bluuebunny/crossref_metadata_2025 huggingface dataset:
A Retrospective Review of Pediatric Patients With Epididymitis, Testicular Torsion, and Torsion of Testicular Appendages
Authors: Kadish Howard A. , Bolte Robert G.
Published: August 2004

Study Objective. To compare historical features, physical examination findings, and testicular color Doppler ultrasound in pediatric patients with epididymitis, testicular torsion, and torsion of appendix testis.

Methods. A retrospective review of patients with the diagnosis of epididymitis, testicular torsion, or torsion of appendix testis.

Results. Ninety patients were included in the study (64 with epididymitis, 13 with testicular torsion, and 13 with torsion of appendix testis). Historical features did not differ among groups except for duration of symptoms. Of 13 patients with testicular torsion all had a tender testicle and an absent cremasteric reflex. When compared with the testicular torsion group, fewer patients with epididymitis had a tender testicle (69%) or an absent cremasteric reflex (14%). 62 (97%) patients with epididymitis had a tender epididymis and 43 (67%) had scrotal erythema/edema. By comparison, 3 (23%) and 5 (38%) patients with testicular torsion had a tender epididymis or scrotal erythema/edema, respectively. Doppler ultrasound showed decreased or absent blood flow in 8 patients, 7 of whom were diagnosed with testicular torsion. Ten out of 13 patients with testicular torsion had a salvageable testicle at the time of surgery.

Conclusion. The physical examination is helpful in distinguishing among epididymitis, testicular torsion, and torsion of appendix testis. Patients presenting with a tender testicle and an absent cremasteric reflex were more likely to have a testicular torsion rather than epididymitis or torsion of appendix testis. An absent cremasteric reflex was the most sensitive physical finding for diagnosing testicular torsion. Color Doppler ultrasound is a useful adjunct in the evaluation of the acute scrotum when physical findings are equivocal.
Maternal Asthma and Transient Tachypnea of the Newborn
Authors: Demissie Kitaw , Marcella Stephen W. , Breckenridge Mary B. , Rhoads George G.
Published: August 2004

Objective. To examine the relationship between transient tachypnea of the newborn and asthma complicating pregnancy.

Design. Historical cohort analysis.

Setting. Singleton live deliveries in New Jersey hospitals during 1989 to 1992 (n = 447 963).

Patients. Mother-infant dyads were identified from linked birth certificate and maternal and infant hospital claims data. Women with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code (493) for asthma (n = 2289) were compared with a four-fold larger randomly selected control sample (n = 9156) from the remaining pool of women.

Main Outcome Measure. Transient tachypnea of the newborn.

Results. In the overall sample, after controlling for the confounding effects of important variables, infants of asthmatic mothers were more likely [odds ratio (OR), 1.79; 95% confidence interval (CI), 1.35–2.37] than infants of control mothers to exhibit transient tachypnea of the newborn. A stratified analysis by gestational age and sex revealed larger and statistically significant associations in term infants (OR, 2.02; 95% CI, 1.42–2.87) as opposed to preterm infants (OR, 1.51; 95% CI, 0.94–2.43) and in male infants (OR, 1.91; 95% CI, 1.35–2.71) as opposed to female infants (OR, 1.51; 95% CI, 0.92–2.47). On the other hand, after adjusting for important confounding variables, respiratory distress syndrome and maternal asthma were not found to be associated (OR, 1.14; 95% CI, 0.79–1.64).

Conclusion. The results of this study provide evidence that maternal asthma is a risk factor for transient tachypnea of the newborn and differences in gestational age and sex were apparent in this association. The mechanism for this association remains to be determined.
Desensitization to Pancreatic Enzyme Intolerance in a Child With Cystic Fibrosis
Authors: Chamarthy Latha M. , Reinstein L. Julio , Schnapf Bruce , Good Robert A. , Bahna Sami L.
Published: August 2004

Objective. Pancreatic enzyme is essential in the treatment of cystic fibrosis (CF), but intolerance to it occasionally occurs. We encountered a child who was intolerant to multiple commercially available preparations of pancreatic enzymes and, hence, desensitization was attempted, with success.

Case Presentation. A 33-month-old girl was diagnosed with CF at 6 months of age. Initially, she was started on Pancrease MT 16, which was subsequently discontinued because fecal fat studies were normal and she seemed to do well on Nutramigen and vitamin supplements. At 29 months of age, she developed diarrhea with bulky stools and weight loss. A fecal fat 72-hour study revealed a coefficient of absorption of 50%. She was treated with Pancrease MT 16, but had consistent vomiting 1 to 2 hours after administration of enzymes. The vomiting occurred on switching to different pancreatic enzymes preparations, ie, Creon 10, Viokase, and Pancrease MT 16. Vomiting occurred even with small doses of enzymes disguised in food. She had no history suggestive of gastroesophageal reflux, peptic ulcer, or pork allergy, and no vomiting on days when enzymes were not given. This was suggestive of type I hypersensitivity reaction. Pancreatic enzymes were discontinued, and she was given a low-fat, high-carbohydrate diet with satisfactory weight gain.

