bluuebunny/crossref_metadata_2025 huggingface dataset:
Is Chlamydia pneumoniae Infection Associated With Stroke in Children With Sickle Cell Disease?
Authors: Goyal Meenakshi , Miller Scott T. , Hammerschlag Margaret R. , Gelling Maureen , Gaydos Charlotte A. , Hardick Justin , Wood Billie Jo , Reznik Tamara , Rao S.P.
Published: August 2004

Background. Stroke is often a devastating complication of sickle cell disease (SCD). Most children with SCD-related stroke have stenotic and occlusive disease of cerebral blood vessels due to intimal hyperplasia. This hyperplasia is hypothesized to result from an inflammatory response similar to that in atherosclerosis and has been attributed to infection by Chlamydia pneumoniae.

Objective. To determine whether C pneumoniae infection is associated with stroke and cerebrovascular disease, including transient ischemic attacks and abnormal transcranial Doppler examinations, in children with SCD.

Methods. Children with SCD on chronic transfusion due to a history of stroke, transient ischemic attack, or abnormal transcranial Doppler; children with SCD without stroke; healthy controls; and children being transfused for other reasons were enrolled. Peripheral blood and nasopharyngeal (NP) swab specimens were collected from all patients. In patients on transfusion, pretransfusion specimens and samples from the unit of packed red blood cells being transfused were obtained. Peripheral blood monocytic cells (PBMCs) and NP swab specimens were cultured for C pneumoniae in HEp-2 cells. C pneumoniae polymerase chain reaction was performed on PBMCs with a nested touch-down method with primers from the omp-1gene (in duplicate) and a second real-time polymerase chain reaction by using 16S ribosomal RNA primers.

Results. C pneumoniae DNA was detected in the PBMCs of 1 of 14 (7.1%) children with SCD on chronic transfusion, 1 of 10 (10%) sickle cell controls, 1 of 10 (10%) healthy controls, and none of the 5 children receiving chronic transfusion for other reasons. It was not detected in specimens from transfusion units. One child with SCD and stroke, 1 sickle cell control, and 1 transfusion control had positive NP cultures for C pneumoniae. C pneumoniae DNA was not detected in their PBMCs, and all 3 children were asymptomatic. C pneumoniae was not detected by culture of PBMCs from any of the patients after 7 passages.

Conclusion. Stroke in children with SCD does not seem to be associated with C pneumoniae infection in our population.
Delay in Diagnosis of Slipped Capital Femoral Epiphysis
Authors: Kocher Mininder S. , Bishop Julius A. , Weed Bryce , Hresko M. Timothy , Millis Michael B. , Kim Young Jo , Kasser James R.
Published: August 2004

Objective. Delay in diagnosis of slipped capital femoral epiphysis (SCFE) has important implications in terms of slip severity and long-term hip outcome. The purpose of this study was to identify predictors of delay in the diagnosis of SCFE.

Methods. A review of 196 patients with SCFE was performed. The primary outcome measure was delay from onset of symptoms to diagnosis. Covariates included age, gender, side, weight, pain location, insurance status, family income, slip severity, and slip stability. Delay in diagnosis was not normal in distribution; therefore, nonparametric univariate and multivariate analyses were performed.

Results. The median delay in diagnosis was 8.0 weeks. There was a significant relationship between delay in diagnosis and slip severity (<30°: 10.0 weeks; 30° to 50°: 14.4 weeks; >50°: 20.6 weeks). There were no significant associations between delay in diagnosis and covariates of age, gender, side, and weight. There were significant associations between longer delay in diagnosis and covariates of knee/distal-thigh pain versus hip/proximal-thigh pain (6.0 vs 15.0 weeks), Medicaid coverage versus private insurance (12.0 vs 7.5 weeks), lower family income, and stable slips versus unstable slips (8.0 vs 6.5 weeks). Controlling for the other covariates, knee/distal-thigh pain, Medicaid insurance, and stable slips remained significant independent multivariate predictors of delay in diagnosis.

Conclusions. Patients who present with primarily knee or distal-thigh pain, patients with Medicaid coverage, and patients with stable slips have longer delays in diagnosis of SCFE. Focused intervention programs to reduce the delay in diagnosis of SCFE should emphasize patients with knee/thigh pain and patients with Medicaid coverage.
Wilms Tumor Screening Is Unnecessary in Klippel-Trenaunay Syndrome
Authors: Greene Arin K. , Kieran Mark , Burrows Patricia E. , Mulliken John B. , Kasser James , Fishman Steven J.
Published: August 2004

Background. Children with hemihypertrophy are screened for Wilms tumor, because this condition is a risk factor for developing the neoplasm. Patients with Klippel-Trenaunay syndrome (KTS) are often considered potential candidates for Wilms tumor, because they have unilateral overgrowth of the lower limb. In our experience, however, an association between KTS and Wilms tumor has not been observed.

Methods. To determine whether KTS and Wilms tumor are associated, we reviewed our institutional experience for patients with both diagnoses and searched the Klippel-Trenaunay literature for patients with Wilms tumor. The National Wilms Tumor Study Group database also was studied to identify patients with KTS. Two-sided exact binomial tests were used to evaluate whether patients with 1 condition had an increased risk for the other. Ninety-five percent confidence intervals for these 2 risks were compared with the general population risks of Wilms tumor (1 in 10 000) and KTS (1 in 47 313).

