bluuebunny/crossref_metadata_2025 huggingface dataset:
Nutritional Status of Patients With Cystic Fibrosis With Meconium Ileus: A Comparison With Patients Without Meconium Ileus and Diagnosed Early Through Neonatal Screening
Authors: Lai Hui-Chuan , Kosorok Michael R. , Laxova Anita , Davis Lisa A. , FitzSimmon Stacey C. , Farrell Philip M.
Published: August 2004

Objective.

This study was pursued as an extension of a randomized clinical investigation of neonatal screening for cystic fibrosis (CF). The objective was to determine if CF patients with meconium ileus (MI) were more likely to be malnourished compared with those without MI who were diagnosed during early infancy through neonatal screening.

Methodology.

Nutritional status was evaluated from early infancy to 13 years of age based on anthropometric, biochemical, and dietary assessments.

Results.

MI patients (n = 32) were smaller at birth (3117 g compared with 3413 g) and were shorter (22nd percentile compared with 48th percentile) and thinner (24th percentile compared with 49th percentile) compared with non-MI early diagnosed patients (n = 50) up to 13 years of age. Poor growth was particularly evident in 26 MI patients who required surgery for MI (height and weight at the 20th percentile), whereas those treated without surgery (n = 6) showed better height (45th percentile) and weight (37th percentile). Abnormal essential fatty acid profiles were significantly more prevalent in MI compared with non-MI early-diagnosed patients before 3 years of age. Daily intakes of calorie (130% compared with 111% recommended dietary allowances) and protein (339% compared with 279% recommended dietary allowances) were higher but the percentage of fat (37% compared with 38%) and linoleic acid (4.5% compared with 4.7%) in the diet were similar between the two groups.

Conclusions.

These results demonstrated a clear association of MI with malnutrition in CF. The observed poor growth among our MI patients was not because of poor dietary intakes, but was related to surgical treatment for MI and poor essential fatty acid status. These findings present new challenges regarding the optimal medical treatment and nutritional intervention for CF patients with MI.
A Randomized, Controlled Trial to Evaluate the Effects of the Newborn Individualized Developmental Care and Assessment Program in a Swedish Setting
Authors: Westrup Björn , Kleberg Agneta , von Eichwald Kristina , Stjernqvist Karin , Lagercrantz Hugo
Published: August 2004

Background and Objective.

Family-centered developmentally supportive care of very low birth weight infants, provided by the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has been reported to have positive medical and economic impacts. Our aim was to investigate its effect on need of ventilatory assistance, growth, and hospitalization in a Swedish setting.

Methods.

Preterm infants born between September 1994 and April 1997 with a gestational age <32 weeks and with a need of ventilatory assistance at 24 hours were randomly assigned to either NIDCAP (n = 12) or conventional care (n = 13). The 2 groups were comparable (median [range]) with respect to birth weight (1083 [630–1411] vs 840[636–1939 g]), head circumference (24.0 [22.3–26.5] vs 24.0 [21.1–30.0 cm]), gestational age (27.6 [24.0–28.7] vs 26.1 [23.9–30.3] weeks), female/male ratio (3/9 vs 9/8) and Clinical Risk Index for Babies (4.0 [0–11] vs 6.0 [2–15]). The infants in the intervention group were cared for in a separate room by a group of specially trained nurses. Formal weekly observations of these infants starting within 3 days after birth and continuing until 36 weeks postconception were used to develop individualized care plans. These plans provided recommendations as to how care might be attuned to the current developmental stage of the infant and how the family might be supported and stimulated to participate in this care. The treatment of the 2 groups was in all other respects identical.

Results.

The duration of mechanical ventilation (median [range] was 2.8 [0–36.7] days in the intervention group vs 4.8 [.1–29.8] days; not significant [NS]) among the controls and continuous positive airway pressure was applied for 26.1 (6.9–52.0) vs 43.9 (5.0–65.1) days. Supplementary oxygen was withdrawn at 33.0 (29.3–35.7) vs 38.1 (33.1–44.9) weeks of postconceptional age (PCA). The weight gain up to 35 weeks of PCA was 13.0 (6.7–21.0) vs 9.8 (6.8–16.6) g/day (NS). The head growth up to 35 weeks of PCA was .73 (.56–1.3) vs .63 (.56-.77) cm/week (NS). The age of the infant at discharge was 38.3 (36.1–57.7) vs 41.0 (36.9–48.4) weeks of PCA (NS).

