bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Parental Application of Eutectic Mixture of Local Anesthetics for Intravenous Insertion
Authors: Koh Jeffrey L. , Fanurik Debra , Stoner Ph.D*‡; JoAnne , Schmitz Michael L. , VonLanthen Maryelle
Published: August 2004

Objective.

To demonstrate that parent application of eutectic mixture of local anesthetics (EMLA) results in equal reduction of the pain of intravenous (IV) placement compared with clinician application of EMLA, and to assess potential difficulties with parental application.

Study Design.

A 2 × 2 randomized block design was used, with 41 children divided into two age groups (5–12 years vs 13–18 years) and randomized to one of two experimental groups (parent-applied EMLA vs clinician-applied EMLA).

Methods.

All children were scheduled to have outpatient gastrointestinal endoscopies with IV sedation. EMLA was placed at least 60 minutes before IV insertion either by the parent or a clinician, depending on the experimental group assignment. Outcome measures were child pain ratings and observed behavioral distress ratings. Parents and children were interviewed to determine parent and child anxiety levels in anticipation of the IV insertion, previous needle stick experience, and previous difficulty coping. Feasibility outcomes included technical difficulty with application of EMLA and appearance of the EMLA cream and occlusive covering.

Results.

Pain ratings and behavioral distress ratings were generally in the low to moderate range for all groups and were consistent with previous empiric reports of EMLA outcome. There were no significant differences in pain or distress ratings for either the age or the experimental groups. Parent ratings of their child's previous difficulty coping was related to the level of behavioral distress exhibited before (r = .50), during (r = .32) and after (r = .44) the IV insertion. In addition, children's anxiety ratings about IV insertion seemed to differ among groups (although not statistically significant for post hoc comparisons), with the most anxiety reported by the younger children when clinicians applied the EMLA and by older children when parents applied the EMLA.

Conclusion.

Parent application of EMLA appears to be as effective as clinician application in reducing children's pain and distress associated with IV insertion. Permitting parents to apply the EMLA at home can allow children who are having procedures on an outpatient basis to benefit from topical anesthesia without having to arrive early to the clinic or hospital. Additionally, application by parents may result in less anticipatory anxiety for younger children.
School Start and Occurrence of Headache
Authors: Anttila Pirjo , Metsähonkala Liisa , Sillanpää Matti
Published: August 2004

Objectives.

The purpose of the study was to examine the occurrence of childhood headache at the start of school.

Study Design.

An unselected population-based questionnaire study on the occurrence of headache was conducted in 1433 children between the ages of 6 and 7 years old (ranging from 6 years 8 months to 7 years 8 months) who started school in 1992. The first questionnaire was given within 3 months of school entry in 1992. Of 1433 children, 1290 responded satisfactorily to the second headache questionnaire at the end of the second school year. The children (n= 725) who had had headache in 1994 were sent a more detailed questionnaire concerning risk factors of headache.

Results.

A significant increase in the incidence density of overall headache in children was found during the first 12 school months compared with the 6 months immediately before school started or with the subsequent 6 school months (13th–18th month). The increase was attributable to occasional headache. During the first school months, the frequency of headache increased in 20% of children who had had headache before the 6 months preceding the start of school. The mothers and fathers of 129 children who started to have headache after school entry had a higher socioeconomic status than the mothers and fathers of children who had headache before the start of school. No significant difference in family history of headache or school-related factors was found among children. Predictably, the incidence density of recurrent headache after school start was higher than before school start. However, occasional headache showed a distinct peak at school start but regained its initial level at the end of the second school year.

Conclusion.

School start appears to increase the incidence of overall headache (occasional headache in particular) in children, independent of other factors.
Influence of the Home Environment on the Development of Obesity in Children
Authors: Strauss Richard S. , Knight Judith
Published: August 2004

Context.

Obesity is the most common health problem facing children. The most recent data from the National Health and Nutrition Examination Survey III suggest that 22% of children and adolescents are overweight and that 11% are obese.

Objective.

To investigate prospectively the association between the home environment and socioeconomic factors and the development of obesity in children.

Design.

Prospective cohort study.

Setting.

The National Longitudinal Survey of Youth.

Population.

A total of 2913 normal weight children between the ages of 0 and 8 years were followed over a 6-year period. We examined the roles of race, marital status, maternal education, family income, and parental occupation, as well as standardized measures of the home environment (The Home Observation for Measurement of the Environment [HOME]-Short Form) on the development of childhood obesity.

Primary Outcome Measure.

Incidence of obesity. Obesity was defined as a body mass index >95th percentile for age and gender at the 6-year follow-up.

Results.

Maternal obesity was the most significant predictor of childhood obesity (OR: 3.62 [2.65–4.96]). The HOME-Short Form cognitive scores and household income were also significant predictors of childhood obesity (OR, low HOME-cognitive: 2.64 [1.48–4.70], medium HOME-cognitive: 2.32 [1.39–3.88]; low income: 2.91 [1.66–5.08], medium income: 2.04 [1.21–3.44]). Children who lived with single mothers were also significantly more likely to become obese by the 6-year follow-up, as were black children, children with nonworking parents, children with nonprofessional parents, and children whose mothers did not complete high school. Neither the child's gender nor the HOME-emotional scores contributed to the development of obesity. After controlling for the child's initial weight-for-height z-score, maternal body mass index, race, marital status, occupation, education, and HOME emotional scores, only the HOME cognitive score and family income remained significant predictors of childhood obesity.

