screening increase the chance that treatment will be initiated by 6 months of age for infants at average risk or for those at high risk? (3) What are the adverse effects of screening and early treatment?

METHODS. Medline and Cochrane databases were searched to identify articles published since the 2002 recommendation. Data from studies that met inclusion criteria were abstracted, and studies were rated for quality with predetermined criteria.

RESULTS. A good-quality retrospective study of children with hearing loss indicates that those who had early versus late confirmation and those who had undergone universal newborn screening versus none had better receptive language at 8 years of age but not better expressive language or speech. A good-quality nonrandomized trial of a large birth cohort indicates that infants identified with hearing loss through universal newborn screening have earlier referral, diagnosis, and treatment than those not screened. These findings are corroborated by multiple descriptive studies of ages of referral, diagnosis, and treatment. Usual parental reactions to an initial nonpass on a hearing screen include worry, questioning, and distress that resolve for most parents. Cochlear implants have been associated with higher risks for bacterial meningitis in young children.

CONCLUSIONS. Children with hearing loss who had universal newborn hearing screening have better language outcomes at school age than those not screened. Infants identified with hearing loss through universal screening have significantly earlier referral, diagnosis, and treatment than those identified in other ways.
Risks of Invasive Pneumococcal Disease in Children With Underlying Chronic Diseases
Authors: Hjuler Thomas , Wohlfahrt Jan , Staum Kaltoft Margit , Koch Anders , Biggar Robert John , Melbye Mads
Published: July 2008

OBJECTIVE. The risk of invasive pneumococcal disease is increased among children with some chronic diseases. The objective of this study was to quantify the risk of invasive pneumococcal disease in a wide range of chronic diseases.

PATIENTS AND METHODS. Cases of invasive pneumococcal disease among children (aged 0–17 years) were identified from 1977 through 2005 by using a national surveillance program in Denmark. Rate ratios were assessed in a case-control study by using 10 age- and gender-matched controls per case. Chronic diseases were defined a priori.

RESULTS. Among 1655 children with invasive pneumococcal disease, 19% had a history of chronic disease, according to our definition, versus 5% of controls. An increased risk of invasive pneumococcal disease was observed for children followed >30 days after initial hospital contact for a chronic disease, but it was also increased in children with ≥5 hospital contacts for any other reason. Children with a history of cancer, chronic renal disease, splenectomy, and transplantation were particularly susceptible to invasive pneumococcal disease. Adjusted for number of hospital contacts, the risk for children with other types of chronic disease was 1.4-fold more than for those with hospital contacts for any reason.

CONCLUSIONS. Cancer, chronic renal diseases, splenectomy, and transplantation were strongly associated with an increased risk of invasive pneumococcal disease in children. For children with other chronic diseases, their excess risk seemed to be attributable mostly to frail children having repeated hospital contact rather than their underlying condition.
Epidemiology of Pediatric Burns Requiring Hospitalization in China: A Literature Review of Retrospective Studies
Authors: Kai-Yang Lv , Zhao-Fan Xia , Luo-Man Zhang , Yi-Tao Jia , Tao Tan , Wei Wei , Bing Ma , Jie Xiong , Yu Wang , Yu Sun
Published: July 2008

OBJECTIVE. This review was an effort to systematically examine the nationwide data available on pediatric burns requiring hospitalization to reveal burn epidemiology and guide future education and prevention.

METHODS. The China Biomedical Disk Database, Chongqing VIP Database, and China Journal Full-Text Database were searched for articles reporting data on children and their burns from January 2000 through December 2005. Studies were included that systematically investigated the epidemiology of pediatric burns requiring hospitalization in China. Twenty-eight articles met the inclusion criteria, all of which were retrospective analyses. For each study included, 2 investigators independently abstracted the data related to the population description by using a standard form and included the percentage of patients with burn injury who were <15 years old; gender and distribution of age; type of residential area; place of injury; distribution of months and time; reasons for burn; anatomical sites of burn; severity of burn; and mortality and cause of death. These data were extracted, and a retrospective statistical description was performed with SPSS11.0 (SPSS Inc, Chicago, IL).