Results. None of the 115 patients with KTS followed at our institution developed Wilms tumor. One case of Wilms tumor has been reported in 1363 patients with KTS in the literature, giving a confidence interval of (1/57 377) and (1/267). None of the 8614 patients in the National Wilms Tumor Study Group database had KTS, giving a confidence interval of (0, 1/2336). Because the risks of KTS and Wilms tumor in the population fall within these confidence intervals, one cannot conclude that the risks of KTS among Wilms tumor patients or Wilms tumor among KTS patients are any different from the corresponding risks in the general population.

Conclusions. Patients with KTS are not at increased risk for developing Wilms tumor and thus should not undergo routine ultrasonographic screening.
All-Terrain Vehicle Legislation for Children: A Comparison of a State With and a State Without a Helmet Law
Authors: Keenan Heather T. , Bratton Susan L.
Published: August 2004

Background. All-terrain vehicles (ATVs) continue to be a source of morbidity and mortality in the pediatric population despite recommendations from the American Academy of Pediatrics that children <16 years old not ride in or drive ATVs. ATV injuries have increased significantly in both children and adults most years since 1997.

Objective. To assess the effectiveness of ATV regulations for children on serious injuries by comparing ATV-related admissions to level I and II trauma hospitals in a state with and a state without ATV regulations.

Design. Ecologic study.

Patients. Children <16 years old who died and/or were treated in the trauma system of Pennsylvania or North Carolina after ATV crashes.

Outcome Measures. Injury types and cause of death were examined for all children. Comparisons were made by state (Pennsylvania [regulated] and North Carolina [unregulated]) for patterns of injury, place of injury, helmet use, and death.

Results. There were 1080 children identified in the trauma registries between January 1997 and July 2000. Forty-four percent required intensive care. Head injuries were the primary cause of death (45.7%). Fewer North Carolina children than Pennsylvania children (16.7% vs 35.8%) wore helmets, and they were more likely to be <11 years old (35.1% vs 27.8%). Living in North Carolina was an independent predictor for not wearing a helmet.

Conclusions. Living in Pennsylvania was associated with decreased risk factors for ATV injury such as young age and riding unhelmeted. However, despite regulations, many children suffered serious morbidity and mortality. These data support the recommendation that children <16 years old should be prohibited from riding or driving ATVs.
Effect of Prenatal Diagnosis on Outcomes in D-Transposition of the Great Arteries
Authors: Bartlett Jodi M. , Wypij David , Bellinger David C. , Rappaport Leonard A. , Heffner Linda J. , Jonas Richard A. , Newburger Jane W.
Published: August 2004

Background. By decreasing preoperative morbidity, prenatal diagnosis could improve neurodevelopmental outcomes in infants with critical congenital heart disease. We explored the impact of prenatal diagnosis on perinatal and perioperative variables and on outcomes at 1 year of age.

Methods. We analyzed a database of children enrolled in prospective studies on surgical support techniques from 1988 to 2000. Selection criteria included a diagnosis of D-transposition of the great arteries with intact ventricular septum or ventricular septal defect, no extracardiac congenital anomalies, birth weight >2.3 kg, and repair by arterial switch procedure.

Results. Of 346 patients at enrollment, 25 had a prenatal diagnosis, and 321 did not. Children with prenatal diagnosis, compared with those without, had a lower likelihood of birth by spontaneous labor, lower birth weights, lower Apgar 5 scores, a higher rate of preoperative endotracheal intubation, and surgery at a younger age. They tended to have a lower incidence of fetal distress during labor. At 1 year of age, 272 patients were tested with the Psychomotor Development Index and Mental Development Index of the Bayley Scales. Mean z scores were similar in those with and without prenatal diagnosis for both Psychomotor Development Index (−0.92 ± 0.93 vs −0.88 ± 1.05) and Mental Development Index (−0.29 ± 1.13 vs −0.41 ± 0.93).

Conclusions. Infants with D-transposition of the great arteries with and without prenatal diagnosis differed with respect to perinatal and perioperative variables, but their development at 1 year of age was similar. Future studies should include a greater number of children with prenatal diagnosis and a variety of congenital heart lesions.
Physical Activity in Urban School-Aged Children With Asthma
Authors: Lang David M. , Butz Arlene M. , Duggan Anne K. , Serwint Janet R.
Published: August 2004

Objectives. To compare the physical activity levels of children with and without asthma and evaluate predictors of activity level in children with asthma.

Methods. Parents of 137 children with asthma and 106 controls 6 to 12 years old who attended an urban primary care pediatric clinic were interviewed by telephone. A structured survey evaluated 1 day’s total activity and the number of days active in a typical week; asthma characteristics and treatment; physician advice; opportunities for physical activity; and caregiver beliefs about physical activity. The activity levels of children with and without asthma were compared. Predictors of activity level of children with asthma were evaluated.

Results. Children with asthma were less active than their peers. The mean amount of daily activity differed by group: 116 (asthma) vs 146 (nonasthma) minutes; 21% (asthma) vs 9% (nonasthma) were active <30 minutes/day; and 23% (asthma) vs 11% (nonasthma) were active <3 days/week. Among children with asthma, disease severity and parental beliefs regarding exercise and asthma predicted activity level. Children with moderate or severe persistent asthma were more likely to be active <30 minutes/day (odds ratio: 3.0; confidence interval: 1.2–7.5), and children whose parents believed exercise could improve asthma were more likely to be highly active ≥120 minutes/day (odds ratio: 2.5; confidence interval: 1.2–5.4).