Conclusions.

NIDCAP does not seem to have detrimental effects on Swedish very low birth weight infants in comparison with conventional care. Indeed, NIDCAP might even be advantageous.
Intrapartum Maternal Fever and Neonatal Outcome
Authors: Lieberman Ellice , Lang Janet , Richardson Douglas K. , Frigoletto Fredric D. , Heffner Linda J. , Cohen Amy
Published: August 2004

Objective.

Much of fever during term labor may not be infectious but rather a consequence of the use of epidural analgesia. Therefore, we investigated the association of elevated maternal intrapartum temperature with neonatal outcome when the infant does not develop an infection.

Methods.

We studied 1218 nulliparous women with singleton, term pregnancies in a vertex presentation and spontaneous labor. Women were excluded if their temperature was >99.5°F at admission for delivery, if they were diabetic or had an active genital herpes infection or if their infant developed a neonatal infection, had a congenital infection, or had a major malformation. Maximum intrapartum temperature was categorized as: ≤100.4°F (afebrile), 100.5°F to 101°F, and >101°F.

Results.

During labor, 123 women (10.1%) developed a fever >100.4°F; 62 (5.1%) women had a maximum temperature of 100.5°F to 101°F and 61 (5.0%) women had a maximum temperature >101°F. Of febrile women, 97.6% had received epidural analgesia for pain relief. Infants of women developing a fever >100.4°F were more likely to have a 1-minute Apgar score <7 (22.8% for >100.4°F vs 8.0% for afebrile) and to be hypotonic after delivery (4.8% for >100.4°F vs .5% for afebrile). Compared with infants of afebrile women, infants whose mothers' maximum temperature was >101°F were more likely to require bag and mask resuscitation (11.5% vs 3.0%) and to be given oxygen therapy in the nursery (8.2% vs 1.3%). We also found a higher rate of neonatal seizure with fever (3.3% vs .2%), but the number of infants with seizure was small (n = 4). All associations remained essentially the same after controlling for confounding in logistic regression analyses.

Conclusions.

Intrapartum maternal fever, particularly if >101°F, was associated with a number of apparently transient adverse effects in the newborn. Larger studies are needed to investigate the association of intrapartum fever with neonatal seizures and to determine whether any lasting injury to the fetus may occur.
Postexposure Effectiveness of Varicella Vaccine
Authors: Watson Barbara , Seward Jane , Yang Alice , Witte Patricia , Lutz James , Chan Christopher , Orlin Sandra , Levenson Robert
Published: August 2004

Objective.

1) To describe the postexposure effectiveness of varicella vaccine in a homeless shelter; and 2) to demonstrate an effective public health intervention and its implications.

Design.

A prospective observational study.

Setting.

A women and children's shelter in Philadelphia with 2 cases of varicella before intervention.

Outcome Measures.

Varicella in vaccinated and unvaccinated shelter residents; vaccine effectiveness for prevention of varicella when administered after exposure among children <13 years of age.

Results.

Sixty-seven shelter residents received varicella vaccine after exposure, including 42 children <13 years of age. One child who was unvaccinated developed varicella, but no vaccinated child developed typical disease. Vaccine effectiveness was 95.2% (95% CI, 81.6%–98.8%) for prevention of any disease and 100% for prevention of moderate or severe disease among the children <13 years of age.

Conclusion.

When used within 36 hours after exposure to varicella in a setting where close contact occurred, varicella vaccine was highly effective in preventing further disease. This study provides support for the recent recommendation by the Advisory Committee on Immunization Practices to administer varicella vaccine after exposure: this practice should minimize the number of moderate or severe cases of disease and prevent prolonged outbreaks.
Carbohydrate Absorption From Fruit Juices in Infants
Authors: Lifschitz Carlos H.
Published: August 2004

Objective.

