bluuebunny/crossref_metadata_2025 huggingface dataset:
A Randomized Trial of Granulocyte-Macrophage Colony-Stimulating Factor in Neonates With Sepsis and Neutropenia
Authors: MD Kemal Bi˙lgi˙n, , Yaramiş Ahmet , Haspolat Kenan , Taş M. Ali , Günbey Sacit , Derman Orhan
Published: August 2004

Objectives.

To determine whether adjunctive therapy with recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) could reverse sepsis-associated neonatal neutropenia and improve neonatal survival and to assess its safety compared with conventional therapy in a control group.

Study Design.

This prospective, randomized, controlled trial was performed in 60 infants with neutropenia and clinical signs of sepsis. A subcutaneous injection of rhGM-CSF (5 μg/kg/day) was administered to 30 of the patients for 7 consecutive days. Hematologic parameters (absolute neutrophil, eosinophil, monocyte, lymphocyte counts, and platelet number) and outcome were compared with 30 conventionally treated (control) patients.

Results.

Twenty-five patients from the GM-CSF-treated group and 24 from the conventionally treated group had early-onset sepsis (≤3 days' postnatal age), and the other 11 patients had late-onset sepsis (>3 days' postnatal age). There was no difference between groups in terms of birth weight; gestational age; gender; maturity; maternal age; and incidence of prolonged rupture of membranes, maternal hypertension, or severity of sepsis. All neonates tolerated GM-CSF well with no adverse reactions. The absolute neutrophil count on day 7 was significantly increased in the GM-CSF-treated group compared with the conventionally treated group: 8088 ± 2822/mm3 versus 2757 ± 823/mm3. The mean platelet count was significantly higher on days 14 in the GM-CSF-treated group compared with conventionally treated group: 266 867 ± 55 102/mm3versus 229 200 ± 52 317/mm3. Hematologic parameters were otherwise similar between groups before treatment and on day 28. Twenty-seven neonates in the rh-GMCSF group and 21 in the control group survived to hospital discharge. The mortality rate in the rhGM-CSF group (10%) was significantly lower than in the conventionally treated group (30%).

Conclusion.

Treatment with rhGM-CSF is associated with an increase in absolute neutrophil, eosinophil, monocyte, lymphocyte, and platelet counts and decreased mortality in critically ill septic neutropenic neonates. These results suggest that rhGM-CSF may be effective in the treatment of neonatal sepsis with neutropenia, and further randomized trials are needed to confirm its beneficial effects.
Serological Screening for Celiac Disease in Healthy 2.5-Year-Old Children in Sweden
Authors: Carlsson Anneli K. , Axelsson Irene E. M. , Borulf Stefan K. , Bredberg Anders C. A. , Ivarsson Sten-A.
Published: August 2004

Objective.

The study was designed to investigate the prevalence of celiac disease (CD) among 2.5-year-old children in a Swedish urban population with a high incidence of CD.

Material and Methods.

Six hundred ninety apparently healthy children, born in the 12-month period of July 1992 through June 1993, were screened for immunoglobulin A (IgA) antigliadin antibodies and IgA antiendomysium antibodies, and those antibody-positive at repeated testing were further investigated with intestinal biopsy.

Results.

Of the 690 children, 6 were both IgA antigliadin antibody- and IgA antiendomysium antibody-positive, and 7 were antiendomysium antibody-positive but antigliadin antibody-negative. Jejunal biopsy, performed in 12 cases, manifested partial or total villous atrophy in 8 cases. Thus, together with an additional child whose parents declined the offered biopsy, but whose response to a gluten-free diet confirmed the presence of CD, the prevalence of CD in the study series was 1.3% (9/690; 95% confidence interval: .4–2.2). However, independent of the study, an additional 22 cases of symptomatic, biopsy-verified CD have already been detected in the birth cohort of 3004 children.

Conclusions.

The prevalence of CD in our study series was high, at least 1.0%, but may be as high as 2.0% if the frequency of silent CD is as high as we have found in the remaining unscreened cohort. These findings confirm that CD is one of the most common chronic disorders.
Weight Status, Parent Reaction, and Self-Concept in Five-Year-Old Girls
Authors: Davison Kirsten Krahnstoever , Birch Leann Lipps
Published: August 2004

Objective.

This study examined the relationship between weight status and self-concept in a sample of preschool-aged girls and whether parental concern about child overweight or restriction of access to food are associated with negative self-evaluations among girls.

Method.

Participants were 197 5-year-old girls and their parents. Girls' weight status (weight for height percentile) was calculated based on height and weight measurements. Girls' self-concept was assessed using an individually administered questionnaire. Parents' concern about their child's weight status and restriction of their child's access to food were assessed using a self-report questionnaire.

Results.

Girls with higher weight status reported lower body esteem and lower perceived cognitive ability than did girls with lower weight status. Independent of girl's weight status, higher paternal concern about child overweight was associated with lower perceived physical ability among girls; higher maternal concern about child overweight was associated with lower perceived physical and cognitive ability among girls. Finally, higher maternal restriction of girls' access to foods was associated with lower perceived physical and cognitive ability among girls with higher weight status but not among girls with lower weight status.

Conclusions.