Conclusion.

Children with obese mothers, low family incomes, and lower cognitive stimulation have significantly elevated risks of developing obesity, independent of other demographic and socioeconomic factors. In contrast, increased rates of obesity in black children, children with lower family education, and nonprofessional parents may be mediated through the confounding effects of low income and lower levels of cognitive stimulation.
Cost of Chickenpox in Canada: Part I. Cost of Uncomplicated Cases
Authors: Law Barbara , Fitzsimon Catherine , Ford-Jones Lee , MacDonald Noni , Déry Pierre , Vaudry Wendy , Mills Elaine , Halperin Scott , Michaliszyn Andrea , Rivière Marc
Published: August 2004

Objective.

The purpose of this study was to assess the direct medical costs and productivity losses associated with uncomplicated chickenpox (no hospitalization) in Canada.

Methods.

A total of 179 otherwise healthy 1- to 9-year-old children with active chickenpox were recruited from schools, day care centers, and physician offices in 5 provinces. Direct medical (physician contacts, medication, and diagnostic tests) and nonmedical (personal expenses including child care) resources expended during the illness were determined by caregiver interview. Productivity losses attributable to the disease were determined by assessing caregiver time lost from work and daily activities. Unit costs for all resources were obtained from sources in 2 provinces, and per-patient treatment costs were determined from the patient, Ministry of Health, and societal perspectives.

Results.

From a societal perspective, the per-case cost for children from 1 to 4 years of age and from 5 to 9 years of age was $370.2 and $236.5, respectively. Direct medical costs accounted for 10% of the total costs in both groups. The largest cost driver in patient care was caregiver productivity losses, which amounted to $316.5 in the younger age group and to $182.7 in the older age group. Based on an estimated yearly incidence of 344 656 cases of uncomplicated chickenpox in Canada, the total annual societal burden of the disease can be estimated at $109.2 million, with a cost to the Ministry of Health of $11.2 million.

Conclusion.

Chickenpox is one of the last common childhood diseases prevalent in Canada, and the uncomplicated disease, despite its rather benign course, imparts a large annual economic burden.
A Case of Congenital Multiple Myofibromatosis Developing in an Infant
Authors: Schrodt Barbara J. , Callen Jeffrey P.
Published: August 2004

Background.

Infantile myofibromatosis is marked by the development of firm, discrete, flesh-colored to purple nodules in skin, muscle, bone, and/or subcutaneous tissues. In cases without visceral involvement, the prognosis is excellent with expected spontaneous regression of nodules in 1 to 2 years. Visceral lesions are associated with significant morbidity and mortality generally within the first few months of life secondary to obstruction of a vital organ, failure to thrive, or infection.

Observation.

We present a case of congenital myofibromatosis initially presenting as a single, asymptomatic nodule on the midback of an otherwise healthy 1-month-old white boy. Over the subsequent 6 months, the child developed a left-sided head tilt with the formation of additional myofibromas of the skin and musculature, but without visceral involvement. Physical examinations have continued to show age-appropriate growth and development.

Conclusion.

Clinicians should be aware of this rare but potentially life-threatening entity and consider infantile myofibromatosis in the differential diagnosis of pediatric dermal and subcutaneous nodules, particularly when associated with a new onset of head tilt. Close clinical follow-up is recommended in all cases of infantile myofibromatosis.
Cord Blood Banking for Potential Future Transplantation: Subject Review
Authors:   Work Group on Cord Blood Banking
Published: August 2004

In recent years, umbilical cord blood, which contains a large number of hematopoietic stem cells, has been used successfully for allogeneic transplantation to treat a variety of pediatric genetic, hematologic, and oncologic disorders. It is a potential alternative when autologous or allogeneic transplantation with HLA-matched marrow is unavailable for children. This advance has resulted in the establishment of not-for-profit and for-profit cord blood banking programs for autologous and allogeneic transplantation. Many issues confront institutions that wish to establish such a program. Parents also seek information from their physicians about this new modality. This document is intended to provide information to guide physicians in responding to parents' questions about cord blood banking. The document also makes recommendations about appropriate ethical and operational standards, including informed consent policies, for the institutions that operate a program.
Iron Fortification of Infant Formulas
Authors:   Committee on Nutrition
Published: August 2004

Despite the American Academy of Pediatrics' (AAP) strong endorsement for breastfeeding, most infants in the United States are fed some infant formula by the time they are 2 months old. The AAP Committee on Nutrition has strongly advocated iron fortification of infant formulas since 1969 as a way of reducing the prevalence of iron-deficiency anemia and its attendant sequelae during the first year.1 The 1976 statement titled “Iron Supplementation for Infants” delineated the rationale for iron supplementation, proposed daily dosages of iron, and summarized potential sources of iron in the infant diet.2 In 1989, the AAP Committee on Nutrition published a statement that addressed the issue of iron-fortified infant formulas3 and concluded that there was no convincing contraindication to iron-supplemented formulas and that continued use of “low-iron” formulas posed an unacceptable risk for iron deficiency during infancy. The current statement represents a scientific update and synthesis of the 1976 and 1989 statements with recommendations about the use of iron-fortified and low-iron formulas in term infants.
The Pediatrician's Role in Development and Implementation of an Individual Education Plan (IEP) and/or an Individual Family Service Plan (IFSP)
Authors:   Committee on Children With Disabilities
Published: August 2004