To compare the absorption of carbohydrate in particular from a lower (10 mL/kg−1) quantity than that previously tested, of white grape juice and pear juice after a single feeding and after ingestion twice daily for 2 weeks, and determine their respective effects on stool water content, in healthy infants.

Study Participants.

Twelve healthy, well-nourished infants, 5 to 9 months of age, who were recruited from the general population.

Design/Methods.

Infants underwent a breath hydrogen test after a serving of pear juice. Three to 5 days later, the test was repeated after a serving of white grape juice. Infants were randomly assigned to receive a 10 mL/kg−1 serving of grape juice or pear juice twice daily for 2 weeks. The breath tests were repeated after the ingestion of the juices in the same sequence. With the second breath test with pear juice, a charcoal marker and 20 mg13C fructose, a stable, nonradioactive isotope, were mixed with the juice. Water content of the stools was compared before and after the 2-week feeding of the juice, and fecal samples were analyzed for 13C enrichment by mass spectrometry.

Results.

After the ingestion of the fruit juices, only 1 infant had an abnormal peak hydrogen (H2; ≥10 ppm), which followed the pear juice. That same infant was the only one who had H2 levels ≥10 ppm after grape juice. There was no significant difference in the peak breath H2 levels after grape juice and pear juice either at the beginning of the study or 2 weeks after taking the juice assigned (2.8 ppm ± 2.9 vs 6.2 ppm ± 9, respectively). The difference in breath H2response before and after the 2 weeks of fruit juice intake was not significant. Mean (±standard deviation) fecal 13C enrichment at baseline was 3.0 Δ%o (±2.4), which was not significantly different from after 2 weeks of juice intake (2.4 Δ%o [±1.5]), regardless of the juice assigned: 2.7 Δ%o (±1.6) for grape juice and 2.2 Δ%o (±1.5) for pear juice. Mean (±standard deviation) percentage of fecal water at baseline was 24.1% (±5.1), which was not significantly different from after 2 weeks of juice (22.5% [±6]), regardless of the juice received: 21.8% (±5.8) for grape juice and 23.2% (±6.7) for pear juice.

Conclusion.

When either grape or pear juice is administered in a dosage of 10 mL/kg/day, the carbohydrate is well absorbed, produces no adverse gastrointestinal symptoms, and has no effect on stool water in healthy infants.
Four Strategies for the Management of Esophageal Coins in Children
Authors: Soprano Joyce V. , Mandl Kenneth D.
Published: August 2004

Objective.

To compare clinical outcomes and costs under 4 strategies for the management of esophageal coins in children.

Methods.

We developed a decision analysis model of 4 possible strategies for managing esophageal coins: 1) endoscopic removal under general anesthesia; 2) esophageal bougienage, 3) an outpatient 12- to 24-hour observation period to allow spontaneous coin passage; and 4) an inpatient observation period. Probabilities of success and complication rates for endoscopy and esophageal bougienage were obtained from published data. The probability of spontaneous coin passage was derived from chart review data at our institution. Costs were calculated from charges using a cost-to-charge ratio of .72. Hypothetical patients included in the model were those with a single esophageal coin presenting within 24 hours of ingestion, with no respiratory compromise on presentation and with no previous history of esophageal disease. Strategy-specific outcomes were overall complication rate and total cost in dollars per patient. Sensitivity analyses were performed to account for variations in the data.

Results.

The esophageal bougienage strategy resulted in no complications and a total cost per patient of $382, which represents a marginal advantage of $2915 per patient compared with the endoscopic removal strategy. On sensitivity analysis over the range of success and complication rates of bougienage, this strategy maintained a considerable decrease in both overall complications and total cost per patient compared with all other strategies. Both outpatient and inpatient observation strategies had overall complication rates of 4.2% compared with the complication rate of 5.8% for the endoscopy strategy. The total cost per patient under these strategies was $2439 for the outpatient and $3141 for the inpatient strategy, representing a marginal advantage of $858 and $156 per patient, respectively, compared with the endoscopy strategy. Both observation strategies maintained a lower overall complication rate compared with endoscopy in the sensitivity analysis. The outpatient observation strategy maintained a marginal advantage of $645 to $1257 per patient compared with endoscopy; however, the inpatient observation strategy total cost per patient surpassed that of endoscopy at a spontaneous passage rate <23%.