At least as early as age 5 years, lower self-concept is noted among girls with higher weight status. In addition, parents' concern about their child's weight status and restriction of access to food are associated with negative self-evaluations among girls. Public health programs that raise parental awareness of childhood overweight without also providing constructive and blame-free alternatives for addressing child weight problems may be detrimental to children's mental health.
Varicella Outbreak at a Summer Camp for Human Immunodeficiency Virus-Infected Children
Authors: Winquist Andrea G. , Roome Aaron , Hadler James
Published: August 2004

Objectives.

Varicella can result in severe, persistent, or recurrent disease in human immunodeficiency virus (HIV)-infected children. In the summer of 1997, we were notified of a suspected varicella outbreak among attendees of a summer camp for HIV-infected children. We investigated this outbreak to determine the extent and sequelae of the outbreak, and to identify factors that contributed to the outbreak to identify measures for preventing such outbreaks at the camp in the future.

Design.

To identify varicella-susceptible persons and those developing varicella after camp and to evaluate the camp's varicella prevention measures, we reviewed camp records for the 110 campers and 96 staff at the implicated camp session, mailed questionnaires to the campers' parents/guardians and physicians, and interviewed susceptible staff. We defined a case as varicella in a person who attended the session with onset ≤21 days after the session ended.

Results.

Eleven of 31 susceptible children (36%) and 2 of 4 susceptible adults developed varicella. Two children were hospitalized. One developed cellulitis. Cases occurred among children in 5 of 15 cabins. The most likely index case was a child with active zoster at camp, reported to the camp after the session ended. The camp had varicella-prevention measures in place, but the varicella-susceptibility and exposure information provided to the camp was often incomplete or inaccurate. Staff with no varicella history underwent serologic testing, but susceptible staff members were not vaccinated.

Conclusions.

Widespread varicella transmission occurred at the camp. A case of zoster was the most likely source. The risk for such outbreaks can be minimized through vaccinating susceptible staff members, considering vaccination for asymptomatic or mildly symptomatic HIV-infected children according to Advisory Committee on Immunization Practices and American Academy of Pediatrics guidelines, rigorously collecting recent varicella and zoster exposure information, excluding anyone with active varicella or zoster or with recent varicella or zoster exposure, and considering varicella and zoster exposures at camp to be potentially camp-wide. varicella, human immunodeficiency virus infections, disease outbreaks, intravenous immunoglobulin.
The Impact of Record Scattering on the Measurement of Immunization Coverage
Authors: Stokley Shannon , Rodewald Lance E. , Maes Edmond F.
Published: August 2004

Background.

Lack of a consolidated immunization record may lead to problems with determining individual immunization needs at office visits as well as measuring vaccination coverage levels of a clinician's practice or a community's population.

Objectives.

For children with multiple immunization providers, evaluate the difference in coverage levels using data from all responding immunization providers compared with: 1) the most recent immunization provider's records, 2) the first immunization provider's records, and 3) a randomly selected immunization provider's records. Identify characteristics of the most recent provider that may be associated with reporting incomplete immunization histories.

Methods.

Data from the 1995 National Immunization Provider Record Check Study (NIPRCS) were used for analysis. The NIPRCS is a provider validation study of the household reported immunization histories of all children 19 to 35 months of age included in the National Health Interview Survey (NHIS). Providers identified by the child's parent during the NHIS interview are mailed a 2-page survey to report all immunizations (type and date) the child received, regardless of the provider who administered the shots, and child's first and most recent visit dates to the practice.

Results.

Of the 1352 children with provider data, 304 (22%) had received immunizations from more than one provider. Compared with information from all providers and depending on the vaccine, the most recent provider records underestimated coverage by 9.6 to 13.4 percentage points; the initial provider records underestimated coverage by 15.6 to 34.6 percentage points; and the randomly selected provider records underestimated coverage by 10.0 to 20.7 percentage points. Public facilities and having an immunization summary sheet in the patient's chart were associated with having complete records.

Conclusion.

Scattered immunization records significantly compromise the ability of clinicians to determine the immunization status of their patients who received immunizations at other sites of health care. Routinely assessing immunization coverage levels at the practice level, implementing a recall system, and developing community-wide immunization registries are some strategies to reduce the problem of scattered immunization records. immunization, assessment, provider validation, record scattering.
Very Low Birth Weight Outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1995 Through December 1996
Authors: Lemons James A. , Bauer Charles R. , Oh William , Korones Sheldon B. , Papile Lu-Ann , Stoll Barbara J. , Verter Joel , Temprosa Marinella , Wright Linda L. , Ehrenkranz Richard A. , Fanaroff Avroy A. , Stark Ann , Carlo Waldemar , Tyson Jon E. , Donovan Edward F. , Shankaran Seetha , Stevenson David K. ,   for the NICHD Neonatal Research Network
Published: August 2004

Objectives.

To determine the mortality and morbidity for infants weighing 401 to 1500 g (very low birth weight [VLBW]) at birth by gestational age, birth weight, and gender.

Study Design.

Perinatal data were collected prospectively on an inborn cohort from January 1995 through December 1996 by 14 participating centers of the National Institute of Child Health and Human Development Neonatal Research Network and were compared with the corresponding data from previous reports. Sociodemographic factors, perinatal events, and the neonatal course to 120 days of life, discharge, or death were evaluated.

Results.