The Individual Education Plan and Individual Family Service Plan are legally mandated documents developed by a multidisciplinary team assessment that specifies goals and services for each child eligible for special educational services or early intervention services. Pediatricians need to be knowledgeable of federal, state, and local requirements; establish linkages with early intervention, educational professionals, and parent support groups; and collaborate with the team working with individual children.
Human Immunodeficiency Virus Screening
Authors:   American Academy of Pediatrics American College of Obstetricians and Gynecologists
Published: August 2004

This Policy Statement was retired March 2015.
Randomized Placebo-controlled Trial of a 42-Day Tapering Course of Dexamethasone to Reduce the Duration of Ventilator Dependency in Very Low Birth Weight Infants: Outcome of Study Participants at 1-Year Adjusted Age
Authors: O'Shea T. Michael , Kothadia Jamanadas M. , Klinepeter Kurt L. , Goldstein Donald J. , Jackson Barbara G. , Weaver R. Grey , Dillard III‡; and Robert G.
Published: August 2004

Objective.

Ventilator-dependent preterm infants are often treated with a prolonged tapering course of dexamethasone to decrease the risk and severity of chronic lung disease. The objective of this study was to assess the effect of this therapy on developmental outcome at 1 year of age.

Methods.

Study participants were 118 very low birth weight infants who, at 15 to 25 days of life, were not weaning from assisted ventilation and were then enrolled in a randomized, placebo-controlled, double-blind trial of a 42-day tapering course of dexamethasone. Infants were examined at 1 year of age, adjusted for prematurity, by a pediatrician and a child psychologist. A physical and neurologic examination was performed, and the Bayley Scales of Infant Development were administered. All examiners were blind to treatment group.

Results.

Groups were similar in terms of birth weight, gestational age, gender, and race. A higher percentage of dexamethasone recipients had major intracranial abnormalities diagnosed by ultrasonography (21% vs 11%). Group differences were not found for Bayley Mental Development Index (median [range] for dexamethasone-treated group, 94 [50–123]; for placebo group, 90 [28–117]) or Psychomotor Development Index Index (median [range]) for dexamethasone-treated group, 78 (50–109); for placebo-treated group, 81 [28–117]). More dexamethasone-treated infants had cerebral palsy (25% vs 7%) and abnormal neurologic examination findings (45% vs 16%). In stratified analyses, adjusted for major cranial ultrasound abnormalities, these associations persisted (OR values for cerebral palsy, 5.3; 95% CI: 1.3–21.4; OR values for neurologic abnormality 3.6; 95% CI: 1.2–11.0).

Conclusions.

A 42-day tapering course of dexamethasone was associated with an increased risk of cerebral palsy. Possible explanations include an adverse effect of this therapy on brain development and/or improved survival of infants who either already have neurologic injury or who are at increased risk for such injury.
Adapting the Gang Model: Peer Mentoring for Violence Prevention
Authors: Sheehan Karen , DiCara Joseph A. , LeBailly Susan , Christoffel Katherine Kaufer
Published: August 2004

Objectives.

This study assessed the effectiveness of an inner-city peer-mentoring program in modifying the attitudes and behaviors involving violence of preadolescent mentees.

Methods.

In a case-matched cohort study involving 7- to 13-year-old children, 50 children enrolled in peer mentoring (case subjects) were compared with 75 control subjects. Case subjects were involved before enrollment in the community program in which the intervention occurred; control subjects lived in the same housing project and were matched with case subjects on age, sex, and census tract. A total of 19 community adolescents mentored the case subjects by designing and presenting violence prevention lessons. Two reliable self-report scales, Determining our Viewpoints of Violent Events and Normative Beliefs About Aggression Scale, were used to measure attitudinal change. Teachers completed the Revised Behavior Problem Checklist to assess changes in behavior.

Results.

At baseline, the survey scores of the case and control subjects were not different. After the intervention period, the case scores indicated less support for violence than the control scores. Case behavior scores did not change, but control behavior scores worsened.

Conclusions.

The data suggest that peer mentoring for younger children may be an important component of efforts to reduce youth violence. A larger multisite trial is warranted. violence prevention, peer mentoring, community-based.
Comparative Analysis of Serologic Screening Tests for the Initial Diagnosis of Celiac Disease
Authors: Russo Pierre A. , Chartrand Lucie J. , Seidman Ernest
Published: August 2004

Objective.

To prospectively evaluate and compare the sensitivity, specificity, and positive and negative predictive values of serum antigliadin (AGA) and antiendomysium antibodies (EMA) in predicting the initial diagnosis of celiac disease.

Design.

Sera were tested prospectively for IgA and IgG AGA by enzymed-linked immunosorbent assay and IgA EMA by immunofluorescence techniques on monkey esophagus and human umbilical cord sections in 95 pediatric patients referred for duodenal biopsies.