Conclusions.

Given the high success and low complication rates reported for esophageal bougienage, substantial savings in overall complications and costs would be expected with the use of this procedure. With spontaneous passage rates >23%, either an outpatient or an inpatient observation strategy would reduce costs and complications, compared with endoscopic removal of all esophageal coins.
Biobehavioral Pain Responses in Former Extremely Low Birth Weight Infants at Four Months' Corrected Age
Authors: Oberlander Tim F. , Grunau Ruth Eckstein , Whitfield Michael F. , Fitzgerald Colleen , Pitfield Sandy , Saul J. Philip
Published: August 2004

Objective.

To compare biobehavioral responses to acute pain at 4 months' corrected age between former extremely low birth weight (ELBW) infants and term-born controls.

Methodology.

Measures of facial behavioral and cardiac autonomic reactivity in 21 former ELBW infants (mean birth weight = 763 g) were compared with term-born infants (n = 24) during baseline, lance, and recovery periods of a finger-lance blood collection. Further, painful procedures experienced during neonatal care were quantified in both groups.

Results.

Overall, behavioral and cardiac autonomic responses to the lance were similar between groups. However, the ELBW group seemed to have a less intense parasympathetic withdrawal in the lance period and a more sustained sympathetic response during recovery than the control group. Further, in the recovery period, two behavioral patterns (early recovery and a late recovery) were apparent among the ELBW group.

Conclusions.

Biobehavioral pain responses were similar overall between both groups of infants. Subtle differences were observed in cardiac autonomic responses during the lance period and in behavioral recovery among ELBW infants. Whether these findings represent a long-term effect of early pain experience or a developmental lag in pain response remains unclear. The lack of an overall difference runs counter to previously reported findings of reduced behavioral response in former ELBW infants. biobehavioral pain response, premature infants, repetitive pain, heart rate variability.
Detection of Pathogen Transmission in Neonatal Nurseries Using DNA Markers as Surrogate Indicators
Authors: Oelberg David G. , Joyner Sarah E. , Jiang Xi , Laborde Danielle , Islam Monica P. , Pickering Larry K.
Published: August 2004

Objective.

Nosocomial infections are a major problem confronting neonatal intensive care units (NICUs). This study was conducted to determine if DNA markers designed from the cauliflower mosaic virus (CaMV 35S DNA) can serve as surrogate indicators of nosocomial pathogen transmission in NICUs.

Methods.

Regions of cauliflower CaMV 35S promoter DNA were designed to serve as surrogate markers of microbial transmission pathways. Each of 6 pods within the NICU under study houses 8 newborn infants. DNA marker was placed on the telephone handle in only 1 of the 6 NICU pods (study pod). Bedside caregivers were blinded as to when placebo or marker were placed in the pod. Thirty-two samples were collected from predetermined sites within each pod at 0, 4, 8, 24, and 48 hours and 7 days after DNA placement. Similar sites were sampled in each of the 6 pods. Additional samples were collected concurrently from areas of the NICU segregated from direct patient care. Polymerase chain reactions were performed on collected samples, and products were analyzed by agarose gel electrophoresis.

Results.

One thousand three hundred samples of the environment and hands of personnel were collected and analyzed. Within the study pod, 58% of sites tested positive for the DNA marker throughout all time points; positive sites peaked at 8 hours (78%) and declined to 23% positive at 7 days. The other 5 pods had a mean of 18% of sites positive throughout the 7 days and exhibited a similar decline throughout time. The most consistently positive sites within all pods were the blood gas analyzers, computer mice, telephone handles, medical charts, ventilator knobs, door handles, radiant warmer control buttons, patient monitors, and personnel hands. In areas outside the pods, the nurse's station, resident physician charting area, changing room, and staff break room had a mean of 50% positive sites throughout all time points.