Methods. Double-blind, placebo-controlled titrated oral challenges with pancreatic enzymes resulted in definite vomiting within 1 to 1.5 hours after challenges with Viokase and Pancrease MT 16, but not with placebo. Rush oral desensitization with Viokase solution was attempted, starting with 5 mg, and the dose was doubled every 20 minutes, aiming to reach a cumulative dose of 700 mg. However, the child vomited when a cumulative dose of 315 mg was reached. Another trial of slower desensitization was done using Pancrease MT 16 (1 capsule: 16 000 U of lipase, 48 000 U of amylase, and 48 000 U of protease), starting with ¼ capsule per day, with increments of ¼ capsule every 3 days, until an entire capsule was reached by day 10, then increased by ∼½ capsule every 4 days until reaching the therapeutic dose of 1 capsule with each meal by day 25.

Results. The patient tolerated this fairly well and has been on this treatment and regular diet for >1 year, without any adverse reaction. This illustrates a rare case of gastrointestinal adverse reaction to pancreatic enzymes that was treated successfully with desensitization.

Conclusion. Pancreatic enzyme intolerance, although rare, would be a major problem in the management of patients with CF. Hence, desensitization would be essential and may be accomplished successfully using the protocol described in this report.
Incidence of Passive Exposure to Crack/Cocaine and Clinical Findings in Infants Seen in an Outpatient Service
Authors: Lustbader Andrew S. , Mayes Linda C. , McGee Barbara A. , Jatlow Peter , Roberts William L.
Published: August 2004

Objectives. Passive exposure to crack/cocaine and the associated clinical symptoms may present a significant health risk to very young infants and children. This study was designed to determine the incidence of cocaine exposure, presumed to be passive, in ill infants younger than 1 year of age, using a threshold of detection for cocaine and/or its major metabolite, benzoylecognine (BE), that is lower than the current National Institute on Drug Abuse standard. The study also investigates the morbidity associated with passive cocaine exposure in this population.

Methods. We prospectively obtained 124 samples of urine from 122 children younger than 1 year of age for routine clinical indications from the emergency department at Yale–New Haven Hospital. Samples were analyzed by radioimmunoassay (RIA) for cocaine, with cross-reactivity for BE. The presence of BE in a portion of the RIA-positive samples also was detected in additional analyses by enzyme-multiplied immunoassay technique or by gas chromatography-mass spectrometry. A chart review was conducted on all 122 patients by reviewers blind to the urine toxicology results. Presenting complaints, symptoms, vital signs, and diagnosis were obtained for all visits before the first birthday. Birth history, including maternal drug history and birth weight, demographics, and number of medical visits in the first year, were recorded as well.

Results. Of the 124 samples, 45 (36.3%) were positive (≥50 ng/mL of BE equivalents) for cocaine and/or cocaine metabolite by RIA testing. The positive results, determined by RIA, were highly correlated with patients who had lower and upper respiratory symptoms and sought medical care more often.

Conclusions. The incidence of unsuspected, passive cocaine exposure in ill infants seeking medical care primarily through an emergency service may be as high as 1 in 3 to 6 infants from our predominantly inner city population. Current immunoassay methods, specific for BE, and their routine threshold of detection (200 to 300 ng/mL) may not be sensitive enough to detect cocaine and BE in the urine samples of children younger than 1 year of age who are exposed passively. The development of upper and lower respiratory symptoms is correlated significantly with positive urine results in this study. The increased use of health care resources correlated with passive cocaine exposure in this sample may serve as an indirect marker for the increased medical needs of these infants.
Neuroimaging, Physical, and Developmental Findings After Inflicted and Noninflicted Traumatic Brain Injury in Young Children
Authors: Ewing-Cobbs Linda , Kramer Larry , Prasad Mary , Canales Denise Niles , Louis Penelope T. , Fletcher Jack M. , Vollero Hilda , Landry Susan H. , Cheung Kim
Published: August 2004

Objective. To characterize neuroimaging, physical, neurobehavioral, and developmental findings in children with inflicted and noninflicted traumatic brain injury (TBI) and to identify characteristic features of inflicted TBI.

Methods and Patients. Forty children, 0 to 6 years of age, hospitalized for TBI who had no documented history of previous brain injury were enrolled in a prospective longitudinal study. TBI was categorized as either inflicted (n = 20) or noninflicted (n = 20) based on the assessment of hospital and county protective services. Glasgow Coma Scale scores and neonatal history were comparable in both groups.

Outcome Measures. Acute computed tomography/magnetic resonance imaging studies and physical findings were evaluated. Glasgow Outcome Scale scores, cognitive development, and motor functioning were assessed an average of 1.3 months after TBI. χ2 analyses assessed differences in the distribution of findings in the inflicted and noninflicted TBI groups.

Results. Signs of preexisting brain injury, including cerebral atrophy, subdural hygroma, and ex vacuo ventriculomegaly, were present in 45% of children with inflicted TBI and in none of the children with noninflicted TBI. Subdural hematomas and seizures occurred significantly more often in children with inflicted TBI. Intraparenchymal hemorrhage, edema, skull fractures, and cephalohematomas were similar in both groups. Retinal hemorrhage was only identified in the inflicted TBI group. Glasgow Outcome Scale scores indicated a significantly less favorable outcome after inflicted than noninflicted TBI. Mental deficiency was present in 45% of the inflicted and 5% of the noninflicted TBI groups.