Patients.

Ninety-five pediatric patients were referred for duodenal biopsies, with a clinical suspicion of celiac disease; 24 of those patients had celiac disease by criteria of the European Society for Pediatric Gastroenterology and Nutrition.

Setting.

A pediatric gastroenterology clinic of a tertiary care pediatric university hospital.

Results.

EMA testing on human umbilical cords was the most specific but was also the least sensitive. All the patients with biopsy-proven celiac disease were identified by either one or both serologic tests (100% combined sensitivity). The combination of AGA and EMA on monkey esophagus resulted in a negative predictive value of 100% accuracy.

Conclusions.

A combination of AGA and EMA tests resulted in 100% sensitivity and 100% negative predictive value, useful in selecting patients for duodenal biopsy.
Oral Versus Initial Intravenous Therapy for Urinary Tract Infections in Young Febrile Children
Authors: Hoberman Alejandro , Wald Ellen R. , Hickey Robert W. , Baskin Marc , Charron Martin , Majd Massoud , Kearney Diana H. , Reynolds Ellen A. , Ruley Jerry , Janosky Janine E.
Published: August 2004

Background.

The standard recommendation for treatment of young, febrile children with urinary tract infection has been hospitalization for intravenous antimicrobials. The availability of potent, oral, third-generation cephalosporins as well as interest in cost containment and avoidance of nosocomial risks prompted evaluation of the safety and efficacy of outpatient therapy.

Methods.

In a multicenter, randomized clinical trial, we evaluated the efficacy of oral versus initial intravenous therapy in 306 children 1 to 24 months old with fever and urinary tract infection, in terms of short-term clinical outcomes (sterilization of the urine and defervescence) and long-term morbidity (incidence of reinfection and incidence and extent of renal scarring documented at 6 months by99mTc-dimercaptosuccinic acid renal scans). Children received either oral cefixime for 14 days (double dose on day 1) or initial intravenous cefotaxime for 3 days followed by oral cefixime for 11 days.

Results.

Treatment groups were comparable regarding demographic, clinical, and laboratory characteristics. Bacteremia was present in 3.4% of children treated orally and 5.3% of children treated intravenously. Of the short-term outcomes, 1) repeat urine cultures were sterile within 24 hours in all children, and 2) mean time to defervescence was 25 and 24 hours for children treated orally and intravenously, respectively. Of the long-term outcomes, 1) symptomatic reinfections occurred in 4.6% of children treated orally and 7.2% of children treated intravenously, 2) renal scarring at 6 months was noted in 9.8% children treated orally versus 7.2% of children treated intravenously, and 3) mean extent of scarring was ∼8% in both treatment groups. Mean costs were at least twofold higher for children treated intravenously ($3577 vs $1473) compared with those treated orally.

Conclusions.

Oral cefixime can be recommended as a safe and effective treatment for children with fever and urinary tract infection. Use of cefixime will result in substantial reductions of health care expenditures.
Prevalence and Parental Origin in Tetralogy of Fallot Associated With Chromosome 22q11 Microdeletion
Authors: Lu Jen-Her , Chung Ming-Yi , Hwang Betau , Chien Hsieh-Ping
Published: August 2004

Objective.

Tetralogy of Fallot is a common cardiac anomaly that is associated with chromosome 22q11 microdeletion. In this study we examined the mode of transmission as well as the parental origin of microdeletion in patients with tetralogy of Fallot.

Methods.

Eighty-four children with sporadic tetralogy of Fallot (40 boys and 44 girls; mean age, 34 months) were analyzed for microdeletion at chromosome 22q11 by genotype analysis, using five microsatellite markers, D22S427, D22S941, D22S944, D22S264 and D22S311, and confirmed by quantitative polymerase chain reaction, using TUPLE1 and D22S264. All parents of these subjects consented to their own participation and their child's participation in the clinical evaluation and molecular study. To provide a molecular characterization of microdeletion, we isolated DNA from the parents and typed their DNA with each of the five polymorphic markers.

Results.

Sixty-six patients were associated with pulmonary stenosis; and 8 of these cases (12%) had microdeletion. Eighteen patients were associated with pulmonary atresia, and 6 (33%) of these cases had microdeletion. The parental origins of the 14 patients with microdeletion were paternal in 3 cases and maternal in 11 cases. The most common mode of transmission was de novo without parental hemizygosity (93%). Transmission by autosomal dominant heredity was uncommon (7%).

Conclusions.

Biased parental origin was consistently found in tetralogy of Fallot patients with chromosomal 22q11 microdeletion. Our results indicated a higher prevalence of microdeletion because of inheritance of maternal microdeletion (78%).
Serum Concentrations of Antidepressants and Benzodiazepines in Nursing Infants: A Case Series
Authors: Birnbaum Carol S. , Cohen Lee S. , Bailey Jennie W. , Grush Lynn R. , Robertson Laura M. , Stowe Zachary N.
Published: August 2004

Objective.