Conclusions.

DNA markers proved useful as safe, surrogate indicators of microorganism transmission within and outside pods in the NICU. We speculate that utilization of these techniques in the hospital environment will provide important information about transmission of pathogens in the NICU, assist in developing and enforcing cleaning procedures, and permit testing of educational intervention programs targeting a decrease in nosocomial infections. nosocomial infection, neonatal intensive care, DNA marker, polymerase chain reaction, infection control.
Links Between Early Adrenal Function and Respiratory Outcome in Preterm Infants: Airway Inflammation and Patent Ductus Arteriosus
Authors: Watterberg Kristi L. , Scott Susan M. , Backstrom Conra , Gifford Kathleen L. , Cook Kristen L.
Published: August 2004

Objective.

To investigate the relationship of cortisol concentrations during the first week of life to patent ductus arteriosus (PDA), markers of lung inflammation, and respiratory outcome in very low birth weight infants.

Methods.

Newborns <1500 g birth weight were prospectively enrolled at 2 centers. Serum cortisol was measured 3 times during days 2 to 7 of life. Tracheal lavage was performed on intubated infants and analyzed for interleukin-1β, -6, and -8, and for total protein, albumin, and α-1 protease inhibitor. Infants receiving prenatal glucocorticoids were excluded.

Results.

We obtained 337 cortisol values from 125 infants. Infants treated for PDA had lower cortisol values after day 2. One hundred thirty-three tracheal fluid samples were obtained on matching days from 71 intubated infants. Cortisol correlated inversely with tracheal interleukins and proteins. Lower cortisol values during the second half of the week correlated with longer duration of supplemental oxygen therapy and with subsequent development of chronic lung disease at 28 days and at 36 weeks.

Conclusion.

Infants with lower cortisol values in the first week of life had an increased incidence of PDA, increased lung inflammation, and an increased incidence of chronic lung disease. These findings suggest that early adrenal insufficiency may underlie the previously observed association of increased lung inflammation and PDA with adverse respiratory outcome in this population.
School Difficulties at Adolescence in a Regional Cohort of Children Who Were Extremely Low Birth Weight
Authors: Saigal Saroj , Hoult Lorraine A. , Streiner David L. , Stoskopf Barbara L. , Rosenbaum Peter L.
Published: August 2004

Objectives.

To compare measures of psychometric assessment and school difficulties in a cohort of extremely low birth weight (ELBW) teenagers and term controls, and to determine whether there is stability in psychometric measures between age 8 and the teen years.

Study Design.

Longitudinal follow-up; geographically defined region. Participants: 150 of 169 (89%) ELBW survivors born between 1977 and 1982 and 124 of 145 (86%) sociodemographically matched term controls between 12 and 16 years of age. Psychometric measures: Wechsler Intelligence Scale for Children-Revised, Wide Range Achievement Test-Revised, and a validated parent questionnaire.

Results.

Neurosensory impairments were present in 28% of ELBW and 1% of controls. The mean Wechsler Intelligence Scale for Children-Revised scores were ELBW: 89 ± 19 and controls: 102 ± 13. ELBW children did less well on Wide Range Achievement Test-Revised Reading, Spelling, and Arithmetic measures with mean scores in the range from 75 to 85. ELBW children <750 g were more disadvantaged, compared with those ≥750 g. A significantly higher proportion of ELBW children were receiving special educational assistance and/or had repeated a grade (ELBW: 58%; controls: 13%; odds ratio: 9.0). Paired analysis of within-cohort data at age 8 and teen years showed that for both cohorts Arithmetic scores declined, but there were small improvements in other measures, predominantly in the term children.

Conclusions.

Differences of 13 to 18 points in psychometric measures in ELBW teens compared with controls are both statistically significant and clinically relevant. Decreasing birth weight was associated with increased risk on all measures. The high utilization of special educational resources has economic implications, and the incremental cost attributable to being extremely premature needs to be determined.
Use Assessment of Self-Administered Epinephrine Among Food-Allergic Children and Pediatricians
Authors: Sicherer Scott H. , Forman Joel A. , Noone Sally A.
Published: August 2004

Background and Objectives.