Conclusions. Characteristic features of inflicted TBI included acute computed tomography/magnetic resonance imaging findings of preexisting brain injury, extraaxial hemorrhages, seizures, retinal hemorrhages, and significantly impaired cognitive function without prolonged impairment of consciousness.
Psychological Findings in Preterm Children Related to Neurologic Status and Magnetic Resonance Imaging
Authors: Olsén Paivi , Vainionpää Leena , Pääkkö Eija , Korkman Marit , Pyhtinen Juhani , Järvelin Marjo-Riitta
Published: August 2004

Objective. Preterm children experience learning disabilities more often than full-term children, but detailed information on their neuropsychological and neurologic determinants is lacking. We therefore examined these problems more closely and also studied if clinical neurologic examination and/or magnetic resonance imaging (MRI) can be used as tools to screen the preterm children at risk for these problems.

Methods. In a population-based study, the psychological performance of 42 preterm children with a birth weight <1750 g and of their matched controls was assessed at 8 years of age and the findings were then related to clinical neurologic examination and MRI. Learning disabilities of these children, reported by the teachers, were also studied.

Results. The cognitive ability of the preterm children, although in the normal range, was significantly lower than that of the control children. They performed particularly poorly in tasks requiring spatial and visuoperceptual abilities, which were associated with the finding of periventricular leukomalacia in MRI, especially with posterior ventricular enlargement. The preterm children with minor neurodevelopmental dysfunction (MND) had the most problems in neuropsychological tests, whereas the clinically healthy preterm children and those with cerebral palsy had fewer problems. The problems of MND children emerged in the domain of attention. They also experienced the most problems at school.

Conclusions. Visuospatial problems were associated with periventricular leukomalacia in MRI, but learning disabilities were most frequent among the preterm children with minor neurologic abnormalities. We recommend closer follow-up of preterm children with MND.
Hepatitis C Virus Infection in the Mothers and Infants Cohort Study
Authors: Granovsky Monica O. , Minkoff Howard L. , Tess Beatriz H. , Waters David , Hatzakis Angelos , Devoid David E. , Landesman Sheldon H. , Rubinstein Arye , Di Bisceglie Adrian M. , Goedert James J.
Published: August 2004

Objectives. To estimate the hepatitis C virus (HCV) vertical transmission rate, the effect of potential risk factors, and the pattern of HCV antibody response and viremia in HCV-infected infants.

Study Design. The Mothers and Infants Cohort Study enrolled both human immunodeficiency virus (HIV)-seropositive and HIV-seronegative pregnant women at five obstetric clinics in New York City in a prospective cohort study between January 1986 and January 1991. HCV-infected mothers and their 122 offspring were followed-up for a minimum of 12 months for evidence of HCV infection as determined by persistent HCV antibodies or detection of HCV RNA by reverse transcription polymerase chain reaction. Comparisons among groups for categorical variables were performed using the Fisher's exact test.

Results. Seven (6%; 95% confidence interval, 2%-11%) of the 122 infants were HCV-infected. There was a tendency for increased risk of transmission with maternal viral and obstetrical factors, such as coinfection with HIV (7% vs 4%), high HIV viral load (13% vs 6%), HCV viremia (8% vs 3%), vaginal delivery (6% vs 0%), and female gender of offspring (8% vs 3%), although none of the associations reached statistical significance. After loss of maternal antibody, HCV antibody seroconversion occurred at a mean age of 26 months in 3 HIV-coinfected infants compared with 7 months of age in 4 HCV-infected HIV-uninfected infants. Serial samples showed that HCV RNA persisted in 6 infants for at least 18 to 54 months.

Conclusions. Our study is in accordance with other studies that have shown low overall HCV vertical transmission risk and a trend toward higher risk with maternal risk factors such as HIV-coinfection or HCV viremia. A delay in infant HCV antibody response may be associated with HIV coinfection although larger studies are needed to confirm these findings.
Course and Outcome of Chronic Fatigue in Children and Adolescents
Authors: Krilov Leonard R. , Fisher Martin , Friedman Stanford B. , Reitman David , Mandel Francine S.
Published: August 2004

Purpose. To describe the epidemiology, symptoms, and psychosocial characteristics of children and adolescents evaluated in a chronic fatigue program and determine the course and outcome of the syndrome in these patients.

Methods. During the summer of 1994, chart review was performed for the 58 patients evaluated between 1990 and 1994 and a telephone follow-up was conducted with 42 of the 58 families. Patients were predominantly female (71%) and white (94%), with 50% between the ages of 7 and 14 years and 50% between the ages of 15 and 21 years (mean age 14.6 years).

Results. At time of presentation, 50% of patients had been fatigued for 1 to 6 months and 50% had been fatigued for 7 to 36 months. Sixty percent indicated the fatigue had begun with an acute illness and 60% had a history of allergies. Most commonly reported symptoms were fatigue (100%), headache (74%), sore throat (59%), abdominal pain (48%), fever (36%), and difficulties with concentration and/or memory (33%). Most patients had a worsening of school performance and a decrease in social activities. On follow-up, there was significant improvement in many patients during the summer after the first visit, with continued improvement in most patients during the second and third years. At time of the follow-up telephone call, 43% of families considered their child “cured” and 52% considered their child “improved,” whereas only 5% considered their child to be “the same.” Statistical analyses demonstrated no demographic or clinical factors that distinguished between those who did or did not participate in the follow-up study, or between those who did or did not do well on follow-up.