The relative risk of psychotropic medication use in women with puerperal psychiatric illness who are breastfeeding has yet to be quantified adequately. Although the emotional and medical benefits of breastfeeding and adverse effects of maternal depression on infant development are well described, how these absolute benefits weigh against the potential effects of psychotropic drug use during lactation to ultimately guide clinical decisions is still unclear. The objective of this report was to evaluate the extent that psychotropic medications were present in the serum of infants breastfed by mothers treated with antidepressants and benzodiazepines.

Design.

Serum samples were obtained from 35 nursing infants whose mothers were treated with psychotropic medications while breastfeeding. When a detectable concentration of medication was reported, information regarding infant behavior was obtained by maternal report.

Setting.

The Perinatal and Reproductive Psychiatry Program at Massachusetts General Hospital serves as a regional consultation center for the treatment of psychiatric disorders during pregnancy and the postpartum period.

Patients.

Subjects were mothers referred to the Perinatal Psychiatry Program for consultation regarding the relative safety of psychotropic medication use while breastfeeding.

Primary Outcome Measures.

Presence of detectable levels of medication in infants whose mothers breastfed while taking psychotropic medications during pregnancy and/or during the puerperium and the well-being (based on maternal report) of infants who had detectable serum concentrations of medication.

Results.

Seventy-four percent (n = 26) of infants had serum medication concentrations below the laboratory limit of detection (assay sensitivity 5–50 ng/mL). In the remaining 26% of the sample (n = 9), serum concentrations of psychotropic medications and/or active metabolites were detected. In each of these cases, infants had been exposed to the medication during pregnancy. Medications were not detected in infant serum when mothers had taken these agents solely during the postpartum period. No readily apparent difficulties with the infants were reported by mothers.

Conclusions.

These data support the low incidence of infant toxicity and adverse effects associated with antidepressant and benzodiazepine use during breastfeeding. These data also suggest that infant serum monitoring is helpful in the assessment of medication exposure in children of mothers who breastfeed while using psychotropic medications. Given the limited accumulated data regarding serum concentrations of psychotropic medications in breastfeeding infants, no single agent seems to be safer than another. Therefore, choice of pharmacologic treatment should be guided by the likelihood that it will result in restoration of maternal psychiatric well-being.
Previous Exposure to Measles, Mumps, and Rubella—but Not Vaccination During Adolescence—Correlates to the Prevalence of Pancreatic and Thyroid Autoantibodies
Authors: Lindberg Bengt , Ahlfors Karin , Carlsson Annelie , Ericsson Ulla-Britt , Landin-Olsson Mona , Lernmark Åke , Ludvigsson Johnny , Sundkvist Göran , Ivarsson Sten-Anders
Published: August 2004

Objective.

This study was designed to determine whether a relationship exists between previous exposure to measles, mumps, and rubella (MMR) by natural infection or vaccination or by new immunization with MMR vaccine, and either the presence or levels of autoantibodies against thyroid cell and pancreatic β-cell antigens.

Methods.

Antibodies against MMR and autoantibodies against thyroglobulin, thyroid peroxidase, pancreas islet cells (ICA), islet cell surface, glutamic acid decarboxylase 65k autoantibodies, and insulin were studied before, and 3 months after, vaccination with combined MMR vaccine in 386 school children between 11 and 13 years of age.

Results.

The vaccination changed neither the prevalence nor the level of autoantibodies. Children with rubella antibodies before vaccination had higher levels of ICA than did the rubella seronegative children. In contrast, thyroid autoantibody levels and prevalence were lower in children with antibodies against measles, mumps, or both before vaccination than in children without those antibodies.

Conclusions.

Previous natural infection or vaccination against measles, mumps, or both seemed to have an inhibitory effect on the development of thyroid autoantibodies. In contrast, children with previous exposure to rubella had higher levels of ICA. No evidence was found that MMR vaccination during adolescence may trigger autoimmunity.
Rehospitalization in the First Two Weeks After Discharge From the Neonatal Intensive Care Unit
Authors: Escobar Gabriel J. , Joffe Steven , Gardner Marla N. , Armstrong Mary Anne , Folck Bruce F. , Carpenter Diane M.
Published: August 2004

Background.

High-risk newborns are known to have higher than average utilization of services after discharge from the neonatal intensive care unit (NICU). Most studies on this subject report aggregate data over periods ranging from 1 to 3 years postdischarge. Little is known about events that are temporally close to NICU discharge.

Objectives.

To characterize rehospitalizations within the first 2 weeks after discharge from six community NICUs.

Methods.

We scanned electronic databases and reviewed the charts of rehospitalized infants from six NICUs in the Kaiser Permanente Medical Care Program. We subdivided infants into five groups based on gestational age (GA) and birth hospitalization length of stay (LOS): 1) ≥37 weeks' GA with <4 days LOS (n = 2593); 2) ≥37 weeks' GA with ≥4 days' LOS (n = 1133); 3) from 33 to 36 weeks' GA with <4 days' LOS (n = 545); 4) from 33 to 36 weeks' GA with ≥4 days' LOS (n = 1196); and 5) <33 weeks' GA (n = 587). We performed bivariate and multivariate analyses to identify predictors that might be useful for practitioners.

Results.