Food allergy is a common cause of anaphylaxis, and early treatment with epinephrine can be life-saving. We sought to determine the ability of families with food allergic children and pediatricians to properly use self-injectable epinephrine.

Methods.

We enrolled families of consecutive, food-allergic pediatric patients newly referred to our allergy practice but previously prescribed epinephrine and a sampling of pediatricians. Parents or teenage patients answered a structured questionnaire concerning use of self-injectable epinephrine and demonstrated the use of devices with which they were familiar. Demonstrations were scored in a standard manner.

Results.

One hundred one families of food-allergic children (mean age of patients, 6.4 years) were enrolled. Self-injectable epinephrine was prescribed (mean of 2.7 years previously) primarily by pediatricians (n = 46) and allergists (n = 49). Patients were prescribed EpiPen (n = 93), EpiE-Z Pen (n = 11), and Ana-Kit (n = 3). Eighty-six percent of the families responded that they had the device with them “at all times,” but only 71% of this group had epinephrine at the visit. Among those with the epinephrine, 10% had devices beyond the labeled expiration date. Thus, only 55% of the 101 families had unexpired epinephrine on-hand at the time of the survey. Among children in school, 77% had the medication available in school, and 81% stated that the school knew the indications for administration. Only 32% of the participants correctly demonstrated the use of the device. Twenty-nine attending pediatricians were enrolled (mean 14 yrs in practice; mean 4 epinephrine prescriptions/year). Familiarity with the devices was as follows: EpiPen (86%), EpiE-Z Pen (17%) and Ana-Kit (7%). Only 24% generally gave patients written materials concerning indications. Overall, 18% were familiar with and able to demonstrate correct use of at least 1 device (21% correctly demonstrated Epi-Pen). Seventeen pediatric residents were enrolled; 65% were familiar with the EpiPen; 36% demonstrated it correctly and only 1 resident was familiar with Ana-Kit.

Conclusions.

Many parents of severely food-allergic children, and food-allergic teenagers cannot correctly administer their self-injectable epinephrine and may not have the medication readily available. Pediatricians are not familiar with these devices and may fail to review their use with patients. Improved patient and physician education is needed to ensure proper use of this life-saving medication.
Exogenous Apotransferrin and Exchange Transfusions in Hereditary Iron Overload Disease
Authors: Fellman Vineta , von Bonsdorff Leni , Parkkinen LicTech‡; and Jaakko
Published: August 2004

Objective.

To investigate whether apotransferrin administration and exchange transfusion can improve outcome in patients with the recently described recessive congenital iron overload disease, presenting with intrauterine growth retardation, severe lactic acidosis, aminoaciduria, and hemosiderosis of the liver that so far has been treatment-resistant and lethal.

Methodology.

Because the patients have hypotransferrinemia, hyperferritinemia, increased transferrin saturation, and bleomycin detectable iron in plasma, we designed a treatment regime aiming at decreasing free iron and iron overload. The serum transferrrin concentration was increased to adult level (2–5 g/L) by intravenous apotransferrin administrations and thereafter exchange transfusion was performed.

Results.

Two patients were treated. In patient 1, the transferrin saturation decreased from a baseline value of 100% and remained normal after the third exchange transfusion, and in patient 2, a reversible beneficial effect was seen on transferrin saturation and bleomycin-detectable iron. However, both infants died later of the disease, at 10 and 8 weeks of age, respectively.

Conclusions.

Exogenous apotransferrin administration proved to be safe and might deserve evaluation in other neonatal diseases with presence of free iron in plasma. hemosiderosis, metabolic acidosis, newborn infant, transferrin.
Rhabdomyolysis Associated With Infection byMycoplasma pneumoniae: A Case Report
Authors: Berger Rachel Pardes , Wadowksy Robert M.
Published: August 2004

Background.