Eighty four percent of 4438 infants weighing 501 to 1500 g at birth survived until discharge to home or to a long-term care facility (compared with 80% in 1991 and 74% in 1988). Survival to discharge was 54% for infants 501 to 750 g at birth, 86% for those 751 to 1000 g, 94% for those 1001 to 1250 g, and 97% for those 1251 to 1500g. The incidence of chronic lung disease (CLD; defined as receiving supplemental oxygen at 36 weeks' postmenstrual age; 23%), proven necrotizing enterocolitis (NEC; 7%), and severe intracranial hemorrhage (ICH; grade III or IV; 11%) remained unchanged between 1991 and 1996. Furthermore, 97% of all VLBW infants and 99% of infants weighing <1000 g at birth had weights less than the 10th percentile at 36 weeks' postmenstrual age.

Mortality for 195 infants weighing 401 to 500 g was 89%, with nearly all survivors developing CLD. Mortality in infants weighing 501 to 600 g was 71%; among survivors, 62% had CLD, 35% had severe ICH, and 15% had proven NEC.

Conclusions.

Survival for infants between 501 and 1500 g at birth continued to improve, particularly for infants weighing <1000 g at birth. This improvement in survival was not associated with an increase in major morbidities, because the incidence of CLD, proven NEC, and severe ICH did not change. However, poor postnatal growth remains a major concern, occurring in 99% of infants weighing <1000 g at birth. Mortality and major morbidity (CLD, severe ICH, and NEC) remain high for the smallest infants, particularly those weighing <600 g at birth.
Placebo-Controlled Evaluation of Amphetamine Mixture—Dextroamphetamine Salts and Amphetamine Salts (Adderall): Efficacy Rate and Side Effects
Authors: Ahmann Peter A. , Theye Fred W. , Berg Richard , Linquist Ann J. , Van Erem Alayne J. , Campbell Lois R.
Published: August 2004

Objective.

The primary objective of this study was to determine the efficacy rate of Adderall in children newly diagnosed with attention-deficit/hyperactivity disorder (ADHD). A secondary objective was to address the severity of side effects associated with Adderall treatment in children with ADHD using the Barkley Side Effects Questionnaire (BSEQ).

Design.

Randomized, double-blind, placebo-controlled crossover trial.

Setting.

A large rural tertiary care clinic.

Patients.

Participants were prospectively recruited from children 5 to 18 years of age referred for academic and/or attention problems; 154 children who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for ADHD were enrolled.

Interventions.

Two doses of Adderall (0.15 mg/kg/dose and 0.3 mg/kg/dose) were compared with placebo in separate 2-week trials. Participants received each dosage regimen twice daily for 7 consecutive days.

Measurements and Main Results.

Efficacy rates were determined by comparing Adderall with placebo during the low-dose crossover sequence and also during the high-dose crossover sequence. The criteria that defined a positive response to Adderall relative to placebo (with each patient serving as their own control) included an indication of response by at least 1 of 2 parent measures of children's behavior or at least 2 of 5 teacher measures of children's behavior. The Adderall efficacy rate was determined based on parent criteria alone, teacher criteria alone, and by a more stringent definition of response that required concurrence between parent and teacher criteria. The Adderall response rate in this study ranged from 59% when requiring concurrence between parent and teacher observers, to 82% when based on parent criteria alone. Overall, 137 of 154 participants (89%) showed a positive response by either the parent or teacher response criteria.

Parents completed a modified version of the BSEQ during each week of the trial. Appetite, stomachaches, and insomnia were rated as worse by parents while children were receiving either dose of Adderall; headaches were rated as worse when children were receiving the higher dose of Adderall. Parents rated certain side effects, including staring/daydreaming, sadness, euphoria, and anxious/irritable, as worse during placebo regimens.

Conclusions.

We found that Adderall is highly efficacious in our population of youth diagnosed with ADHD. In addition, Adderall is well-tolerated with a side effect profile similar to that reported for other psychostimulants.
Successful Treatment of Antiepileptic Drug Hypersensitivity Syndrome With Intravenous Immune Globulin
Authors: Scheuerman Oded , Nofech-Moses Yehuda , Rachmel Avinoam , Ashkenazi Shai
Published: August 2004

Intravenous immune globulin (IVIG) has proved beneficial for severe immunologically related cutaneous adverse reactions. We report a child with severe antiepileptic drug hypersensitivity syndrome who was successfully treated with IVIG. IVIG should be considered in the pharmacologic armamentarium of severe antiepileptic drug hypersensitivity syndrome. antiepileptic drugs, hypersensitivity, immune globulin.
A Randomized, Double-Blind Study of Triple Nucleoside Therapy of Abacavir, Lamivudine, and Zidovudine Versus Lamivudine and Zidovudine in Previously Treated Human Immunodeficiency Virus Type 1-Infected Children
Authors: Sáez-Llorens Xavier , Nelson Robert P. , Emmanuel Patricia , Wiznia Andrew , Mitchell Charles , Church Joseph A. , Sleasman John , Van Dyke Russell , Richardson Carol Gilbert , Cutrell Amy , Spreen William , Hetherington Seth ,   the CNAA3006 Study Team
Published: August 2004

Objectives.

Abacavir (ABC) is a potent inhibitor of human immunodeficiency virus type 1 (HIV-1) reverse transcriptase. We compared the efficacy, safety, and tolerability of combination therapy with ABC, lamivudine (3TC), and zidovudine (ZDV) versus 3TC and ZDV in antiretroviral experienced HIV-1-infected children over 48 weeks.

Methods.