Conclusions. These data demonstrate that children and adolescents with chronic fatigue have a syndrome that is similar to that described in adults, but that the syndrome differs in several ways, most specifically, presentation earlier in the course of the illness and a more optimistic outcome.
School-based Interventions Improve Heart Health in Children With Multiple Cardiovascular Disease Risk Factors
Authors: Harrell Joanne S. , Gansky Stuart A. , McMurray Robert G. , Bangdiwala Shrikant I. , Frauman Annette C. , Bradley Chyrise B.
Published: August 2004

Objective. To determine the immediate effects of two types of elementary school-based interventions on children with multiple cardiovascular disease (CVD) risk factors.

Design. Randomized, controlled field trial.

Setting. Conducted in 18 randomly selected elementary schools across North Carolina.

Study Participants. Four hundred twenty-two children age 9 ± 0.8 years with at least two risk factors at baseline: low aerobic power and either high serum cholesterol or obesity.

Intervention. Both 8-week interventions consisted of a knowledge and attitude program and an adaptation of physical education. The classroom-based intervention was given by regular teachers to all children in the 3rd and 4th grades. The risk-based intervention was given in small groups only to children with identified risk factors. Children in the control group received usual teaching and physical education.

Outcome Measures. The primary outcome measure was cholesterol; additional measures were blood pressure, body mass index, body fat, eating and activity habits, and health knowledge.

Results. Both interventions produced large reductions in cholesterol (−10.1 mg/dL and −11.7 mg/dL) compared with a small drop (−2.3 mg/dL) in the controls. There was a trend for systolic blood pressure to increase less in both intervention groups than in the controls. Both intervention groups had a small reduction in body fat and higher health knowledge than the control group.

Conclusions. Both brief interventions can improve the CVD risk profile of children with multiple risk factors. The classroom-based approach was easier to implement and used fewer resources. This population approach should be considered as one means of early primary prevention of CVD.
Colonoscopy Under General Anesthesia in Children
Authors: Dillon Michelle , Brown Siobhan , Casey William , Walsh Deirdre , Durnin Marie , Abubaker Kabir , Drumm Brendan
Published: August 2004

Objective. In children, colonoscopy is usually performed using deep sedation that may be associated with significant risks. The purpose of this study was to evaluate the safety of colonoscopy performed under general anesthesia.

Methods. All patients undergoing colonoscopy during a 3-year period were reviewed for the study. One hundred and thirty-six procedures were performed. Colonoscopies were performed by a pediatric gastroenterologist. Anesthesia was administered by a pediatric anesthetist in a gastroenterology procedure room, adjacent to the operating recovery area.

Results. Three patients had significant abdominal pain and tenderness after the procedure, 1 of whom suffered a perforation of the sigmoid colon. This patient had severe ulcerative colitis. The gastrointestinal complication rate was no higher than reported in adult patients undergoing colonoscopy under sedation. No significant complications relating to the administration of anesthesia were encountered.

Conclusion. We conclude that colonoscopy performed under general anesthesia in children is a very safe procedure. It is superior to the use of sedation because the child is not placed at risk of respiratory compromise. Furthermore, the procedure is less worrisome for children when performed under a general anesthetic.
Prevalence of Urinary Tract Infection in Febrile Young Children in the Emergency Department
Authors: Shaw Kathy N. , Gorelick Marc , McGowan Karin L. , Yakscoe Noreen McDaniel , Schwartz J. Sanford
Published: August 2004

Objective. Establish prevalence rates of urinary tract infection (UTI) in febrile infants and young girls in an emergency department (ED) by demographics and clinical parameters.

Methods. Cross-sectional prevalence survey of 2411 (83%) of all infants younger than 12 months and girls younger than 2 years of age presenting to the ED with a fever (≥38.5°C) who did not have a definite source for their fever and who were not on antibiotics or immunosuppressed. Otitis media, gastroenteritis, and upper respiratory infection were considered potential but not definite sources of fever.

Results. Overall prevalence of UTI (growth of ≥104 CFU/mL of a urinary tract pathogen) was 3.3% (95% confidence interval [CI]: 2.6,4.0). Higher prevalences occurred in whites (10.7%; 95% CI: 7.1,14.3), girls (4.3%; 95% CI: 3.3,5.3), uncircumcised boys (8.0%; 95% CI: 1.9,14.1), and those who did not have another potential source for their fever (5.9%; 95% CI: 3.8,8.0), had a history of UTI (9.3%; 95% CI: 3.0,20.3), malodorous urine or hematuria (8.6%; 95% CI: 2.8,19.0), appeared “ill” (5.7%; 95% CI: 4.0,7.4), had abdominal or suprapubic tenderness on examination (13.2%; 95% CI: 3.7,30.7), or had fever ≥39°C (3.9%; 95% CI: 3.0,4.8). White girls had a 16.1% (95% CI: 10.6,21.6) prevalence of UTI.