RESULTS. Of the pediatric patients studied, the proportion of children with burn injury ranged from 22.50% to 54.66%, and the male/female ratio ranged from 1.25:1 to 4.42:1. The ratio of children aged ≤3 years to those >3 years was 0.19:1 to 4.18:1. The rural/urban ratio was 1.60:1 to 12.94:1. The ratio of those who were burned indoors versus outdoors was 1.62 to 17.00, and there were no effective hints on the distribution of seasons and anatomical sites of burn that could be found. The peak hours of pediatric burn were between 17:00 and 20:00. Most articles reported the sequence of reasons as hot liquid > flame > electricity > chemical, and scalding was, by far, the most predominant reason for burn. The majority of the studies reported the highest proportion involved in moderate burn, and the lowest proportion was for critical burn. The mortality rate ranged from 0.49% to 9.08%, and infection, shock, and multiple organ dysfunction syndrome were the most common causes of death.

CONCLUSIONS. Considering the national proportion of children, a high proportion of hospitalized patients with burn injury were children; those who were male, aged ≤3 years, and lived most of the time indoors were especially susceptible. Great attention should be paid when hot water is used or during suppertime. This compilation and analysis of hospitalization-based information has proved useful in establishing the rational priorities for prevention; a family-school-factory-government mode of preventive strategy has come into being and was performed effectively.
Age at First Introduction of Cow Milk Products and Other Food Products in Relation to Infant Atopic Manifestations in the First 2 Years of Life: The KOALA Birth Cohort Study
Authors: Snijders Bianca E.P. , Thijs Carel , van Ree Ronald , van den Brandt Piet A.
Published: July 2008

OBJECTIVES. Scientific evidence is scarce about timing of solid-food introduction and its association with the development of atopy. We aimed to evaluate any associations between the introduction of cow milk products/other solid food products and infant atopic manifestations in the second year of life, taking into account reverse causation.

METHODS. Data from 2558 infants in an ongoing prospective birth cohort study in the Netherlands were analyzed. Data on the main determinants (introduction of cow milk products and other food products), outcomes (eczema; atopic dermatitis [United Kingdom Working Party criteria]; recurrent wheeze; any sensitization; sensitization against cow milk, hen egg, peanut, and at least 1 inhalant allergen), and confounders were collected by repeated questionnaires at 34 weeks of gestation and 3, 7, 12, and 24 months postpartum. Information on sensitization was gathered by venous blood collections performed during home visits at age 2. Analyses were performed by multiple logistic regression analyses.

RESULTS. More delay in introduction of cow milk products was associated with a higher risk for eczema. In addition, a delayed introduction of other food products was associated with an increased risk for atopy development at the age of 2 years. Exclusion of infants with early symptoms of eczema and recurrent wheeze (to avoid reverse causation) did not essentially change our results.

DISCUSSION. Delaying the introduction of cow milk or other food products may not be favorable in preventing the development of atopy.
Global Occurrence of Infant Botulism, 1976–2006
Authors: Koepke Ruth , Sobel Jeremy , Arnon Stephen S.
Published: July 2008

OBJECTIVE. To summarize the worldwide occurrence of reported infant (intestinal toxemia) botulism cases since first recognition of the disease in 1976.

PATIENTS AND METHODS. We collected information on infant botulism cases by active and passive surveillance, by provision of therapeutic Human Botulism Immune Globulin to suspected cases, and by searching the medical literature. We defined a case as laboratory-confirmed botulism that occurred in an infant ≤12 months of age that was not caused by the ingestion of botulinum toxin in food.

RESULTS. Twenty-six countries representing 5 continents reported the occurrence of at least 1 case of infant botulism among their residents. The United States, Argentina, Australia, Canada, Italy, and Japan, in this order, reported the largest number of cases. A history of honey exposure was significantly more common among case subjects hospitalized outside of the United States than among those who were recently hospitalized in California.