Two hundred five HIV-1-infected children who had received previous antiretroviral therapy and had CD4+ cell counts ≥100 cells/mm3 were stratified by age and by previous treatment. Participants were randomly assigned to receive ABC (8 mg/kg twice daily [BID]) plus 3TC (4 mg/kg BID) and ZDV (180 mg/m2 BID; ABC/3TC/ZDV group) or ABC placebo plus 3TC (4 mg/kg BID) and ZDV (180 mg/m2; 3TC/ZDV group). Participants who met a protocol-defined switch criteria (plasma HIV-1 RNA >0.5 log10 copies/mL above baseline at week 8 or >10 000 copies/mL after week 16) had the option to switch to open-label ABC plus any antiretroviral combination or continue randomized therapy or withdraw from the study.

Results.

The Kaplan-Meier estimates (95% confidence interval) of the proportion of participants who maintained HIV-1 RNA levels ≤10 000 copies/mL for 48 weeks or more was significantly better in the ABC/3TC/ZDV group compared with the 3TC/ZDV group: 33% (23%–42%) versus 21% (13%–29%). At week 48, the proportions of participants with HIV-1 RNA ≤10 000 copies/mL were 36% versus 26% for the ABC/3TC/ZDV and 3TC/ZDV groups, respectively, by intent-to-treat analysis. For the subgroup of participants with baseline HIV-1 RNA >10 000 copies/mL, a significantly higher proportion of participants in the ABC/3TC/ZDV group had HIV-1 RNA ≤10 000 copies/mL compared with the 3TC/ZDV group (29% vs 12%) but no difference was observed in the subgroup of participants with baseline HIV-1 RNA ≤10 000 copies/mL (78% vs 72%). The median changes from baseline in CD4+ cell counts were greater in the ABC/3TC/ZDV group than in the 3TC/ZDV group. Few participants (3%) experienced abacavir-related hypersensitivity reaction.

Conclusions.

ABC, in combination with 3TC and ZDV, provides additional antiretroviral activity over 48 weeks, compared with combination therapy with 3TC and ZDV in antiretroviral experienced HIV-1-infected children. ABC was safe and generally well-tolerated and should be considered an active component of combination antiretroviral therapy in this pediatric population.
Safety of Late In Utero Exposure to Zidovudine in Infants Born to Human Immunodeficiency Virus-Infected Mothers: Bangkok
Authors: Chotpitayasunondh Tawee , Vanprapar Nirun , Simonds R. J. , Chokephaibulkit Kulkanya , Waranawat Naris , Mock Philip , Stat M App , Chuachoowong Rutt , Young Nancy , Mastro Timothy D. , Shaffer Nathan ,   for the Bangkok Collaborative Perinatal HIV Transmission Study Group
Published: August 2004

Background.

Short-course zidovudine (ZDV) given in the late antenatal period can reduce mother–infant human immunodeficiency virus (HIV) transmission by one half. Because this intervention is being implemented in developing countries, evidence of its safety is needed.

Methods.

In a randomized, double-blinded, placebo-controlled trial in Bangkok, HIV-infected pregnant women received either ZDV (300 mg twice daily from 36 weeks' gestation until labor, then every 3 hours until delivery) or an identical placebo regimen. Infants were evaluated at birth and at 1, 2, 4, 6, 9, 12, 15, and 18 months of age. Growth, clinical events, and hematologic and immunologic measurements were compared between treatment groups.

Results.

Of the 395 children born (196 in ZDV group and 199 in placebo group), 330 were uninfected, 55 were infected, and 10 had indeterminate infection status. Overall, 319 children (81%) completed 18 months of follow-up, and 14 (4%) died before 18 months of age. Among uninfected children, the mean hematocrit was lower in the ZDV group at birth (49.1% vs 51.5%) but not at later ages; mean weight, height, head circumference, and CD4+ and CD8+ T lymphocyte counts were similar in both groups at all ages. Five uninfected children in the ZDV group but only one in the placebo group had a febrile convulsion. No other signs suggestive of mitochondrial dysfunction and no tumors were observed. Among infected children, an estimated 62% in the ZDV group and 77% in the placebo group survived free of Centers for Disease Control and Prevention class C disease during the 18-month follow-up.

Conclusions.

No significant adverse events were associated with short-course ZDV during 18 months of follow-up in this population.
The Effect of a Community Intervention Trial on Parental Knowledge and Awareness of Antibiotic Resistance and Appropriate Antibiotic Use in Children
Authors: Trepka Mary Jo , Belongia Edward A. , Chyou Po-Huang , Davis Jeffrey P. , Schwartz Benjamin
Published: August 2004

Background.

Overuse of antibiotics for children's upper respiratory infections is widespread and contributes to the emergence of antibiotic-resistant bacteria.

Objective.

To assess changes in knowledge and awareness regarding antibiotic resistance and appropriate antibiotic use after community-wide educational interventions to reduce inappropriate antibiotic use.

Design.

Baseline survey conducted during June through July 1997 and postintervention survey of baseline participants during June through August 1998.

Setting.

Communities in northern Wisconsin.

Participants.

Parents of 729 randomly selected children <4 years of age were called until 215 in each of the intervention and control areas were reached. Of the 430 baseline participants, 365 (85%) participated in the postintervention survey.

Intervention.

Parent-oriented activities included distribution of materials and presentations. Physician-oriented activities included formal presentations and small group meetings.

Outcome Measure.

Change in awareness about antibiotic resistance and knowledge about antibiotic indications.

Results.