Conclusions. Disease severity and parental health beliefs contribute to the lower activity level of children with asthma. Pediatricians should evaluate exercise level as an indicator of disease control and address exercise and its benefits with patients and caregivers to help achieve the goal of normal physical activity in children with asthma.
Community-Acquired Methicillin-Resistant Staphylococcus aureus in Southern New England Children
Authors: Dietrich Dinusha W. , Auld Dianne B. , Mermel Leonard A.
Published: August 2004

Objective. This study was performed to understand the epidemiology of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in southern New England children.

Methods. A retrospective review was conducted of the medical records of children 0 to 18 years old with MRSA isolated by the Rhode Island Hospital microbiology laboratory (Providence, RI) between 1997 and 2001. A case was classified as either health care-associated MRSA (HCA-MRSA) or CA-MRSA based on time of culture and other strict criteria. The spectrum of illness of the HCA-MRSA and CA-MRSA cases was compared, as were the antibiotic-susceptibility patterns of their isolates. Risk factors for CA-MRSA acquisition were identified, and molecular subtyping of selected isolates was performed.

Results. Between 1997 and 2001, S aureus was isolated from 1063 children. Of these children, 57 had MRSA. During this period, both the absolute number of MRSA cases and the proportion of S aureus cases due to MRSA rose more than threefold due to increases in both CA-MRSA and HCA-MRSA infections. Of the 57 MRSA cases, 23 (40%) were CA-MRSA. CA-MRSA patients were more likely to have skin/soft-tissue infections than HCA-MRSA patients (83% vs 38%). Risk factors for acquisition of MRSA including intrafamilial spread, frequent antibiotic exposure, and child-care attendance were identified in 8 of the 23 (35%) CA-MRSA patients. CA-MRSA isolates were more likely to be susceptible to non-β-lactam antibiotics than HCA-MRSA isolates. All isolates were vancomycin susceptible.

Conclusions. MRSA accounts for an increasing proportion of all pediatric S aureus infections in southern New England. A significant percentage of these cases are due to CA-MRSA. Pediatricians should have heightened suspicion for CA-MRSA in children with presumed S aureus infections, especially if they have skin/soft-tissue infections or risk factors for MRSA acquisition.
Cerebellar Infarction in Adolescent Males Associated With Acute Marijuana Use
Authors: Geller Thomas , Loftis Laura , Brink David S.
Published: August 2004

Objective. To demonstrate the clinical characteristics, radiologic findings, and neuropathological features of tetrahydrocannabinol-related posterior fossa ischemic stroke in adolescent patients.

Design. A retrospective case and chart review of 3 cases encountered at a tertiary care institution over a span of 5 years.

Setting. Inpatient and intensive care hospitalization units managing children and adolescents.

Subjects. Male adolescent patients with ischemic cerebellar stroke after use of marijuana.

Diagnostic Investigations. Computed tomography brain scans (3 subjects), magnetic resonance imaging brain study (1 subject), cerebral arteriography (1 subject), cerebellar biopsy (1 subject), and necropsy (2 subjects).

Results. Three adolescent males had similar presentations of headache, fluctuating level of consciousness or lethargy, visual disturbance, and variable ataxia after self-administration of marijuana. They developed primary cerebellar infarctions within days after the exposure that could not be attributed to supratentorial herniation syndromes and only minimally involved brainstem structures.

Conclusions. Episodic marijuana use may represent a risk factor for stroke in childhood, particularly in the posterior circulation. Early recognition of the cerebellar stroke syndrome may allow prompt neurosurgical intervention, reducing morbidity.
Foreign Body Granuloma of the External Auditory Canal
Authors: Harris Kevin C. , Conley Stephen F. , Kerschner Joseph E.
Published: August 2004

External auditory canal polyps are most commonly inflammatory in nature but may also manifest more severe disease. Prolonged conservative therapy may delay the correct diagnosis and appropriate intervention. A case is presented of a child with chronic otorrhea treated for 4 months with topical drops and antibiotics. On referral, a large external auditory canal polyp was confirmed to represent a foreign body granuloma covering a large electrical cap, with erosion approaching the facial nerve. External auditory canal polyps that fail to respond promptly to conservative medical therapy warrant a computed tomography scan and surgical exploration with biopsy.
Intracardiac Yolk Sac Tumor and Dysrhythmia as an Etiology of Pediatric Syncope
Authors: Morin Melinda J. , Hopkins Richard A. , Ferguson William S. , Ziegler James W.
Published: August 2004

This report describes a new etiology of pediatric syncope. Epilepsy, brain anomalies, infection, electrolyte abnormalities, and trauma are commonly identified etiologies of seizures in the pediatric population. We report here a child with third-degree heart block and right ventricular outflow tract obstruction related to an intracardiac tumor presenting with syncope and seizure-like activity. Echocardiography revealed a large (3 × 8-cm) intracardiac mass filling the right atrium, extending across the tricuspid valve into the right ventricle and crossing the atrial septum into the left atrium, extending into the left ventricular outflow tract. She underwent emergent cardiopulmonary bypass with removal of the majority of the tumor mass, clearing both the left and right ventricular outflow tracts of obstruction and repairing the tricuspid valve. Postoperative cardiac conduction remained blocked and required permanent pacing. The initial serum α-fetoprotein level was grossly elevated, and the tumor showed characteristic histopathologic features of a yolk sac tumor. Four years after the completion of her chemotherapy, she remains clinically well, with no evidence of recurrent tumor by echocardiography or radiographic studies, and her α-fetoprotein remains in the normal range. The clinical manifestations of tumor infiltration of the heart with complete heart block resulting in loss of consciousness with tonic-clonic movements are detailed. Although rare, cardiac syncope has multiple known causes and should be suspected in any patient with sudden loss of consciousness and pallor. In the pediatric population, cardiac rhythm disturbances are typically the result, rather than the cause, of acute cardiac emergencies. Pediatricians should be aware of depressed cardiac output and dysrhythmias as etiologies of new-onset syncope. Evaluation should include a cardiac assessment with electrocardiogram to exclude a life-threatening arrhythmia as a potential cause.
Extremely Elevated Relative Risk of Paraffin Lamp Oil Exposures in Orthodox Jewish Children
Authors: Hoffman Robert J. , Morgenstern Solomon , Hoffman Robert S. , Nelson Lewis S.
Published: August 2004