Conclusions. UTI is prevalent in young children, particularly white girls, without a definite source of fever. Specific clinical signs and symptoms of UTI are uncommon, and the presence of another potential source of fever such as upper respiratory infection or otitis media is not reliable in excluding UTI.
Hemodynamic Support in Fluid-refractory Pediatric Septic Shock
Authors: Ceneviva Gary , Paschall J. Alan , Maffei Frank , Carcillo Joseph A.
Published: August 2004

Objective. Assess outcome in children treated with inotrope, vasopressor, and/or vasodilator therapy for reversal of fluid-refractory and persistent septic shock.

Design. Survey; case series.

Setting. Three pediatric hospitals.

Patients. Fifty consecutive patients with fluid-refractory septic shock with a pulmonary artery catheter within 6 hours of resuscitation.

Interventions. Patients were categorized according to hemodynamic state and use of inotrope, vasopressor, and/or vasodilator therapy to maintain cardiac index (CI) >3.3 L/min/m2 and systemic vascular resistance >800 dyne-sec/cm5/m2 to reverse shock.

Outcome Measures. Hemodynamic state, response to class of cardiovascular therapy, and mortality.

Results. After fluid resuscitation, 58% of the children had a low CI and responded to inotropic therapy with or without a vasodilator (group I), 20% had a high CI and low systemic vascular resistance and responded to vasopressor therapy alone (group II), and 22% had both vascular and cardiac dysfunction and responded to combined vasopressor and inotropic therapy (group III). Shock persisted in 36% of the children. Of the children in group I, 50% needed the addition of a vasodilator, and in group II, 50% of children needed the addition of an inotrope for evolving myocardial dysfunction. Four children showed a complete change in hemodynamic state and responded to a switch from inotrope to vasopressor therapy or vice versa. The overall 28-day survival rate was 80% (group I, 72%; group II, 90%; group III, 91%).

Conclusions. Unlike adults, children with fluid-refractory shock are frequently hypodynamic and respond to inotrope and vasodilator therapy. Because hemodynamic states are heterogeneous and change with time, an incorrect cardiovascular therapeutic regimen should be suspected in any child with persistent shock. Outcome can be improved compared with historical literature.
Chewing Gum Bezoars of the Gastrointestinal Tract
Authors: Milov David E. , Andres Joel M. , Erhart Nora A. , Bailey David J.
Published: August 2004

Children have chewed gum since the Stone Age. Black lumps of prehistoric tar with human tooth impressions have been found in Northern Europe dating from ∼7000 BC (Middle Stone Age) to 2000 BC (Bronze Age).1 The bite impressions suggest that most chewers were between 6 and 15 years of age. The Greeks chewed resin from the mastic tree (mastic gum). North American Indians chewed spruce gum. The first manufacturing patent for chewing gum was issued in 1869 for a natural gum, chicle, derived from the Sopadilla tree, indigenous to Central America. Chewing gum sold today is a mixture of natural and synthetic gums and resins, with added color and flavor sweetened with corn syrup and sugar. Chewing gum is big business. A significant amount of the $21 billion US candy industry sales is from chewing gums, many of which appeal almost exclusively to children. Despite the history and prevalence of gum chewing, the medical literature contains very little information about the adverse effects of chewing gum. In the present report, we briefly review gum-chewing complications and describe three children who developed intestinal tract and esophageal obstruction as a consequence of swallowing gum.
Perinatal Human Immunodeficiency Virus-1 Transmission and Intrauterine Growth: A Cohort Study in Butare, Rwanda
Authors: Weng Ssu , Bulterys Marc , Chao Ann , Stidley Christine A. , Dushimimana Abel , Mbarutso Etienne , Saah Alfred
Published: August 2004

Objective. To study the association of perinatal human immunodeficiency virus (HIV)-1 transmission with birth outcomes, including birth weight, gestational age, ponderal index, head circumference, and weight/head ratio.

Methods. Data from a prospective cohort study of 627 pregnant women and their infants in Butare, Rwanda, from October 1989 until April 1994 were analyzed. A total of 318 HIV-1-infected and 309 seronegative women were enrolled during pregnancy and gave birth to 590 live singletons. Multiple linear regression modeling was used to assess the association of mother–child HIV status with several birth outcome measures.

Results. Unadjusted mean birth weight of HIV- infected infants was 235 g (95% confidence interval [CI] = 94 to 376 g) less than that of HIV-uninfected infants born to HIV-positive mothers (the reference group). After adjustment for gestational age, socioeconomic factors, maternal age, parity, hematocrit, and anthropomorphic measures, mean birth weight of HIV-infected infants was 154 g (95% CI = 38 to 271 g) lower than that of the reference group. When infants born to HIV-seronegative mothers were compared with the reference group, mean birth weights did not differ. Adjusted models resulted in estimates of mean head circumference 0.6 cm smaller (95% CI = 0.2 to 1.1 cm), ponderal index 0.14 lower (95% CI = 0.05 to 0.23), weight/head ratio 3.5 lower (95% CI = 0.5 to 6.4), and gestational age 0.5 weeks shorter (95% CI = 0.1 to 0.9 weeks) for HIV-infected infants than for the reference group.