There were 6054 newborns discharged alive from the six study NICUs between August 1, 1992 and December 31, 1995, and 99.5% of these infants remained in the health plan during the 2 weeks after NICU discharge. The overall rehospitalization rate was 2.72%, which is 20% higher than the rate among healthy term newborns in the Kaiser Permanente Medical Care Program (2.26%). The two most common reasons for rehospitalization were jaundice (62/165, 37.6%) and feeding difficulties (25/165, 15.2%). Infants with 33 to 36 weeks' GA and <4 days' LOS were rehospitalized at a significantly higher rate than were all other infants (5.69%); 71% of infants in this group were rehospitalized for jaundice. The following variables predicted rehospitalization in multivariate models: <33 weeks' GA (adjusted OR [AOR]: 1.88; 95% CI: 1.10–3.21), from 33 to 36 weeks' GA with <96 hours' LOS (AOR: 2.94; 95% CI: 1.87–4.62), and birth at facility B, which had the highest rehospitalization rate of the six facilities (AOR: 1.92; 95% CI: 1.39–2.65).

Conclusions.

The rate of rehospitalization among NICU graduates is higher than among healthy term infants. Most of the rehospitalizations among infants with from 33 to 36 weeks' GA and <4 days' LOS are for illnesses that are not life-threatening. Collaborative studies and new process and outcomes measures are needed to assess the effectiveness of follow-up strategies in high-risk newborns.
The Effects of Different Resistance Training Protocols on Muscular Strength and Endurance Development in Children
Authors: Faigenbaum Avery D. , Westcott Wayne L. , Loud Rita LaRosa , Long Cindy
Published: August 2004

Background.

Previous research has shown that children can increase their muscular strength and muscular endurance as a result of regular participation in a progressive resistance training program. However, the most effective exercise prescription regarding the number of repetitions remains questionable.

Objective.

To compare the effects of a low repetition–heavy load resistance training program and a high repetition–moderate load resistance training program on the development of muscular strength and muscular endurance in children.

Design.

Prospective, controlled trial.

Setting.

Community-based youth fitness center.

Subjects.

Eleven girls and 32 boys between the ages of 5.2 and 11.8 years.

Intervention.

In twice-weekly sessions of resistance training for 8 weeks, children performed 1 set of 6 to 8 repetitions with a heavy load (n = 15) or 1 set of 13 to 15 repetitions with a moderate load (n = 16) on child-size exercise machines. Children in the control group (n = 12) did not resistance train. One repetition maximum (RM) strength and muscular endurance (repetitions performed posttraining with the pretraining 1-RM load) were determined on the leg extension and chest press exercises.

Results.

One RM leg extension strength significantly increased in both exercise groups compared with that in the control subjects. Increases of 31.0% and 40.9%, respectively, for the low repetition–heavy load and high repetition–moderate load groups were observed. Leg extension muscular endurance significantly increased in both exercise groups compared with that in the control subjects, although gains resulting from high repetition–moderate load training (13.1 ± 6.2 repetitions) were significantly greater than those resulting from low repetition–heavy load training (8.7 ± 2.9 repetitions). On the chest press exercise, only the high repetition–moderate load exercise group made gains in 1-RM strength (16.3%) and muscular endurance (5.2 ± 3.6 repetitions) that were significantly greater than gains in the control subjects.

Conclusion.

These findings support the concept that muscular strength and muscular endurance can be improved during the childhood years and favor the prescription of higher repetition–moderate load resistance training programs during the initial adaptation period.
Pediatric Myocardial Infarction After Racemic Epinephrine Administration
Authors: Butte Manish J. , Nguyen Bac X. , Hutchison Tim J. , Wiggins James W. , Ziegler James W.
Published: August 2004

Myocardial infarction is a previously unreported complication of treatment with racemic epinephrine that is used commonly in the emergency department for severe respiratory distress in bronchiolitis or croup syndrome. We describe a pediatric patient who presented with the croup syndrome and severe respiratory distress that required multiple doses of nebulized racemic epinephrine in the emergency department. The patient developed ventricular tachycardia and mild chest discomfort during one treatment, which resolved spontaneously on discontinuation of the nebulization. Persistently abnormal electrocardiograms and elevated creatine phosphokinase MB isoenzyme (CPK–MB) levels suggested a myocardial infarction had occurred. Subsequent echocardiography, cardiac catheterization, and angiography revealed an anatomically normal heart with normal coronary circulation; however, a stress nuclear study showed a small myocardial infarct. The significance of this previously unreported complication of racemic epinephrine is discussed, along with recommendations for proper use in the emergency department.
Minimum Incidence and Diagnostic Rate of First Urinary Tract Infection
Authors: Jakobsson Birgir , Esbjörner Elisabeth , Hansson Sverker ,   on behalf of the Swedish Pediatric Nephrology Association
Published: August 2004

Objective.

To study awareness of urinary tract infections (UTIs) by determining the diagnostic rate of first UTI in children <2 years of age and to estimate the minimum incidence.

Methods.

Twenty-six of a total of 43 pediatric centers participated in the study. Sixty-four percent of the total childhood population <2 years of age was covered. The number of all children included in the study was used to calculate the diagnostic rate. Only UTI confirmed by either suprapubic aspiration (any growth) or midstream or bag samples with ≥100 000 bacteria/mL, together with a positive nitrite reaction, was used to estimate the minimum incidence.