Background. In observance of the Sabbath and other religious holidays, many Orthodox Jews maintain a burning lamp that uses paraffin lamp oil as fuel. Unintentional pediatric exposure to paraffin lamp oil, a hydrocarbon, is typically by ingestion and carries a risk of aspiration with subsequent pneumonitis. This investigation was prompted by an apparent increase in paraffin lamp oil exposures during the Jewish Sabbath, from sunset Friday until sunset Saturday, noted by the staff of our regional poison control center.

Objective. In this investigation, we retrospectively reviewed all exposures to paraffin lamp oil occurring in our large city in children <18 years old reported to our regional poison control center between January 1, 2000, and February 1, 2003. Reports were investigated to ascertain the frequency of occurrence of paraffin lamp oil exposures on the Jewish Sabbath and Jewish religious holidays. Caregivers of involved children were surveyed by telephone to determine the exposed child’s religion and circumstances of exposure.

Results. During these 25 months, 45 cases met inclusion criteria, and all were ingestions. Orthodox Jews accounted for 32 cases (71%), 4 cases (9%) occurred in children who were not Orthodox Jews, and demographic data were unavailable in 9 cases (20%). Twenty-four cases (53%) occurred within 10 hours before or during the Jewish Sabbath or Jewish religious holidays. The relative risk of Orthodox Jewish children to ingest paraffin lamp oil, calculated by using census data, is 374 times that of other children.

Conclusions. Public health authorities and caregivers of Orthodox Jewish children should be cognizant of this phenomenon. Educational efforts directed toward both Orthodox Jews and the general public aimed at preventing paraffin lamp oil exposures are warranted.
Chronic Recurrent Multifocal Osteomyelitis of the Spine and Mandible: Case Report and Review of the Literature
Authors: Chun Colleen S. Y.
Published: August 2004

At initial presentation, chronic recurrent multifocal osteomyelitis may mimic acute hematogenous osteomyelitis; however, cultures of affected bone are sterile. Nuclear scintigraphy identifies additional foci of involvement that present concurrently or sequentially. Unlike acute bacterial osteomyelitis, chronic recurrent multifocal osteomyelitis seems unaffected by antibiotic therapy and typically responds to treatment with antiinflammatory drugs. Surgical decortication has been reported for refractory cases. The case presented here illustrates the rare involvement of the mandible after initial presentation in the spine of a 4-year-old girl and the refractory nature of the disease over 6 years despite treatment with various medical and surgical therapies.
Are Complete Blood Cell Counts Useful in the Evaluation of Asymptomatic Neonates Exposed to Suspected Chorioamnionitis?
Authors: Jackson Gregory L. , Engle William D. , Sendelbach Dorothy M. , Vedro Debra A. , Josey Sue , Vinson Jodi , Bryant Carol , Hahn Gary , Rosenfeld Charles R.
Published: August 2004

Objective. Chorioamnionitis complicates 1% to 10% of pregnancies and increases the risk of neonatal infection. Women with chorioamnionitis receive intrapartum antibiotics, often resulting in inconclusive neonatal blood cultures. Peripheral neutrophil values are used frequently to assist in the diagnosis of neonatal infection and to determine duration of antibiotics; we sought to determine the utility of this approach.

Methods. A prospective observational study was performed in 856 near-term/term neonates who were exposed to suspected chorioamnionitis. Each received antibiotics for 48 hours unless clinical infection or positive blood cultures occurred. Peripheral neutrophils were measured serially and analyzed using the reference ranges of Manroe et al; an additional analysis of only the initial neutrophil values used the normal ranges of Schelonka et al. Results of neutrophil analyses were not used to determine duration of therapy. Fifty percent of asymptomatic neonates were seen postdischarge to ascertain recurrent infection. Local patient charges were examined.

Results. Ninety-six percent of neonates were asymptomatic and had negative cultures, and antibiotics were discontinued at 48 hours. A total of 2427 neutrophil counts were analyzed. Although abnormal neutrophil values were more frequent in infected or symptomatic neonates, 99% of asymptomatic neonates had ≥1 abnormal value. The specificity and negative predictive values for abnormal neutrophil values ranged between 0.12 and 0.95 and 0.91 and 0.97, respectively; sensitivity was 0.27 to 0.76. Significant differences in interpretation of the initial neutrophil values were noted, depending on the normal values used. Follow-up was performed for 373 asymptomatic neonates until 3 weeks’ postnatal age. Eight required rehospitalization; none had evidence of bacterial infection. If neutrophil values had been used to determine duration of antibiotics, then local costs would have increased by $76 000 to $425 000 per year.