Conclusions. After adjustment for potential confounding variables, this study showed statistically significant differences in birth weight, gestational age, ponderal index, and weight/head ratio when HIV-infected infants were compared with noninfected infants born to HIV-positive mothers. HIV-1, mother-to-child transmission, Africa, intrauterine growth, birth weight, gestational age, ponderal index.
Videotape Increases Parent Knowledge About Poliovirus Vaccines and Choices of Polio Vaccination Schedules
Authors: Dunn Ruth Ann , Shenouda Pamela E. , Martin Denny R. , Schultz Abbigail J.
Published: August 2004

Objective. To study the effect of an educational videotape about poliovirus vaccines and choices of schedules for parents/guardians of children starting the polio vaccination series.

Design. Prospective, randomized trial comparing two educational interventions.

Setting. Five pediatric offices (two university-based, two health maintenance organization staff models, and one private practice) and a local health department immunization clinic in the greater Lansing, MI, area.

Participants. A total of 287 parents/guardians of 2- to 3-month-olds presenting for well-child care and due for the first set of immunizations including poliovirus vaccine.

Interventions. Parents/guardians were randomized to read the vaccine information statement (VIS) alone or to read the VIS and view a 15-minute videotape about polio vaccination and choices of schedules produced by Michigan State University. The intervention groups were similar by race/ethnicity, education, and relationship to the child.

Outcome Measures. Change in knowledge about the risk of poliomyelitis in the United States, transmission of poliomyelitis, characteristics of the two poliovirus vaccines, and choices of polio vaccination schedules; and parent opinion on effectiveness of the interventions, as measured by pre- and postintervention questionnaires.

Results. Both interventions resulted in increased test scores of knowledge. However, videotape viewers scored significantly higher on their posttest compared with parents/guardians assigned to VIS only. This significant increase was noted across all practice types, two of three major racial/ethnic groups, and educational levels. (The increase for Hispanic parents/guardians approached significance). Reading the VIS did not improve posttest scores for videotape viewers. Reading the VIS did improve posttest scores for those assigned to VIS only, but these scores still were not as high as for videotape viewers who did not read the VIS.

Conclusions. This study demonstrated that a complicated discussion of risks/benefits of two vaccines and their schedules of administration could be communicated effectively via a videotaped presentation. In addition, the videotape was more effective than VIS alone in increasing short-term knowledge, regardless of practice type, race/ethnicity, or educational level. As immunization schedules increase in complexity and parents are asked to make more choices, videotaped information may be a better method to achieve the goal of truly informed consent.
Palivizumab, a Humanized Respiratory Syncytial Virus Monoclonal Antibody, Reduces Hospitalization From Respiratory Syncytial Virus Infection in High-risk Infants
Authors:   The IMpact-RSV Study Group
Published: August 2004

Objective.

To determine the safety and efficacy of prophylaxis with palivizumab in reducing the incidence of hospitalization because of respiratory syncytial virus (RSV) infection in high-risk infants.

Methods.

A randomized, double-blind, placebo-controlled trial was conducted at 139 centers in the United States, the United Kingdom, and Canada. During the 1996 to 1997 RSV season, 1502 children with prematurity (≤35 weeks) or bronchopulmonary dysplasia (BPD) were randomized to receive 5 injections of either palivizumab (15 mg/kg) or an equivalent volume of placebo by intramuscular injection every 30 days. The primary endpoint was hospitalization with confirmed RSV infection. Children were followed for 150 days (30 days from the last injection). Those with hospitalization as a result of RSV infection were evaluated for total number of days in the hospital, total days with increased supplemental oxygen, total days with moderate or severe lower respiratory tract illness, and incidence and total days of intensive care and mechanical ventilation. The incidence of hospitalization for respiratory illness not caused by RSV and the incidence of otitis media were also evaluated. The placebo and palivizumab groups were balanced at entry for demographics and RSV risk factors. Ninety-nine percent of children in both groups completed the protocol and ∼93% received all five scheduled injections.

Results.

Palivizumab prophylaxis resulted in a 55% reduction in hospitalization as a result of RSV (10.6% placebo vs 4.8% palivizumab). Children with prematurity but without BPD had a 78% reduction in RSV hospitalization (8.1% vs 1.8%); children with BPD had a 39% reduction (12.8% vs 7.9%). When gender, entry age, entry weight, BPD, and gestational age were included in a logistic regression model, the effect of prophylaxis with palivizumab remained statistically significant. The palivizumab group had proportionally fewer total RSV hospital days, fewer RSV hospital days with increased oxygen, fewer RSV hospital days with a moderate/severe lower respiratory tract illness, and a lower incidence of intensive care unit admission. Palivizumab was safe and well tolerated. No significant differences were observed in reported adverse events between the two groups. Few children discontinued injections for related adverse events (0.3%). Reactions at the site of injection were uncommon (1.8% placebo vs 2.7% palivizumab); the most frequent reaction was mild and transient erythema. Mild or moderate elevations of aspartate aminotransferase occurred in 1.6% of placebo recipients and 3.6% of palivizumab recipients; for alanine aminotransferase these percentages were 2.0% and 2.3%, respectively. Hepatic and renal adverse events related to the study drug were similar in the two groups.

Conclusions.

Monthly intramuscular administration of palivizumab is safe and effective for prevention of serious RSV illness in premature children and those with BPD.
Three-Year Multicenter Surveillance of Systemic Pneumococcal Infections in Children
Authors: Kaplan Sheldon L. , Mason Edward O. , Barson William J. , Wald Ellen R. , Arditi Moshe , Tan Tina Q. , Schutze Gordon E. , Bradley John S. , Givner Laurence B. , Kim Kwang Sik , Yogev Ram
Published: August 2004

Objective.