Mycoplasma pneumoniae is responsible for approximately 20% of the cases of community-acquired pneumonia. The onset of respiratory symptoms is gradual and systemic complaints such as headache, malaise, arthalgias, and low-grade fever are frequently prominent. Extrapulmonary manifestations of M pneumoniae are common and hematologic (thrombocytopenia, splenomegaly, disseminated intravascular coagulation, hemolytic anemia), dermatologic (Stevens-Johnson syndrome), gastrointestinal (vomiting, diarrhea, pancreatitis), renal (interstitial nephritis, glomerulonephritis), cardiac (pericarditis, myocarditis, pericardial effusion) and central nervous system (meningitis, transverse myelitis, polyradiculopathy, cerebellar ataxia, sensorineural hearing loss) complications can occur.1–3

Observation.

We describe the case of an adolescent girl with massive rhabdomyolysis associated with an infection caused byM pneumoniae. We briefly review the differential diagnosis of a patient presenting with acute rhabdomyolysis and discuss the use of a new polymerase chain reaction-based assay for direct detection of M pneumoniae in throat swab specimens.

Conclusion.

Clinicians should be aware of a possible association between rhabdomyolysis and infection with M pneumoniae and should consider testing for M pneumoniae when they are presented with a patient with idiopathic rhabdomyolysis. The new polymerase chain reaction-based assay for detection of M pneumoniae is a more accurate and more efficient method than traditional culture.
Personal Watercraft Use by Children and Adolescents
Authors:   Committee on Injury and Poison Prevention
Published: August 2004

The use of personal watercraft (PWC) has increased dramatically during the past decade as have the speed and mobility of the watercraft. A similar dramatic increase in PWC-related injury and death has occurred simultaneously. No one younger than 16 years should operate a PWC. The operator and all passengers must wear US Coast Guard-approved personal flotation devices. Other safety recommendations are suggested for parents and pediatricians.
Impact of Dietary Fat and Fiber Intake on Nutrient Intake of Adolescents
Authors: Nicklas Theresa A. , Myers LN*; Leann , O'Neil Carol , Gustafson Nancy
Published: August 2004

Objective.

To evaluate the impact of fat and fiber intake on energy and nutrient intake of 15-year-old adolescents.

Study Design.

Twenty-four-hour dietary recalls were collected on a random sample of 15-year-olds. Subjects were then categorized into groups based on fat and fiber intake, with 319 students meeting criteria for 1 of 4 dietary intake quadrants: low fat, low fiber; low fat, high fiber; high fat, low fiber; and high fat, high fiber. Students with medium fat or fiber intakes were excluded from the study. Low-fat and high-fat intake were defined as <30% and >40% of total energy intake, respectively. Low- and high-fiber intake were defined as <15 g/day and >20 g/day, respectively.

Results.

Low-fat and high-fiber intake had a minimal impact on energy intake and did not adversely affect nutrient intake. High-fiber intake was associated with greater likelihood of adequate intake of vitamins A, B6, B12, and C; niacin; thiamin; riboflavin; folacin; magnesium; iron; zinc; phosphorus; and calcium. High-fat intake was associated with greater likelihood of adequate vitamin B12 intake. Significant differences in fat and fiber intake distributions were found for ethnic background and gender, with more non-white than white students in the high-fat groups and more males than females in the high-fiber groups.

Conclusions.

A low-fat and high-fiber diet meeting current nutrition recommendations does not adversely affect energy or nutrient intake, increases nutrient density of the diet, and increases the likelihood of adequate intake for several key nutrients.
Intestinal Transplantation for Short Gut Syndrome Attributable to Necrotizing Enterocolitis
Authors: Vennarecci Giovanni , Kato Tomoaki , Misiakos Evangelos P. , Neto Alexandre Bakonyi , Verzaro Roberto , Pinna Antonio , Nery Jose , Khan Farrukh , Thompson John F. , Tzakis Andreas G.
Published: August 2004

Background.