Conclusions. Single or serial neutrophil values do not assist in the diagnosis of early-onset infection or determination of duration of antibiotic therapy in asymptomatic, culture-negative neonates who are ≥35 weeks’ gestation and are delivered of women with suspected chorioamnionitis.
To Tap or Not to Tap: High Likelihood of Meningitis Without Sepsis Among Very Low Birth Weight Infants
Authors: Stoll Barbara J. , Hansen Nellie , Fanaroff Avroy A. , Wright Linda L. , Carlo Waldemar A. , Ehrenkranz Richard A. , Lemons James A. , Donovan Edward F. , Stark Ann R. , Tyson Jon E. , Oh William , Bauer Charles R. , Korones Sheldon B. , Shankaran Seetha , Laptook Abbot R. , Stevenson David K. , Papile Lu-Ann , Poole W. Kenneth
Published: August 2004

Context. Neonatal meningitis is associated with significant morbidity and mortality. We speculated that meningitis may be underdiagnosed among very low birth weight (VLBW) infants because of the failure to perform lumbar punctures (LPs) in infants with suspected sepsis.

Objective. This study was undertaken to review the epidemiology of late-onset meningitis in VLBW (401–1500 g) infants and to evaluate the concordance of cerebrospinal fluid (CSF) and blood culture (BC) results.

Methods. VLBW infants (excluding those with intraventricular shunts) born at centers of the National Institute of Child Health and Human Development Neonatal Research Network from September 1, 1998, through December 31, 2001, were studied. Late-onset meningitis was defined by culture-based criteria and classified as meningitis with or without associated sepsis. Unadjusted comparisons were made using χ2 tests and adjusted comparisons using regression models.

Results. Of 9641 VLBW infants who survived >3 days, 2877 (30%) had ≥1 LPs, and 6056 (63%) had ≥1 BC performed after day 3. One hundred thirty-four infants had late-onset meningitis (1.4% of all patients; 5% of those with an LP). Pathogens associated with meningitis were similar to those associated with sepsis. One third (45 of 134) of the infants with meningitis had negative BCs. Lower gestational age and prior sepsis increased risk for meningitis. Compared with uninfected infants, those with meningitis had a longer time on mechanical ventilation (28 vs 18 days), had longer hospitalizations (91 vs 79 days), were more likely to have seizures (25% vs 2%), and were more likely to die (23% vs 2%).

Conclusions. Meningitis is a serious complication among VLBW infants, associated with increased severity of illness and risk of death. Of note, one third of the infants with meningitis had meningitis in the absence of sepsis. Because CSF cultures were performed only half as often as BCs, this discordance in blood and CSF culture results suggests that meningitis may be underdiagnosed among VLBW infants.
Associations Between Overweight and Obesity With Bullying Behaviors in School-Aged Children
Authors: Janssen Ian , Craig Wendy M. , Boyce William F. , Pickett William
Published: August 2004

Objective. The prevalence of overweight and obesity in children is rising. Childhood obesity is associated with many negative social and psychological ramifications such as peer aggression. However, the relationship between overweight and obesity status with different forms of bullying behaviors remains unclear. The purpose of this article is to examine these relationships.

Methods. We examined associations between bullying behaviors (physical, verbal, relational, and sexual harassment) with overweight and obesity status in a representative sample of 5749 boys and girls (11–16 years old). The results were based on the Canadian records from the 2001/2002 World Health Organization Health Behaviour in School-Aged Children Survey. Body mass index (BMI) and bullying behaviors were determined from self-reports.

Results. With the exception of 15- to 16-year-old boys, relationships were observed between BMI category and peer victimization, such that overweight and obese youth were at greater relative odds of being victims of aggression than normal-weight youth. Strong and significant associations were seen for relational (eg, withdrawing friendship or spreading rumors or lies) and overt (eg, name-calling or teasing or hitting, kicking, or pushing) victimization but not for sexual harassment. Independent of gender, there were no associations between BMI category and bully-perpetrating in 11- to 14-year-olds. However, there were relationships between BMI category and bully-perpetrating in 15- to 16-year-old boys and girls such that the overweight and obese 15- to 16-year-olds were more likely to perpetrate bullying than their normal-weight classmates. Associations were seen for relational (boys only) and overt (both genders) forms of bully-perpetrating but not for sexual harassment.

Conclusions. Overweight and obese school-aged children are more likely to be the victims and perpetrators of bullying behaviors than their normal-weight peers. These tendencies may hinder the short- and long-term social and psychological development of overweight and obese youth.
The Effect of Prophylactic Ointment Therapy on Nosocomial Sepsis Rates and Skin Integrity in Infants With Birth Weights of 501 to 1000 g
Authors: Edwards William H. , Conner Jeanette M. , Soll Roger F. ,   for the Vermont Oxford Network Neonatal Skin Care Study Group
Published: August 2004

Objective. Extremely low birth weight infants have a high risk of developing nosocomial bacterial sepsis (NBS). Immature fragile skin may represent an inadequate protective barrier to bacteria colonizing the skin. We conducted a randomized, multicenter trial to determine whether prophylactic application of an emollient ointment would result in a lower incidence of death and/or NBS in the first 28 days of life, compared with routine skin care.

Methods. Infants of birth weight 501 to 1000 g and gestational age ≤30 weeks were assigned randomly to receive generalized application of ointment twice a day through day 14 (prophylactic group [P]) or local application of ointment to the site of injury (routine skin care [R]). The study was conducted at 53 neonatal intensive care units that were members of the Vermont Oxford Network.

Results. Included in the analysis were 1191 infants (P: 602; R: 589). No difference was found in the combined primary outcome of NBS or death (33.6% P vs 30.3% R; relative risk [RR]: 1.10; 95% confidence interval [CI]: 0.89, 1.27). The incidence of death was no different between the groups (10.8% P vs 12.1% R; RR: 0.87; 95% CI: 0.59, 1.25). More infants in the prophylactic group had NBS (25.8% P vs 20.4% R; RR: 1.26; 95% CI: 1.02, 1.54), predominantly in the lower birth weight infants (501–750 g) and for infections caused by coagulase-negative staphylococci. Infants in the prophylactic group had better skin condition on days 1 to 14 of life and less skin injury on days 15 to 28 of life. There was no difference between groups in other complications of prematurity.