CONCLUSIONS. Most countries have not yet reported cases of infant botulism. This limited reporting of the disease to date contrasts with the known global occurrence of Clostridium botulinum spores in soils and dust and suggests that infant botulism may be underrecognized, underreported, or both. When bulbar palsies, hypotonia, and weakness are present, physicians should consider the possibility of infant botulism even if the patient has not been fed honey. Publication of additional case reports and surveillance summaries will enhance understanding of the occurrence and extent of this underrecognized disease.
Increasing Burden and Risk Factors for Bronchiolitis-Related Medical Visits in Infants Enrolled in a State Health Care Insurance Plan
Authors: Carroll Kecia N. , Gebretsadik Tebeb , Griffin Marie R. , Wu Pingsheng , Dupont William D. , Mitchel Edward F. , Enriquez Rachel , Hartert Tina V.
Published: July 2008

OBJECTIVES. The goals were to estimate the year-round burden of health care visits attributable to bronchiolitis and to identify risk factors for bronchiolitis in term healthy infants.

METHODS. We conducted a population-based, retrospective cohort study of 103 670 term, non–low birth weight infants enrolled in Tennessee Medicaid in 1995–2003. We monitored infants through the first year of life. Risk factors for bronchiolitis during infancy and rates of inpatient, emergency department, and outpatient visits during the study period were calculated by using claims data.

RESULTS. Over the 9 study years, rates of bronchiolitis visits were 238 outpatient visits per 1000 infant-years, 77 emergency department visits per 1000 infant-years, and 71 hospitalizations per 1000 infant-years. Average annual rates of bronchiolitis visits increased 41%, from 188 visits per 1000 infant-years to 265 visits per 1000 infant-years, from 1996–1997 to 2002–2003. Analysis of the linear trend in 500-g increments demonstrated a negative association between increasing birth weight and bronchiolitis diagnosis. There was a significant negative trend between maternal age and infant bronchiolitis diagnosis. Compared with infants of mothers 20 to 29 years of age, infants of mothers 15 to 19 years of age had a small increase in risk of having a bronchiolitis visit, whereas infants of older mothers (30–39 or 40–44 years of age) were less likely to have a visit.

CONCLUSIONS. The disease burden of bronchiolitis is substantial, with increasing rates of all types of visits among term, otherwise-healthy infants enrolled in Tennessee Medicaid between 1995 and 2003. Protective factors in this cohort of term infants included higher birth weight and older maternal age.
Global Health Training in Pediatric Residency Programs
Authors: Nelson Brett D. , Lee Anne CC , Newby P. K. , Chamberlin M. Robert , Huang Chi-Cheng
Published: July 2008

OBJECTIVE. Our goal was to describe current resident interest, participation, curricula, resources, and obstacles related to global health training within pediatric residency programs.

METHODS. We conducted a cross-sectional survey of the 201 accredited pediatric residency programs in the United States, Puerto Rico, and the Caribbean from October 2006 to January 2007. Survey topics included resident interest and participation in electives, training opportunities, program support, and educational curricular content related to global health.

RESULTS. Of the 201 surveyed pediatric residency programs, 106 (53%) responded. Fifteen percent of responding programs reported that a majority of their residents were interested in global health. Fifty-two percent offered a global health elective within the previous year, and 47% had formally incorporated global health into their training curricula. Six percent of the programs reported a formalized track or certificate in global health. The median number of residents per program participating in global health electives within the previous year was 0 during postgraduate year 1, 1 during postgraduate year 2, and 2 during postgraduate year 3. The median number of all residents per program participating in a global health elective in the previous year was 3 (7.4% of program size). Among programs that offered a global health elective, support to participating residents included prerequisite clinical training (36%), cultural orientation (36%), language training (15%), faculty mentorship (82%), and postelective debriefing (77%). Fourteen percent of the programs provided full funding for resident electives. Characteristics of pediatric residency programs that were significantly associated with higher resident participation in a global health elective were larger program size, university affiliation, greater reported resident interest, and faculty involvement in global health.