Results.

The mean diagnostic rate was 1.5% for boys (range, 0.7%–3.0%) and 1.7% for girls (range, 0.7%–2.9%). The diagnostic rate was significantly higher in June than in December. The mean incidence was 1.0% for both boys and girls (range, 0.3%–3.0% and 0.4%–2.9%, respectively). The minimum cumulative incidence at 2 years of age was estimated to be 2.2% for boys and 2.1% for girls.

Conclusion.

This study suggests a high UTI awareness in Sweden as indicated by a higher diagnostic rate and, despite stricter diagnostic criteria, a higher incidence of UTI in children <2 years of age than previously reported. It is suggested that a high UTI awareness may reduce chronic renal failure because of pyelonephritic renal scarring.
Safety of Withdrawing Inhaled Nitric Oxide Therapy in Persistent Pulmonary Hypertension of the Newborn
Authors: Davidson Dennis , Barefield Elaine S. , Kattwinkel John , Dudell Golde , Damask Michael , Straube Richard , Rhines Jared , Chang Cheng-Tao ,   the I-NO/PPHN Study Group
Published: August 2004

Objective.

Because of case reports describing hypoxemia on withdrawal of inhaled nitric oxide (I-NO), we prospectively examined this safety issue in newborns with persistent pulmonary hypertension who were classified as treatment successes or failures during a course of I-NO therapy.

Methods.

Randomized, placebo-controlled, double-masked, dose-response clinical trial at 25 tertiary centers from April 1994 to June 1996. Change in oxygenation and outcome (death and/or extracorporeal membrane oxygenation) during or immediately after withdrawing I-NO were the principal endpoints. Patients (n = 155) were term infants, <3 days old at study entry with echocardiographic evidence of persistent pulmonary hypertension of the newborn. Exclusion criteria included previous surfactant treatment, high-frequency ventilation, or lung hypoplasia. Withdrawal from treatment gas (0, 5, 20, or 80 ppm) started once treatment success or failure criteria were met. Withdrawal of treatment gas occurred at 20% decrements at <4 hours between steps.

Results.

The patient profile was similar for placebo and I-NO groups. Treatment started at an oxygenation index (OI) of 25 ± 10 (mean ± SD) at 26 ± 18 hours after birth. For infants classified as treatment successes (mean duration of therapy = 88 hours, OI <10), decreases in the arterial partial pressure of oxygen (Pao2) were observed only at the final step of withdrawal. On cessation from 1, 4, and 16 ppm, patients receiving I-NO demonstrated a dose-related reduction in Pao2 (−11 ± 23, −28 ± 24, and −50 ± 48 mm Hg, respectively). For infants classified as treatment failures (mean duration of therapy = 10 hours), no change in OI occurred for the placebo group (−13 ± 36%, OI of 31 ± 11 after the withdrawal process); however a 42 ± 101% increase in OI to 46 ± 21 occurred for the pooled nitric oxide doses. One death was possibly related to withdrawal of I-NO.

Conclusion.

For infants classified as treatment successes, a dose response between the I-NO dose and decrease in Pao2 after discontinuing I-NO was found. A reduction in I-NO to 1 ppm before discontinuation of the drug seems to minimize the decrease in Pao2 seen. For infants failing treatment, discontinuation of I-NO could pose a life-threatening reduction in oxygenation should extracorporeal membrane oxygenation not be readily available or I-NO cannot be continued on transport.
Cerebral Blood Flow Velocity During Tilt Table Test for Pediatric Syncope
Authors: Rodriguez Rosendo A. , Snider Kimberly , Cornel Garry , Teixeira Otto H. P.
Published: August 2004

Background.

Brain hypoperfusion during neurocardiogenic syncope develops as a consequence of hypotension and bradycardia. Transcranial Doppler indicates that an increase in cerebral vascular resistance occurs before or during the loss of consciousness.

Objective.

Cerebral blood flow velocity was studied during tilt table testing in pediatric patients with neurocardiogenic syncope. We assessed whether a critical reduction in flow velocity (>40%) was predictive of the presyncopal manifestations during the test.

Methods.

A 2-MHz transcranial Doppler measured blood flow velocity in the right middle cerebral artery in 27 pediatric patients (ages, 8 to 18 years) during a three-stage 80° tilt table test protocol. A positive test required development of syncope or presyncope with at least 30% decrease in systolic blood pressure and/or heart rate relative to preceding values. Patients were divided into: group I (isoproterenol-induced positive tests), group II (positive without isoproterenol), and group III (negative tests).

Results.

Within the first 3 minutes of the upright position mean cerebral blood flow velocity in groups I, II, and III decreased by 18%, 29%, and 17%, respectively, as the systolic and diastolic blood pressures showed only minimal changes. A decreased mean blood flow velocity of 48% and 45% and an increase in resistance index of 42% and 26% from supine values in the absence of hypotension, were detected in groups I and II at 46 seconds (range, 30–120 seconds) and 50 seconds (range, 0–300 seconds) before any clinical symptom (presyncope latency). Mean blood flow velocity during presyncope decreased by 58% and 59%, whereas resistance index was double. A significant correlation (ρ = −0.62) was found between presyncope latency and the decreased mean cerebral blood flow velocity. Similar blood flow velocity changes were not detected in group III.