Conclusions. Prophylactic application of ointment did not lead to a difference in death and/or NBS in the first 28 days of life. There may be an increase in the risk of NBS associated with this practice.
Sleep Deprivation for Pediatric Sedated Procedures: Not Worth the Effort
Authors: Shields Cynthia H. , Johnson Sandi , Knoll Jeffery , Chess Cathy , Goldberg David , Creamer Kevin
Published: August 2004

Objective. Sleep deprivation is commonly used to enhance the effectiveness of pediatric sedation and to decrease sedation failures. We reviewed our sedation database to evaluate the efficacy of sleep deprivation.

Methods. The entire pediatric sedation unit database (n = 5640) was reviewed retrospectively. Patients without complete data sets were excluded. The remaining patients were separated into 2 groups: 3272 patients who underwent noninvasive procedures and 1210 who underwent invasive procedures. A subgroup of noninvasive procedure patients <2 years old (n = 1398) was also analyzed. The sedation failure rate (%) and nursing care hours for both sleep-deprived and non-sleep-deprived patients were analyzed.

Results. In the noninvasive procedure group, the sedation failure rate was 5.7% for the sleep-deprived patients and 5.6% for the non-sleep-deprived patients, whereas the sedation failure rate for children <2 years old was 4.2% for sleep-deprived patients and 4.7% for non-sleep-deprived patients. The sedation failure rate in the invasive procedure group was 7.5% for sleep-deprived patients and 7.2% for non-sleep-deprived patients. Nursing care hours in the noninvasive procedure group were significantly longer for the sleep-deprived patients (4.5 ± 1.6 hours) versus the non-sleep-deprived patients (3.8 ± 1.6 hours). This finding was true also for the subgroup of children <2 years old (sleep-deprived patients: 4.2 ± 1.4 hours; non-sleep-deprived patients: 3.5 ± 1.4 hours). No difference was noted in nursing care hours for the invasive procedure group.

Conclusions. Sleep deprivation had no effect in reducing the pediatric sedation failure rate. The patients having noninvasive procedures who were sleep deprived required significantly more nursing care hours than their non-sleep-deprived counterparts. Routine use of sleep deprivation for pediatric sedation should be critically reevaluated.
Preterm Delivery, Level of Care, and Infant Death in Sweden: A Population-Based Study
Authors: Johansson Stefan , Montgomery Scott M. , Ekbom Anders , Olausson Petra Otterblad , Granath Fredrik , Norman Mikael , Cnattingius Sven
Published: August 2004

Objective. To elucidate the role of level of care in combination with other perinatal risk factors for infant death in very preterm deliveries.

Design. Population-based cohort study.

Setting. Sweden, 1992–1998.

Subjects. Singleton infants (2285) born at 24 to 31 completed weeks of gestation to primiparous women.

Main Outcome Measure. Infant mortality.

Results. The rate of infant mortality increased from 5% among infants born at 31 weeks’ gestation to 56% among infants born at 24 weeks’ gestation. Compared with infants born at university hospitals, the unadjusted odds ratio (OR) of infant death was 0.70 (95% confidence interval [CI]: 0.54–0.90) among infants delivered at general hospitals. However, after adjustment, the OR of infant death shifted to 1.33 (95% CI: 0.88–2.02) for preterm births at general hospitals. This shift was primarily due to different gestational age distributions in regional and general hospitals. Among infants born at 24 to 27 weeks’ gestation, infant mortality rates were 23% (87 deaths) in university hospitals and 32% (73 deaths) in general hospitals, giving an adjusted OR of 2.00 for general versus university hospitals (95% CI: 1.15–3.49). The risk of death at 24 to 27 weeks’ gestation in general hospitals was increased specifically in pregnancies with placental complications.

Conclusion. Taking obstetric complications into account, there is an excess mortality risk among extremely preterm infants born at general hospitals.
Discipline in the African American Community: The Impact of Socioeconomic Status on Beliefs and Practices
Authors: Horn Ivor B. , Cheng Tina L. , Joseph Jill
Published: August 2004

Objective. To describe and compare disciplinary beliefs and practices among African American parents from diverse socioeconomic backgrounds.

Methods. A cross-sectional survey was conducted of self-identified African American parents of children <48 months of age at 2 ambulatory teaching clinics, 2 community health centers, and 3 private practices in Washington, DC, and the surrounding metropolitan area. Disciplinary beliefs and practices of African American parents were measured.

Results. A total of 175 of the 189 parents who were approached for the study completed the survey for a participation rate of 92.5%. Middle/upper socioeconomic status (SES) parents in this study were more likely to be married (60.9% vs 14.7%), older (31.4 years vs 25 years), and more educated (80% having attended at least some college vs 34.4%) than lower SES parents. There were no significant differences between middle/upper and lower SES parents with regard to their belief in a preferred disciplinary method (teaching, spanking, removing) or approach (positive, negative). Lower SES parents were more likely to endorse spanking a 1- to 3-year-old child if they were doing something that was not safe (90.5% vs 78.3%). Middle/upper SES parents were significantly more likely to reward their child for positive behavior than lower SES parents (66.1% vs 47.1%).