CONCLUSIONS. More than half of the pediatric residency programs surveyed offered a global health elective in the previous year. An American Academy of Pediatrics survey 10 years earlier had shown 1 of 4 programs with global health electives. Observance of American Academy of Pediatrics consensus guidelines for global health electives varied widely among programs, and additional efforts should focus on resident preparation, mentorship, and funding.
Effects of Higher Versus Lower Dexamethasone Doses on Pulmonary and Neurodevelopmental Sequelae in Preterm Infants at Risk for Chronic Lung Disease: A Meta-analysis
Authors: Onland Wes , De Jaegere Anne P. , Offringa Martin , van Kaam Anton H.
Published: July 2008

OBJECTIVES. Systemic postnatal dexamethasone treatment reduces the risk of chronic lung disease in preterm infants but also may be associated with increased risk of neurodevelopmental impairment. Because it is not known whether these effects are modulated by the cumulative dexamethasone dose, we systematically reviewed the available randomized evidence on the effects of lower versus higher cumulative dexamethasone doses, in terms of death, pulmonary morbidity, and neurodevelopmental outcomes, in preterm infants.

METHODS. Randomized, controlled trials comparing higher- versus lower-dosage dexamethasone regimens in ventilated preterm infants were identified by searching the main electronic databases, references from relevant studies, and abstracts from the Societies for Pediatric Research (from 1990 onward). Eligibility and quality of trials were assessed, and data on study design, patient characteristics, and relevant outcomes were extracted.

RESULTS. Six studies that enrolled a total of 209 participants were included; 2 studies contrasted cumulative dexamethasone doses in the higher ranges (>2.7 mg/kg in the higher-dosage regimen) and 4 in the lower ranges (≤2.7 mg/kg in the higher-dosage regimen). Meta-analysis revealed no effect of dexamethasone dose on rates of death and neurodevelopmental sequelae in these 2 subgroups. Subgroup analysis of the studies contrasting dexamethasone doses in the higher ranges showed that the higher dose of dexamethasone was more effective in reducing the occurrence of chronic lung disease than was the lower dose. Interpretation of these data was hampered by the small samples of randomly assigned children, heterogeneity of study populations and designs, use of late rescue glucocorticoids, and lack of long-term neurodevelopmental data in some studies.

CONCLUSIONS. Recommendations for optimal dexamethasone doses for preterm infants at risk for chronic lung disease cannot be based on current evidence. A well-designed, large, randomized, controlled trial is urgently needed to establish the optimal dexamethasone dosage regimen.
Impact of the HIV/AIDS Epidemic on the Neurodevelopment of Preschool-Aged Children in Kinshasa, Democratic Republic of the Congo
Authors: Van Rie Annelies , Mupuala Aimee , Dow Anna
Published: July 2008

OBJECTIVES. Pediatric HIV infection is a growing problem in most regions of the world. Data on the effects of HIV on the neurodevelopment of children in resource-poor settings are scarce but necessary to guide interventions. The purpose of this study was to compare the neurodevelopment of preschool-aged HIV-infected, HIV-affected (HIV-uninfected AIDS orphans and HIV-uninfected children whose mother had symptomatic AIDS), and healthy control children in Kinshasa, Democratic Republic of Congo.

METHODS. Thirty-five HIV-infected, 35 HIV-affected, and 90 control children aged 18 to 72 months were assessed by using the Bayley Scales of Infant Development II, Peabody Developmental Motor Scales, Snijders-Oomen Nonverbal Intelligence Test, and Rossetti Infant-Toddler Language Scale, as appropriate for age.

RESULTS. Overall, 60% of HIV-infected children had severe delay in cognitive function, 29% had severe delay in motor skills, 85% had delays in language expression, and 77% had delays in language comprehension, all significantly higher rates as compared with control children. Young HIV-infected children (aged 18–29 months) performed worse, with 91% and 82% demonstrating severe mental and motor delay, respectively, compared with 46% and 4% in older HIV-infected children (aged 30–72 months). HIV-affected children had significantly more motor and language expression delay than control children.