Conclusion.

A sustained reduction >40% in mean cerebral blood flow velocity in the absence of hypotension always resulted in presyncopal or syncopal manifestations. It seems that once this critical threshold is identified during the tilt table testing, supine position may be resumed several seconds before the clinical manifestations of syncope.
The Etiology and Outcome of Cerebral Ventriculomegaly at Term in Very Low Birth Weight Preterm Infants
Authors: Ment Laura R. , Vohr Betty , Allan Walter , Westerveld Michael , Katz Karol H. , Schneider Karen C. , Makuch Robert W.
Published: August 2004

Background.

Despite improvements in survival data, the incidence of neurodevelopmental handicaps in preterm infants remains high. To prevent these handicaps, one must understand the pathophysiology behind them. For preterm infants, cerebral ventriculomegaly (VM) may be associated with adverse neurodevelopmental outcome. We hypothesized that although the causes of VM are multiple, the incidence of handicap at 4.5 years of age in preterm infants with this ultrasonographic finding at term would be high.

Methods.

To test this hypothesis, we provided neurodevelopmental follow-up for all 440 very low birth weight survivors of the Multicenter Randomized Indomethacin Intraventricular Hemorrhage (IVH) Prevention Trial. A total of 384 children (87%) were evaluated at 54 months' corrected age (CA), and 257 subjects were living in English-speaking, monolingual households and are included in the following data analysis.

Results.

Moderate to severe low pressure VM at term was documented in 11 (4%) of the English-speaking, monolingual survivors. High grade IVH and bronchopulmonary dysplasia (BPD) were both risk factors for the development of VM. Of 11 (45%) children with VM, 5 suffered grades 3 to 4 IVH, compared with 2/246 (1%) children without VM who experienced grades 3 to 4 IVH. Similarly, 9/11 (82%) children with VM had BPD, compared with 120/246 (49%) children without VM who had BPD.

Logistic regression analysis was performed using birth weight, gestational age, gender, Apgar score at 5 minutes, BPD, sepsis, moderate to severe VM, periventricular leukomalacia, grade of IVH, and maternal education to predict IQ <70. Although maternal education was an important and independent predictor of adverse cognitive outcome, in this series of very low birth weight prematurely born children, VM was the most important predictor of IQ <70 (OR: 19.0; 95% CI: 4.5, 80.6). Of children with VM, 6/11 (55%) had an IQ <70, compared with 31/246 (13%) of children without VM. Children with VM had significantly lower verbal and performance scores compared with children without VM.

Conclusions.

These data suggest that, for preterm neonates, VM at term is a consequence of the vulnerability of the developing brain. Furthermore, its presence is an important and independent predictor of adverse cognitive and motor development at 4.5 years' CA.
Relationship Among Genotype, Biochemical Phenotype, and Cognitive Performance in Females With Phenylalanine Hydroxylase Deficiency: Report From the Maternal Phenylketonuria Collaborative Study
Authors: Güttler Flemming , Azen Colleen , Guldberg Per , Romstad Anne , Hanley William B. , Levy Harvey L. , Matalon Reuben , Rouse Bobbye M. , Trefz Friedrich , de la Cruz Felix , Koch Richard
Published: August 2004

Objective.

To examine the relationship of phenylalanine hydroxylase (PAH) genotypes to biochemical phenotype and cognitive development in maternal phenylketonuria (PKU).

Methodology.

PAH gene mutations were examined in 222 hyperphenylalaninemic females enrolled in the Maternal PKU Collaborative Study (MPKUCS). A total of 84 different mutations were detected, and complete genotype was obtained in 199 individuals. Based on previous knowledge about mutation–phenotype associations, 78 of the mutations could be assigned to one of four classes of severity (severe PKU, moderate PKU, mild PKU, and mild hyperphenylalaninemia [MHP]). Then, 189 MPKUCS subjects were grouped according to the various combinations of mutation classifications. The sample sizes were large enough for statistical testing in four groups with at least one mutation that completely abolishes enzyme activity. These patients are considered functionally hemizygous.

Results.

The biochemical phenotype predicted from the genotype in functionally hemizygous patients was related significantly to the assigned phenylalanine level. Cognitive performance (IQ) was also significantly related to genotype. The IQ of PAH-deficient mothers with a severe PKU mutation in combination with a MHP mutation or a mild PKU mutation was 99 and 96, respectively, whereas the IQ of PKU mothers with two severe PKU mutations or with one severe and one moderate PKU mutation was 83 and 84, respectively. Of the patients with PKU, 92% had been treated during childhood. Those who were untreated or treated late had lower than average IQ scores for their group of mutation combinations. Females with moderate or mild PKU who were treated early and treated for >6 years showed IQ scores 10 points above average for their group.

Conclusions.

The reproductive outcome in maternal phenylketonuria is dependent on prenatal metabolic control and postnatal environmental circumstances. Both factors depend on the intellectual resources of the mother with PKU. The significant relationship among genotype, biochemical phenotype, and cognitive performance observed in the present study is of importance for the development of an optimal strategy for future treatment of females with PKU who plan pregnancy.