To track antibiotic susceptibility of Streptococcus pneumoniae isolates obtained from children with systemic infections and determine outcome of treatment.

Design.

A 3-year (September 1993 through August 1996) prospective surveillance study of all invasive pneumococcal infections in children.

Patients.

Infants and children cared for at eight children's hospitals in the United States with culture-proven systemic pneumococcal infection.

Results.

One thousand two hundred ninety-one episodes of systemic pneumococcal infection were identified in 1255 children. An underlying illness was present in the children for 27% of the episodes. The proportion of isolates that were nonsusceptible to penicillin or ceftriaxone increased annually and nearly doubled throughout the 3-year period; for the last year the percentages of isolates nonsusceptible to penicillin and ceftriaxone were 21% and 9.3%, respectively. There was no difference in mortality between patients with penicillin-susceptible or nonsusceptible isolates. Only 1 of 742 patients with bacteremia had a repeat blood culture that was positive >1 day after therapy was started. All 24 normal children with bacteremia attributable to isolates resistant to penicillin had resolution of their infection; the most common treatment regimen was a single dose of ceftriaxone followed by an oral antibiotic.

Conclusions.

The percentage of pneumococcal isolates nonsusceptible to penicillin and ceftriaxone increased yearly among strains recovered from children with systemic infection. Because empiric antibiotic therapy already has changed for suspected pneumococcal infections, antibiotic resistance has not been associated with increased mortality. Careful monitoring of antibiotic susceptibility and outcome of therapy is necessary to continually reassess current recommendations for treatment.
Heterogeneity of Diagnoses Presenting as Cyclic Vomiting
Authors: Li B U. K. , Murray Robert D. , Heitlinger Leo A. , Robbins Jennifer L. , Hayes John R.
Published: August 2004

Objective.

To establish the diagnostic profile in children who present with cyclic vomiting.

Methods.

We studied 225 children <18 years of age who presented to our pediatric gastroenterology service from 1986 to 1997 with at least three discrete episodes of vomiting between which they were well. To determine the diagnoses in those presenting with a pattern of cyclic vomiting, the results of diagnostic testing and responses to various treatments were obtained from a combination of chart review and structured telephone interviews.

Results.

The largest diagnostic category included idiopathic cyclic vomiting syndrome (88%). Extraintestinal disorders (7%) and gastrointestinal disorders (5%) constituting the probable cause of vomiting were established in those having complete cessation of episodes after therapy. In 12%, serious surgical disorders of the gastrointestinal (malrotation), renal (acute hydronephrosis), and central nervous systems (neoplasm) were found. In 2%, serious endocrine (Addison's disease) and metabolic disorders (disorder of fatty acid oxidation) were found. Among those with idiopathic cyclic vomiting syndrome, 41% had associated disorders (gastroesophageal reflux and chronic sinusitis) that could contribute to the vomiting, but, based on a partial response to therapy, were not deemed to be the main cause. Altogether 49% had an identified disorder that probably caused or could contribute to the vomiting.

Conclusions.

The cyclic pattern of vomiting is a symptom complex that can be induced by heterogeneous disorders that either cause or contribute to the vomiting. Once the cyclic vomiting pattern is identified, systematic diagnostic testing is warranted to look for these underlying disorders.
Hidden Spears: Handlebars as Injury Hazards to Children
Authors: Winston Flaura K. , Shaw Kathy N. , Kreshak Allyson A. , Schwarz Donald F. , Gallagher Paul R. , Cnaan Avital
Published: August 2004

Objectives.

To delineate the mechanism of serious bicycle handlebar-related injuries in children and make recommendations for preventive strategies.

Methods.

Prospective cross-sectional surveillance system of seriously injured child bicyclists supplemented by in-depth, on-site crash investigation to delineate specific injury mechanisms. Interdisciplinary analyses involved engineers, clinicians, epidemiologists, and biostatisticians.

Setting.

The emergency department and in-patient trauma service of an urban level one pediatric trauma center between October 1995 and September 1997.

Participants.

Patients under 18 years of age who were treated for serious bicycle-related injuries (Abbreviated Injury Scale scores of 2 or greater).

Results.

The surveillance system identified two distinct circumstances for serious child bicyclist injury: 1) handlebar-related injuries associated with minor incidents (falls from bicycles) and 2) nonhandlebar-related injuries associated with severe incidents (bicycle-motor vehicle crashes). Crash investigations explored the minor incidents that resulted in serious handlebar-associated injuries. In the typical mechanism, as the child lost control of the bicycle and began to fall, the front wheel rotated into a plane perpendicular to the child's body. The child then landed on the end of the handlebar resulting in serious truncal injuries.

Conclusions.

A discordancy exists between the apparently minor circumstances and serious injuries sustained by child bicyclists who impact bicycle handlebars. Recognition of the mechanism of handlebar-related injuries might aid the practitioner in early diagnosis of serious abdominal injuries in child bicyclists. This injury mechanism may be avoided through bicycle redesign that would involve both limiting rotation of the front wheel and modifying the ends of handlebars. An integrated approach involving a surveillance system to identify an injury hazard supplemented by in-depth, on-site crash investigations effectively provided the detailed mechanism of injury needed to develop interventions.
Toppled Television Sets Cause Significant Pediatric Morbidity and Mortality
Authors: Bernard Philip A. , Johnston Carden , Curtis Scott E. , King William D.
Published: August 2004

Objective.