CONCLUSIONS. The impact of the HIV pandemic on children's neurodevelopment extends beyond the direct effect of the HIV virus on the central nervous system. AIDS orphans and HIV-negative children whose mothers had AIDS demonstrated significant delays in their neurodevelopment, although to a lesser degree and in fewer developmental domains than HIV-infected children. Young HIV-infected children were the most severely afflicted group, indicating the need for early interventions. Older children performed better as a result of a “survival effect,” with only those children with less aggressive disease surviving.
The Bright Futures Training Intervention Project: Implementing Systems to Support Preventive and Developmental Services in Practice
Authors: Lannon Carole M. , Flower Kori , Duncan Paula , Moore Karen Strazza , Stuart Jayne , Bassewitz Jane
Published: July 2008

OBJECTIVES. The objectives of this study were to assess the feasibility of implementing a bundle of strategies to facilitate the use of Bright Futures recommendations and to evaluate the effectiveness of a modified learning collaborative in improving preventive and developmental care.

METHODS. Fifteen pediatric primary care practices from 9 states participated in a 9-month learning collaborative. Support to practices included a toolkit, 2 workshops, training in quality-improvement methods, monthly conference calls and data feedback, and a listserv moderated by faculty. Aggregated medical chart reviews and practice self-assessments on 6 key office system components were compared before and after the intervention.

RESULTS. Office system changes most frequently adopted were use of recall/reminder systems (87%), a checklist to link to community resources (80%), and systematic identification of children with special health care needs (80%). From baseline to follow-up, increases were observed in the use of recall/reminder systems, the proportion of children's charts that had a preventive services prompting system, and the families who were asked about special health care needs. Of 21 possible office system components, the median number used increased from 10 to 15. Comparing scores between baseline and follow-up for each practice site, the change was significant. Teams reported that the implementation of office systems was facilitated by the perception that a component could be applied quickly and/or easily. Barriers to implementation included costs, the time required, and lack of agreement with the recommendations.

CONCLUSIONS. This project demonstrated the feasibility of implementing specific strategies for improving preventive and developmental care for young children in a wide variety of practices. It also confirmed the usefulness of a modified learning collaborative in achieving these results. This model may be useful for disseminating office system improvements to other settings that provide care for young children.
Pneumococcal Mastoiditis in Children and the Emergence of Multidrug-Resistant Serotype 19A Isolates
Authors: Ongkasuwan Julina , Valdez Tulio A. , Hulten Kristina G. , Mason Edward O. , Kaplan Sheldon L.
Published: July 2008

OBJECTIVE. We review the impact of pneumococcal conjugate vaccine on pneumococcal mastoiditis in children at Texas Children's Hospital.

METHODS. The medical charts (including the number of pneumococcal conjugate vaccine doses) for children with pneumococcal mastoiditis treated at Texas Children's Hospital between January 1995 and June 2007 were reviewed retrospectively. Isolates were serotyped with the capsular swelling method. Pulsed-field gel electrophoresis was performed on the 19A isolates and multilocus sequence typing on selected 19A clones.

RESULTS. Forty-one pneumococcal mastoiditis cases were identified, and 19A (n = 19) was the most common serotype. Before the introduction of pneumococcal conjugate vaccine (from 1995 to December 1999), 0 of 12 cases were 19A. Between April 2000 and October 2006, 15 cases of pneumococcal mastoiditis occurred, and 5 were 19A. Fourteen cases of pneumococcal mastoiditis occurred between November 2006 and June 2007, all of which were 19A. Mastoiditis caused by 19A isolates was more likely to present with subperiosteal abscess and was more likely to need intraoperative mastoidectomy than was mastoiditis caused by non-19A isolates. Multidrug resistance was also common among the 19A isolates; 13 (68%) of the 19A isolates were resistant to all antibiotics tested routinely. Pulsed-field gel electrophoresis analysis placed 14 (74%) of the 19 serotype 19A isolates into a highly related group; 12 isolates were classified as closely related, and 2 were possibly related. Multilocus sequence typing analysis placed the pulsed-field gel electrophoresis cluster isolates into clonal complex 271 (sequence types 320 and 1451).