A higher proportion of parents in the intervention area (53%) were exposed to 2 or more local educational messages, compared with the control area (23%). From the baseline to the postintervention survey, the percentage of parents with a high degree of antibiotic resistance awareness increased more in the intervention area (58% to 73%) than in the control area (60% to 65%). In the intervention area, there was also a larger increase in knowledge regarding appropriate indications for antibiotic use, compared with the control area. The proportion of parents who expected an antibiotic for their child and did not receive one declined in the intervention area (14% to 9%), while it increased in the control area (7% to 10%). In addition, the percentage of parents in the intervention area who brought their child to another physician because they did not receive an antibiotic decreased (5% to 2%), while it increased in the control area (2% to 4%).

Conclusion.

Parental knowledge and awareness about antibiotic indications and antibiotic resistance can be changed with educational interventions directed at parents and clinicians.
Relationships Between Use of Television During Meals and Children's Food Consumption Patterns
Authors: Coon Katharine A. , Goldberg Jeanne , Rogers Beatrice L. , Tucker Katherine L.
Published: August 2004

Objective.

We examined relationships between the presence of television during meals and children's food consumption patterns to test whether children's overall food consumption patterns, including foods not normally advertised, vary systematically with the extent to which television is part of normal mealtime routines.

Methods.

Ninety-one parent–child pairs from suburbs adjacent to Washington, DC, recruited via advertisements and word of mouth, participated. Children were in the fourth, fifth, or sixth grades. Socioeconomic data and information on television use were collected during survey interviews. Three nonconsecutive 24-hour dietary recalls, conducted with each child, were used to construct nutrient and food intake outcome variables. Independent samplet tests were used to compare mean food and nutrient intakes of children from families in which the television was usually on during 2 or more meals (n = 41) to those of children from families in which the television was either never on or only on during one meal (n = 50). Multiple linear regression models, controlling for socioeconomic factors and other covariates, were used to test strength of associations between television and children's consumption of food groups and nutrients.

Results.

Children from families with high television use derived, on average, 6% more of their total daily energy intake from meats; 5% more from pizza, salty snacks, and soda; and nearly 5% less of their energy intake from fruits, vegetables, and juices than did children from families with low television use. Associations between television and children's consumption of food groups remained statistically significant in multiple linear regression models that controlled for socioeconomic factors and other covariates.

Children from high television families derived less of their total energy from carbohydrate and consumed twice as much caffeine as children from low television families. There continued to be a significant association between television and children's consumption of caffeine when these relationships were tested in multiple linear regression models.

Conclusion.

The dietary patterns of children from families in which television viewing is a normal part of meal routines may include fewer fruits and vegetables and more pizzas, snack foods, and sodas than the dietary patterns of children from families in which television viewing and eating are separate activities.
Brain Proton Magnetic Resonance Spectroscopy and Imaging in Children Exposed to Cocaine in Utero
Authors: Smith Lynne M. , Chang Linda , Yonekura M. Lynn , Gilbride Kathleen , Kuo Jennifer , Poland Russell E. , Walot Irwin , Ernst Thomas
Published: August 2004

Objective.

The effects of prenatal cocaine exposure have been examined using neurobehavioral and brain structural evaluations; however, no study has examined the effects of prenatal cocaine on brain metabolism. Proton magnetic resonance spectroscopy (1H-MRS) is a noninvasive method to examine the biochemistry of various brain regions. The purpose of this study was to examine the possible neurotoxic effects of prenatal cocaine exposure on the developing brain using 1H-MRS.

Methods.

Cocaine-exposed children (n = 14) and age-matched unexposed control participants (n = 12) were evaluated with MRI and localized1H-MRS. Metabolite concentrations ofN-acetyl-containing compounds (NA), total creatine (Cr), choline-containing compounds, myoinositol, and glutamate + glutamine were measured in the frontal white matter and striatum.

Results.

Despite an absence of structural abnormalities in either group, children exposed to cocaine in utero had significantly higher Cr (+13%) in the frontal white matter. NA, primarily a measure of N-acetyl aspartate and neuronal content, was normal in both regions examined by 1H-MRS. Normal NA suggests no significant neuronal loss or damage in the 2 brain regions examined in children exposed to cocaine prenatally.

Conclusions.

Consistent with findings in abstinent adult cocaine users, we found increased Cr in the frontal white matter, with normal NA in children exposed to cocaine. These findings suggest the need to investigate further possible abnormalities of energy metabolism in the brain of children exposed to cocaine in utero. In addition, this study demonstrates the feasibility of using 1H-MRS to investigate the effects of prenatal drug exposure on the developing brain.
Long-Term Safety and Efficacy of a Cholesterol-Lowering Diet in Children With Elevated Low-Density Lipoprotein Cholesterol: Seven-Year Results of the Dietary Intervention Study in Children (DISC)
Authors: Obarzanek Eva , Kimm Sue Y. S. , Barton Bruce A. , Van Horn Linda , Kwiterovich Peter O. , Simons-Morton Denise G. , Hunsberger Sally A. , Lasser Norman L. , Robson Alan M. , Franklin Frank A. , Lauer Ronald M. , Stevens Victor J. , Friedman Lisa Aronson , Dorgan Joanne F. , Greenlick Merwyn R. ,   on Behalf of the DISC Collaborative Research Group
Published: August 2004

Objective.

Diets reduced in fat and cholesterol are recommended for children over 2 years of age, yet long-term safety and efficacy are unknown. This study tests the long-term efficacy and safety of a cholesterol-lowering dietary intervention in children.