Conclusions. Lower and middle/upper SES parents in this study population were reasonably similar with respect to disciplinary beliefs and practices. Exceptions to this generalization were that lower SES parents were more likely to endorse spanking as a response to an unsafe behavior on the part of the child, and middle/upper SES parents reported higher levels of reward for positive behavior.
Clinical Features of Children With Screening-Identified Evidence of Celiac Disease
Authors: Hoffenberg Edward J. , Emery Lisa M. , Barriga Katherine J. , Bao Fei , Taylor Jennifer , Eisenbarth George S. , Haas Joel E. , Sokol Ronald J. , Taki Iman , Norris Jill M. , Rewers Marian
Published: August 2004

Objective. At-risk groups commonly undergo screening for autoantibodies associated with celiac disease (CD). However, the clinical significance of a positive test remains uncertain. The objective of this study was to evaluate growth and clinical features of children who test positive for an autoantibody associated with CD.

Methods. A case-control study of Denver area healthy infants and young children with and without CD autoantibodies was conducted. A cohort of HLA-characterized children were followed prospectively since birth for the development of immunoglobulin A antitissue transglutaminase autoantibodies (TG). Clinical evaluation, questionnaire, blood draw, and small bowel biopsy were performed. Growth and nutrition and frequency of positive responses were measured.

Results. Compared with 100 age- and gender-matched TG-negative controls, 18 TG-positive children, 5.5 ± 0.5 years of age, had a greater number of symptoms and lower z scores for weight-for-height and for body mass index. Responses that were independently associated with TG-positive status were irritability/lethargy, abdominal distention/gas, and difficulty with weight gain.

Conclusions. Screening-identified TG-positive children demonstrate mild alterations in growth and nutrition and report more symptoms than control subjects. Additional study is needed on the benefit and risk of identifying CD in at-risk groups.
Immune Parameters and Morbidity in Hard Drug and Human Immunodeficiency Virus-xposed but Uninfected Infants
Authors: Neu Natalie , Leighty Robert , Adeniyi-Jones Samuel , Diaz Clemente , Handelsman Edward , Kaufman Gary , Paul Mary E. , Rich Kenneth , Mofenson Lynne , Pitt Jane ,   for the Women and Infants Transmission Study
Published: August 2004

Objective. To examine the association of maternal hard drug use (injection drugs, cocaine, and opiates) on lymphocyte subsets and clinical morbidity in uninfected infants who are born to human immunodeficiency virus-infected mothers who were enrolled in the Women and Infants Transmission Study (1990–2000).

Methods. Maternal hard drug use was identified by self-report and/or urine toxicology. Infant evaluations occurred at birth and at 1, 2, 4, 6, 9, 12, 18, and 24 months of age.

Results. A total of 401 (28%) of the 1436 uninfected infants were born to drug-using mothers. Maternal CD4 lymphocyte percentage and RNA at delivery were not significantly different between drug users and nonusers. Infants who were born to drug-using mothers had lower mean gestational age (37.8 vs 38.5 weeks) and birth weight (2.9 vs 3.1 kg). Infants with intrauterine drug exposure had lower CD4 lymphocyte percentage over the first 4 months of life after adjusting for covariates and higher natural killer lymphocyte percentage. When the analysis was stratified by time period of entry, the incidence of clinical events was not different between infants who were born to drug users versus nonusers.

Conclusion. Maternal hard drug use is associated with immunologic changes in infants early in life, although these changes did not seem to be associated with increased risk of infections.
Low Expression of Human Epithelial Sodium Channel in Airway Epithelium of Preterm Infants With Respiratory Distress
Authors: Helve Otto , Pitkänen Olli M. , Andersson Sture , O’Brodovich Hugh , Kirjavainen Turkka , Otulakowski Gail
Published: August 2004

Objective. Active ion transport is critical to postnatal clearance of lung fluid. The importance of epithelial sodium channel (ENaC) in this clearance has been demonstrated in animal studies in which α-ENaC knockout mice died postnatally as a result of respiratory insufficiency. In animals, the expression of α-ENaC in respiratory epithelium is dependent on gestational age, but when assessed by in situ hybridization in the human (h), the mRNA is present from the earliest stages of pulmonary development. Therefore, the purpose of the present investigation was to quantify mRNA of the α-, β-, and γ-hENaC subunits of newborn preterm infants with respiratory distress and compare the gene expression data against those detected in healthy term infants. In addition, the effect of systemic dexamethasone therapy on the 3 hENaC subunits was studied in 4 preterm infants who received prolonged assisted ventilation.

Methods. The expression of subunits of hENaC was determined in samples taken from nasal respiratory epithelium of 7 healthy term infants (gestation age: 39.3 ± 0.9 weeks [mean ± standard deviation) and 5 preterm infants (gestational age: 27.2 ± 0.9 weeks) with respiratory distress syndrome within 5 hours of birth. Betamethasone had been given to all mothers of preterm infants. In 4 additional preterm infants who still required assisted ventilation at 43 ± 6 days postnatal age, the expression of α-hENaC was determined in samples taken before and during treatment with dexamethasone.

Results. Preterm infants with respiratory distress syndrome had low expression of all hENaC subunits relative to healthy term infants (α-hENaC: 5.38 ± 2.01 [amol/fmol cytokeratin 18] vs 9.13 ± 2.26; β-hENaC: 2.44 ± 1.43 vs 4.25 ± 1.10; γ-hENaC: 2.43 ± 0.11 vs 6.81 ± 3.24). Each of the 4 preterm infants who were treated with dexamethasone at ∼1 month of age showed an increase in expression of α-hENaC and β-hENaC subunit normalized to cytokeratin 18.