To quantify pediatric injuries and deaths that result from toppled television sets.

Design.

Retrospective analysis of incident files compiled by the US Consumer Product Safety Commission (CPSC) data systems and The Children's Hospital of Alabama (TCHA) inpatient medical records.

Setting.

United States, January 1990–June 1997. TCHA, May 1995–October 1997.

Main Outcome Measures.

Morbidity or mortality as a result of a television set falling onto a child.

Results.

Over the 7-year period from January 1990 to June 1997, 73 cases that involved falling television sets were reported to the CPSC, including 28 deaths. The mean age of all victims was 36 months (SD ± 25.4 months). The mean age of those who died was 31 months (SD ± 22 months). Females accounted for 42 incidents (58%) and 19 deaths (68%). The most common anatomic site of injury was the head, which accounted for 72% of cases investigated by CPSC personnel. Of the 14 deaths further investigated by the CPSC, head injury was responsible for 13, with a generalized crushing injury accounting for the other. Of the 45 cases in which data were available, dressers or stands were identified as the television support 76% of the time. The TCHA database yielded five additional cases, including one death, with demographics similar to the CPSC data.

Conclusion.

Serious injury and death can occur as a result of children toppling television sets from elevated locations in the home. The furniture on which a television set is situated is of fundamental importance. An estimate of overall risk to the population is impossible to determine from these data. In light of 73 reported cases with 28 deaths; however, injury prevention counseling and other strategies supporting in-home safety should include a secure and child-safe location for television sets. Attention should be paid to safer design and placement of this ubiquitous product. television, wounds and injuries, accidents, human, infants, children.
Human Milk Feedings and Infection Among Very Low Birth Weight Infants
Authors: Hylander Mary Ann , Strobino Donna M. , Dhanireddy Ramasubbareddy
Published: August 2004

Background.

Preterm infants are immunologically immature at birth. Previous studies have demonstrated that human milk protects against infection in full-term infants, but there are few studies of its effect for preterm infants.

Objective.

To examine the effect of human milk feedings on infection incidence among very low birth weight (VLBW) infants during their initial hospitalization.

Study Design.

The sample consisted of 212 consecutive VLBW infants admitted to the Georgetown University Medical Center neonatal intensive care unit (NICU) during 1992–1993 and surviving to receive enteral feeding. Type of feeding (human milk vs formula), presence of infection and sepsis/meningitis (clinical signs and positive cultures for pathogenic organisms), and potential confounding variables were abstracted from medical records. Multiple logistic regression was used to control for confounders.

Results.

The incidence of infection (human milk [29.3%] vs formula [47.2%]) and sepsis/meningitis (human milk [19.5%] vs formula [32.6%]) differed significantly by type of feeding. Major risk factors for infection were similar in both groups. Human milk feeding was independently correlated with a reduced odds of infection (odds ratio [OR] = 0.43; 95% confidence interval [CI]: 0.23–0.81), controlling for gestational age, 5-minute Apgar score, mechanical ventilation days, and days without enteral feedings; and was independently correlated with a reduced odds of sepsis/meningitis (OR = 0.47, 95% CI:0.23–0.95), controlling for gestational age, mechanical ventilation days, and days without enteral feedings.

Conclusions.

The incidence of any infection and sepsis/meningitis are significantly reduced in human milk-fed VLBW infants compared with exclusively formula-fed VLBW infants.
A Novel Use of Xylitol Sugar in Preventing Acute Otitis Media
Authors: Uhari Matti , Kontiokari Tero , Niemelä Marjo
Published: August 2004

Background.

Xylitol, a commonly used sweetener, is effective in preventing dental caries. As it inhibits the growth of pneumococci, we evaluated whether xylitol could be effective in preventing acute otitis media (AOM).

Design.

Altogether, 857 healthy children recruited from day care centers were randomized to one of five treatment groups to receive control syrup (n = 165), xylitol syrup (n = 159), control chewing gum (n = 178), xylitol gum (n = 179), or xylitol lozenge (n = 176). The daily dose of xylitol varied from 8.4 g (chewing gum) to 10 g (syrup). The design was a 3-month randomized, controlled trial, blinded within the chewing gum and syrup groups. The occurrence of AOM each time the child showed any symptoms of respiratory infection was the main outcome.

Results.

Although at least one event of AOM was experienced by 68 (41%) of the 165 children who received control syrup, only 46 (29%) of the 159 children receiving xylitol syrup were affected, for a 30% decrease (95% confidence interval [CI]: 4.6%–55.4%). Likewise, the occurrence of otitis decreased by 40% compared with control subjects in the children who received xylitol chewing gum (CI: 10.0%–71.1%) and by 20% in the lozenge group (CI: −12.9%–51.4%). Thus, the occurrence of AOM during the follow-up period was significantly lower in those who received xylitol syrup or gum, and these children required antimicrobials less often than did controls. Xylitol was well tolerated.

Conclusions.

Xylitol sugar, when given in a syrup or chewing gum, was effective in preventing AOM and decreasing the need for antimicrobials.