Methods.

Six hundred sixty-three children 8 to 10 years of age with elevated low-density lipoprotein cholesterol (LDL-C) were randomized to a dietary intervention or usual care group, with a mean of 7.4 years' follow-up. The dietary behavioral intervention promoted adherence to a diet with 28% of energy from total fat, <8% from saturated fat, up to 9% from polyunsaturated fat, and <75 mg/1000 kcal cholesterol per day. Serum LDL-C, height, and serum ferritin were primary efficacy and safety outcomes.

Results.

Reductions in dietary total fat, saturated fat, and cholesterol were greater in the intervention than in the usual care group throughout the intervention period. At 1 year, 3 years, and at the last visit, the intervention compared with the usual care group had 4.8 mg/dL (.13 mmol/L), 3.3 mg/dL (.09 mmol/L), and 2.0 mg/dL (.05 mmol/L) lower LDL-C, respectively. There were no differences at any data collection point in height or serum ferritin or any differences in an adverse direction in red blood cell folate, serum retinol and zinc, sexual maturation, or body mass index.

Conclusion.

Dietary fat modification can be achieved and safely sustained in actively growing children with elevated LDL-C, and elevated LDL-C levels can be improved significantly up to 3 years. Changes in the usual care group's diet suggest that pediatric practices and societal and environmental forces are having positive public health effects on dietary behavior during adolescence.
Comprehensive Mutation Screening in a Cystic Fibrosis Center
Authors: Wine Jeffrey J. , Kuo Eugene , Hurlock Gregory , Moss Richard B.
Published: August 2004

Objectives and Background.

The identities of a cystic fibrosis (CF) patient's CFTRmutations can influence therapeutic strategies, but because >800CFTR mutations exist, cost-effective, comprehensive screening requires a multistage approach. Single-strand conformation polymorphism and heteroduplex analysis (SSCP/HA) can be an important part of mutation detection, but must be calibrated within each laboratory. The sensitivity of a combined commercial-SSCP/HA approach to genotyping in a large, ethnically diverse US center CF population has not been established.

Study Design.

We screened all 27 CFTR exons in 10 human participants who had an unequivocal CF diagnosis including a positive sweat chloride test and at least 1 unknown allele after commercial testing for the 70 most common mutations by SSCP/HA. These participants were compared with 7 participants who had negative sweat tests but at least 1 other CF-like symptom meriting complete genotyping.

Results.

For the 10 CF participants, we detected 11 of 16 unknown alleles (69%) and all 4 of the known alleles (100%), for an overall rate of 75% inpatients not fully genotyped by conventional 70 mutation screen. For 7 participants with negative sweat tests, we confirmed 1 identified mutation in 14 alleles and detected 3 additional mutations. Mutations detected in both groups included 7 missense mutations (S13F, P67L, G98R, S492F, G970D, L1093P, N1303K) and 9 deletion, frameshift, nonsense or splicing mutations (R75X, G542X, ΔF508, 451–458Δ8 bp, 5T, 663ΔT, exon 13 frameshift, 1261+1G→A and 3272–26A→G). Three of these mutations were novel (G970D, L1093P, and 451–458Δ8 bp1). Thirteen other changes were detected, including the novel changes 1812–3 ins T, 4096–278 ins T, 4096–265 ins TG, and 4096–180 T→G.

Conclusion.

When combined with the 70 mutation Genzyme test, SSCP/HA analysis allows for detection of >95% of the mutations in an ethnically heterogeneous CF center population. We discuss 5 possible explanations that could account for the few remaining undetected mutations.
Emergency Contraception: Pediatricians' Knowledge, Attitudes, and Opinions
Authors: Golden Neville H. , Seigel Warren M. , Fisher Martin , Schneider Marcie , Quijano Emilyn , Suss Amy , Bergeson Rachel , Seitz Michele , Saunders Deborah
Published: August 2004

Emergency contraception (EC) is the use of a method of contraception after unprotected intercourse to prevent unintended pregnancy. Although first described over 20 years ago, physician awareness of EC has been limited and many feel uncomfortable prescribing it.

Objective. To assess the knowledge, attitudes, and opinions of practicing pediatricians regarding the use of EC in adolescents.

Methods. An anonymous questionnaire was mailed to all 954 active members of New York Chapter 2, District II of the American Academy of Pediatrics. The questionnaire assessed basic knowledge, attitudes, and opinions regarding EC in adolescents. Data were analyzed by physician age, gender, year completed residency, and practice type.

Results. Two hundred thirty-three practicing pediatricians (24.4%) completed the survey. Of the respondents, 23.7% had been asked to prescribe EC to an adolescent and 49% of these cases involved a rape victim. Only 16.7% of pediatricians routinely counsel adolescent patients about the availability of EC, with female pediatricians more likely to do so. Most respondents (72.9%) were unable to identify any of the Food and Drug Administration-approved methods of EC. Only 27.9% correctly identified the timing for its initiation and only 31.6% of respondents felt comfortable prescribing EC. Inexperience with use was cited as the primary reason for not prescribing EC by 70% of respondents. Twelve percent cited moral or religious reasons and 17% were concerned about teratogenic effects. There were no differences in comfort level based on age, gender, or practice type. Twenty-two percent of respondents believed that providing EC encourages adolescent risk-taking behavior and 52.4% would restrict the number of times they would dispense EC to an individual patient. A minority of respondents (17%) believed that adolescents should have EC available at home to use if necessary and only 19.6% believed that EC should be available without a prescription. The vast majority (87.5%) were interested in learning more about EC.