Conclusion. All 3 subunits of the hENaC are low in preterm relative to full-term infants. α-hENaC mRNA in respiratory epithelium is increased by therapeutic doses of glucocorticosteroid. Low expression of α-hENaC in human respiratory epithelium may play a role in the pathogenesis of respiratory distress in preterm infants.
Serum Leptin Concentration Poorly Reflects Growth and Energy and Nutrient Intake in Young Children
Authors: Hakanen Maarit , Rönnemaa Tapani , Talvia Sanna , Rask-Nissilä Leena , Koulu Markku , Viikari Jorma , Bergendahl Matti , Simell Olli
Published: August 2004

Objective. We studied whether the serum leptin concentration at age 2 years predicts changes in relative body weight by age 8 and whether the serum leptin concentration is associated with intake of energy and nutrients at age 5.

Methods. A total of 156 8-year-old participants of the Special Turku Coronary Risk Factor Intervention Project were chosen to represent children whose relative weight decreased, was stable, or increased during the preceding 6 years. Their serum leptin concentrations were measured in samples collected when they were 2 years. Serum leptin was also measured in 100 5-year-old children in the Special Turku Coronary Risk Factor Intervention Project whose energy and nutrient intakes were analyzed using 4-day food records.

Results. The boys whose relative weight decreased (n = 25), was stable (n = 28), or increased (n = 26) between 2 and 8 years of age had similar serum leptin concentrations at the age of 2 years. The girls whose relative weight decreased (n = 27) had higher serum leptin concentrations at 2 years than the girls whose relative weight remained stable (n = 26) but only when the leptin values were not adjusted for body mass index. The serum leptin concentration was higher in 5-year-old girls than in 5-year-old boys even when adjusted for body mass index. Serum leptin correlated with relative weight in girls and boys (r = 0.65 and r = 0.45, respectively). Serum leptin concentration adjusted for relative weight correlated poorly with intakes of energy, fat, saturated fat, carbohydrates, sucrose, and protein.

Conclusions. Serum leptin concentrations at age 2 poorly predicted changes in relative body weight during the following 6 years and poorly reflected the intake of energy or major nutrients at age 5.
Acute Hyponatremia Related to Intravenous Fluid Administration in Hospitalized Children: An Observational Study
Authors: Hoorn Ewout J. , Geary Denis , Robb Maryanne , Halperin Mitchell L. , Bohn Desmond
Published: August 2004

Objective. To develop hyponatremia (plasma sodium concentration [PNa] <136 mmol/L), one needs a source of water input and antidiuretic hormone secretion release to diminish its excretion. The administration of hypotonic maintenance fluids is common practice in hospitalized children. The objective of this study was to identify risk factors for the development of hospital-acquired, acute hyponatremia in a tertiary care hospital using a retrospective analysis.

Methods. All children who presented to the emergency department in a 3-month period and had at least 1 PNa measured (n = 1586) were evaluated. Those who were admitted were followed for the next 48 hours to identify patients with hospital-acquired hyponatremia. An age- and gender-matched case-control (1:3) analysis was performed with patients who did not become hyponatremic.

Results. Hyponatremia (PNa <136 mmol/L) was documented in 131 of 1586 patients with ≥1 PNa measurements. Although 96 patients were hyponatremic on presentation, our study group consisted of 40 patients who developed hyponatremia in hospital. The case-control study showed that the patients in the hospital-acquired hyponatremia group received significantly more EFW and had a higher positive water balance. With respect to outcomes, 2 patients had major neurologic sequelae and 1 died.

Conclusion. The most important factor for hospital-acquired hyponatremia is the administration of hypotonic fluid. We suggest that hypotonic fluid not be given to children when they have a PNa <138 mmol/L.
Measurement of Percentage of Body Fat in 411 Children and Adolescents: A Comparison of Dual-Energy X-Ray Absorptiometry With a Four-Compartment Model
Authors: Sopher Aviva B. , Thornton John C. , Wang Jack , Pierson Richard N. , Heymsfield Steven B. , Horlick Mary
Published: August 2004

Objective. Pediatricians are encountering body composition information more frequently, with percentage of body fat (%BF) measurement receiving particular attention as a result of the obesity epidemic. One confounding issue is that different methods may yield different %BF results in the same person. The objective of this study was to compare dual-energy X-ray absorptiometry (DXA) with the criterion 4-compartment model (4-CM) for measurement of %BF in a large pediatric cohort and to assist pediatricians in appropriate interpretation of body composition information by recognizing differences between techniques.

Methods. Height, weight, anthropometrics, body density by underwater weighing, total body water by deuterium dilution, and bone mineral content and %BF by DXA (Lunar DPX/DPX-L) were measured in 411 healthy subjects, aged 6 to 18 years. Values for %BF by 4-CM and DXA were compared using regression analysis.

Results. The mean ± standard deviation values for %BF by DXA (22.73% ± 11.23%) and by 4-CM (21.72% ± 9.42%) were different, but there was a strong relationship between the 2 methods (R2 = 0.85). DXA underestimated %BF in subjects with lower %BF and overestimated it in those with higher %BF. The relationship between the 2 methods was not affected by gender, age, ethnicity, pubertal stage, height, weight, or body mass index. The standard error of the estimate was 3.66%.

Conclusion. This analysis demonstrates a predictable relationship between DXA and 4-CM for %BF measurement. Because of its ease of use, consistent relationship with 4-CM, and availability, we propose that DXA has the capacity for clinical application including prediction of metabolic abnormalities associated with excess %BF in pediatrics.