CONCLUSIONS. At Texas Children's Hospital, 19A has become the predominant serotype causing pneumococcal mastoiditis, partly related to the emergence of multidrug-resistant clonal complex 271 strains. Subperiosteal abscesses and the need for mastoidectomy were more common in children with mastoiditis caused by serotype 19A isolates, compared with isolates of other serotypes.
Patterns of Cerebral Injury and Neurodevelopmental Outcomes After Symptomatic Neonatal Hypoglycemia
Authors: Burns Charlotte M. , Rutherford Mary A. , Boardman James P. , Cowan Frances M.
Published: July 2008

BACKGROUND. Symptomatic neonatal hypoglycemia may be associated with later neurodevelopmental impairment. Brain injury patterns identified on early MRI scans and their relationships to the nature of the hypoglycemic insult and neurodevelopmental outcomes are poorly defined.

METHODS. We studied 35 term infants with early brain MRI scans after symptomatic neonatal hypoglycemia (median glucose level: 1 mmol/L) without evidence of hypoxic-ischemic encephalopathy. Perinatal data were compared with equivalent data from 229 term, neurologically normal infants (control subjects), to identify risk factors for hypoglycemia. Neurodevelopmental outcomes were assessed at a minimum of 18 months.

RESULTS. White matter abnormalities occurred in 94% of infants with hypoglycemia, being severe in 43%, with a predominantly posterior pattern in 29% of cases. Cortical abnormalities occurred in 51% of infants; 30% had white matter hemorrhage, 40% basal ganglia/thalamic lesions, and 11% an abnormal posterior limb of the internal capsule. Three infants had middle cerebral artery territory infarctions. Twenty-three infants (65%) demonstrated impairments at 18 months, which were related to the severity of white matter injury and involvement of the posterior limb of the internal capsule. Fourteen infants demonstrated growth restriction, 1 had macrosomia, and 2 had mothers with diabetes mellitus. Pregnancy-induced hypertension, a family history of seizures, emergency cesarean section, and the need for resuscitation were more common among case subjects than control subjects.

CONCLUSIONS. Patterns of injury associated with symptomatic neonatal hypoglycemia were more varied than described previously. White matter injury was not confined to the posterior regions; hemorrhage, middle cerebral artery infarction, and basal ganglia/thalamic abnormalities were seen, and cortical involvement was common. Early MRI findings were more instructive than the severity or duration of hypoglycemia for predicting neurodevelopmental outcomes.
Child Care Problems and Employment Among Families With Preschool-Aged Children With Autism in the United States
Authors: Montes Guillermo , Halterman Jill S.
Published: July 2008

BACKGROUND. The impact of childhood autism on parental employment is largely unknown.

OBJECTIVE. The purpose of this work was to describe the child care arrangements of children with autism and to determine whether families of preschool-aged children with autism are more likely to report that child care arrangements affected employment compared with typically developing children and children at high risk for developmental problems.

METHODS. Parents of 16282 preschool-aged children were surveyed by the National Survey of Children's Health. An autism spectrum disorder was defined as an affirmative response to the question, “Has a doctor or health professional ever told you that [child] has any of the following conditions? Autism?” There were 82 children with autism spectrum disorder in the sample, and 1955 children at high risk on the basis of the Parent's Evaluation of Developmental Status. We used χ2 and multivariate logistic regression analyses.

RESULTS. Ninety-seven percent of preschool-aged children diagnosed with autism spectrum disorder were cared for in community settings, particularly preschool and Head Start, with only 3% in exclusive parental care. Thirty-nine percent of the parents of children with autism spectrum disorder reported that child care problems had greatly affected their employment decisions, compared with 16% of the children at high risk and 9% of those who were typically developing. In multivariate analyses, families with a child with autism spectrum disorder were 7 times more likely to state that child care problems affected employment than other families, after controlling for household and child covariates. This effect was 3 times larger than the effect of poverty.

CONCLUSIONS. Developmental problems and autism spectrum disorder are associated with higher use of child care services and higher probability that child care problems will greatly affect employment. These findings warrant evaluation of the community resources available to families with children with special needs.