Conclusions. Despite the safety and efficacy of EC, the low rate of use is of concern. Pediatricians are being confronted with the decision to prescribe EC but do not feel comfortable prescribing it because of inadequate training in its use. Practicing pediatricians are aware of their lack of experience and are interested in improving their knowledge base.
Lung Recruitment and Breathing Pattern During Variable Versus Continuous Flow Nasal Continuous Positive Airway Pressure in Premature Infants: An Evaluation of Three Devices
Authors: Courtney Sherry E. , Pyon Kee H. , Saslow Judy G. , Arnold Gerald K. , Pandit Paresh B. , Habib Robert H.
Published: August 2004

Objective.

To determine whether lung volume changes and breathing pattern parameters differ among 3 devices for delivery of nasal continuous positive airway pressure (CPAP) in premature infants.

Methods.

Thirty-two premature infants receiving nasal CPAP for apnea or mild respiratory distress were enrolled. Birth weight was (mean ± standard deviation) 1081 ± 316 g, gestational age 29 ± 2 weeks, age at study 13 ± 12 days, and fraction of inspired oxygen (Fio2) at study .29 ± .1. Three devices, applied in random order, were studied in each infant: continuous flow nasal CPAP via CPAP prongs, continuous flow nasal CPAP via modified nasal cannula, and variable flow nasal CPAP. After lung recruitment to standardize volume history, changes in lung volume (ΔVL) were assessed at nasal CPAP of 8, 6, 4, and 0 cm H2O using calibrated direct current-coupled respiratory inductance plethysmography.

Results.

ΔVL was significantly greater overall with the variable flow device compared with both the nasal cannula and CPAP prongs. However, ΔVL was not different between the cannula and the prongs. Respiratory rate, tidal volume, thoraco-abdominal asynchrony, and Fio2 were greater with the modified cannula than for either of the other 2 devices.

Conclusion.

Compared with 2 continuous flow devices, the variable flow nasal CPAP device leads to greater lung recruitment. Although a nasal cannula is able to recruit lung volume, it does so at the cost of increased respiratory effort and Fio2.
The Maternal Lifestyle Study: Drug Use by Meconium Toxicology and Maternal Self-Report
Authors: Lester Barry M. , ElSohly Mahmoud , Wright Linda L. , Smeriglio Vincent L. , Verter Joel , Bauer Charles R. , Shankaran Seetha , Bada Henrietta S. , Walls H. Chip , Huestis Marilyn A. , Finnegan Loretta P. , Maza Penelope L.
Published: August 2004

Objective.

The objective of this study was to describe drug use by pregnant women participating in the 4-site Maternal Lifestyle Study of in utero cocaine and/or opiate exposure.

Methods.

Meconium specimens of 8527 newborns were analyzed by immunoassay with GC/MS confirmation for metabolites of cocaine, opiates, cannabinoids, amphetamines, and phencyclidine. Maternal self-report of drug use was determined by hospital interview.

Results.

The prevalence of cocaine/opiate exposure in the 4 sites was 10.7% with the majority (9.5%) exposed to cocaine based on the combination of meconium analysis and maternal self-report. However, exposure status varied by site and was higher in low birth weight infants (18.6% for very low birth weight and 21.1% for low birth weight). Gas chromatography/mass spectrometry (GC/MS) confirmation of presumptive positive cocaine screens was 75.5%. In the cocaine/opiate-exposed group, 38% were cases in which the mother denied use but the meconium was positive. There was 66% agreement between positive meconium results and positive maternal report. Only 2% of mothers reported that they used only cocaine during pregnancy and mothers were 49 times more likely to use another drug if they used cocaine.

Conclusion.

Accurate identification of prenatal drug exposure is improved with GC/MS confirmation and when the meconium assay is coupled with a maternal hospital interview. However, the use of GC/MS may have different implications for research than for public policy. We caution against the use of quantitative analysis of drugs in meconium to estimate the degree of exposure. Our study also highlights the polydrug nature of what used to be thought of as a cocaine problem.
Childhood Body Composition in Relation to Body Mass Index
Authors: Maynard L. Michele , Wisemandle Wayne , Roche Alex F. , Chumlea Wm. Cameron , Guo Shumei S. , Siervogel Roger M.
Published: August 2004

Objective.

The aim is to describe body composition in relation to body mass index (BMI; body weight/stature2) to provide health care professionals insight into the meaning, significance, and limitations of BMI as an index of adiposity during childhood.

Methods.

Data from 387 healthy, white children 8 to 18 years of age from the Fels Longitudinal Study were analyzed. Measurements were scheduled annually and each child was examined 1 to 11 times, totaling 1748 observations. Total body fat (TBF) and fat-free mass (FFM) were determined from hydrodensitometry. Stature and weight were measured using standard methods and BMI and the components of BMI, TBF/stature2, and FFM/stature2 were calculated. Analyses included correlations between BMI and body composition variables; age-related patterns of BMI, TBF/stature2, and FFM/stature2; and annual changes in BMI, TBF/stature2, and FFM/stature2.

Results.

Generally, correlations between BMI and body composition variables were strong and significantly different from zero. Means for BMI throughout childhood were similar for boys and girls, although significantly larger values were observed for girls at ages 12 to 13 years. Age-related patterns of TBF/stature2and FFM/stature2 differed between sexes. In each sex, annual increases in BMI were driven primarily by increases in FFM/stature2 until late adolescence, with increases in TBF/stature2 contributing to a larger proportion of the BMI increases in girls than in boys.

Conclusions.

Unlike adults, annual increases in BMI during childhood are generally attributed to the lean rather than to the fat component of BMI. Because the properties of BMI vary during childhood, health care professionals must consider factors such as age and sex when interpreting BMI.
Maternal Prenatal Lifestyle Factors and Infectious Disease in Early Childhood: A Follow-Up Study of Hospitalization Within a Danish Birth Cohort
Authors: Yuan Wei , Basso Olga , Sørensen Henrik Toft , Olsen Jørn
Published: August 2004

Objectives.

To examine whether maternal prenatal lifestyle factors were associated with the risk of hospitalization with infectious disease during early childhood and whether a possible association was modified by fetal growth reduction.

Methods.

The study was based on a birth cohort of 10 400 newborns whose mothers attended the midwife centers in Odense and Aalborg, Denmark, from April 1984 to April 1987 at approximately the 36th week of gestation. Information on hospitalization with infectious disease was extracted from the National Hospital Discharge Registry, and newborns were followed up to the end of 1996.

Results.

Among 6022 children who were hospitalized at least once, 31.4% (n = 1892) were hospitalized with infectious diseases. The cumulative incidence rate of hospitalization with infections in children from the age of 6 months to 12 years was 18.9%. The incidence rate ratio in children born to mothers smoking during pregnancy was 1.24 (95% confidence interval: 1.13–1.36) compared with those of nonsmoking mothers. Mothers whose body mass index was <18 kg/m2 were more likely to give birth to infants who were hospitalized with infectious disease (incidence rate ratio: 1.29; 95% confidence interval: 1.05–1.59). The increased risk was present in children only up to the age of 5 years.

Conclusions.

The study shows that maternal smoking during pregnancy and a low prepregnancy body mass index are associated with a higher risk of hospitalization with infectious disease during early childhood. These associations are independent of fetal growth indicators.
Prospective Randomized Multicenter Comparison of High-Frequency Oscillatory Ventilation and Conventional Ventilation in Preterm Infants of Less Than 30 Weeks With Respiratory Distress Syndrome
Authors: Moriette Guy , Paris-Llado Josefa , Walti Hervé , Escande Benoı̂t , Magny Jean-François , Cambonie Gilles , Thiriez Gérard , Cantagrel Sylvain , Lacaze-Masmonteil Thierry , Storme Laurent , Blanc Thierry , Liet Jean-Michel , André Christine , Salanave Benoı̂t , Bréart Gérard
Published: August 2004

Background.

Early use of high-frequency ventilation and exogenous surfactant is proposed as the optimal mode of ventilatory support in infants with respiratory distress syndrome. In very premature infants, we tested the hypothesis that high-frequency versus conventional ventilation could decrease exogenous surfactant requirements and improve pulmonary outcome, without altering the complication rate, including that of severe intraventricular hemorrhage.

Methods.

Preterm infants with a postmenstrual age of 24 to 29 weeks, presenting with respiratory distress syndrome were randomly assigned to high-frequency oscillatory ventilation (lung volume recruitment strategy) or conventional ventilation.

Results.

Two hundred seventy-three infants were enrolled. One hundred fifty-three had a postmenstrual age of 24 to 27 weeks, and 143 had a birth weight ≤1000 g. One hundred thirty-four infants were randomized at 142 minutes of life (median) to receive conventional ventilation (mean postmenstrual age at birth: 27. 6 ± 1.5 weeks; mean birth weight: 997 ± 245 g); and 139 infants were randomized at 145 minutes of life to receive high-frequency ventilation (mean postmenstrual age at birth: 27.5 ± 1.4 weeks; mean birth weight: 976 ± 219 g).

High-frequency ventilation, compared with conventional ventilation, was associated with a twofold reduction in the requirement for ≥2 instillations of exogenous surfactant (30% vs 62%; odds ratio: .27; 95% confidence interval: .16–.44) and no difference in pulmonary outcome. The incidence of severe intraventricular hemorrhage was 24% in the high-frequency group and 14% in the conventional ventilation group (adjusted odds ratio: 1.50; 95% confidence interval: .68–3.30).

Conclusion.

Early use of high-frequency oscillatory ventilation in very premature infants decreases exogenous surfactant requirements, does not improve the pulmonary outcome, and may be associated with an increased incidence of severe intraventricular hemorrhage.
Care of Adolescent Parents and Their Children
Authors:   Committee on Adolescence and Committee on Early Childhood, Care Adoption, and Dependent
Published: August 2004

Many children live with their adolescent parents, alone, or as part of an extended family. This statement updates a previous statement on adolescent parents and addresses specific medical and psychosocial risks specific to adolescent parents and their children. Challenges unique to the adolescent mother and her partner, as well as mitigating circumstances and protective factors that have been identified in the recent literature, are reviewed, along with suggestions for the pediatrician on models for intervention and care.
Guidelines for Emergency Medical Care in School
Authors:   Committee on School Health
Published: August 2004

This Policy Statement was revised. See https://doi.org/10.1542/peds.2022-057987.

Minor and major illnesses and injuries can occur in children during the school day. This statement provides recommendations for emergency health care for children in school, including information about procedures, staff and their education, documentation, and parental notification.