Necrotizing enterocolitis (NEC) is a life-threatening condition of the neonatal age, which frequently requires surgical intervention. After extensive bowel resection, a small proportion of these patients may develop chronic short gut syndrome (SGS) and require chronic total parenteral nutrition (TPN) use. Intestinal transplantation has been performed in these patients as a life-saving option.

This study reviews our experience with intestinal transplantation for SGS attributable to NEC emphasizing the mode of presentation, natural history, timing, and outcome.

Methods.

A retrospective chart review was performed for all pediatric patients who underwent small bowel transplantation for NEC at the University of Miami between August 1994 and March 1999.

Results.

Eleven transplants were performed for 10 patients with NEC (8 male and 2 female; median age: 1.75 years [range: 10 months to 10.1 years]). Procedures performed were isolated intestinal transplants (n = 2), combined liver-intestinal transplants (n = 6), and multivisceral transplants (n = 3). All patients were born prematurely with median birth weight of 1.640 kg (range: 810 g to 2.730 kg). They developed NEC in the first few days of life and subsequently underwent an average of 5 surgeries per patient before transplant. Transplant was indicated for liver failure in 8 patients and recurrent central line sepsis in 2 others.

At present, 6 patients are alive with an overall 1-year and 3-year actuarial survival of 60% and a median follow-up of 29 months (range: 9–46 months). Six children have been weaned off TPN after a median time of 71 days (range: 19–131) from transplantation. All survivors are at home with functional grafts.

Conclusion.

Intestinal transplantation provided a reasonable outcome in patients with NEC-associated SGS who had already developed life-threatening complications related to TPN. Intestinal transplantation replaced the diseased intestine and liver, enfranchised patients from TPN, and conferred improved quality of life. These patients should be actively considered for intestinal transplantation and referred to a transplant center as soon as possible.
Long-Term Developmental Outcomes in Patients With Deformational Plagiocephaly
Authors: Miller Robert I. , Clarren Sterling K.
Published: August 2004

Objectives.

To determine whether there was an increased rate of later developmental delay in school-aged children who presented as infants with deformational plagiocephaly without obvious signs of delay at the time of initial evaluation.

Methods.

A retrospective medical record review of 254 patients evaluated at the Craniofacial Center of the Children's Hospital and Regional Medical Center in Seattle, Washington, from 1980 through 1991 was completed. Consenting patient families were interviewed via telelphone to determine what, if any, special medical or educational problems had occurred for the children who had had plagiocephaly in infancy or their siblings with normal head shapes.

Results.

A total of 181 families from the medical record review could be notified about the study and 63 families agreed to participate in a telephone interview. The sample of participants for the telephone interview was random to and representative of the group as a whole. The families reported that 25 of the 63 children (39.7%) with persistent deformational plagiocephaly had received special help in primary school including: special education assistance, physical therapy, occupational therapy, speech therapy generally through an Individual Education Plan. Only 7 of 91 siblings (7.7%), serving as controls, required similar services (χ2 = 21.24). Delays could not be specifically anticipated at the time of the diagnosis of deformational plagiocephaly from any simple set of factors including treatment with helmet therapy, although effected males with reported uterine constraint were at the highest risk for subsequent school problems.

Conclusions.

Infants with deformational plagiocephaly comprise a high-risk group for developmental difficulties presenting as subtle problems of cerebral dysfunction during the school-age years. There is a need for additional research on the long-term developmental problems in infants with deformational plagiocephaly. plagiocephaly, facial asymmetry, torticollis, developmental delay.
Asthma in Life Context: Video Intervention/Prevention Assessment (VIA)
Authors: Rich Michael , Lamola Steven , Amory Colum , Schneider Lynda
Published: August 2004

Objective.

Video Intervention/Prevention Assessment (VIA) was developed to determine whether medical information gathering might be augmented by video diaries created by patients to show clinicians the realities of managing chronic disease in the contexts of their lives.

Design.

Children and adolescents who met National Heart, Lung, and Blood Institute criteria for moderate or severe asthma were enrolled from an urban pediatric hospital and an inner-city health center. Comprehensive, asthma-specific medical histories were obtained from study participants in standard clinical interviews. Participants were trained to use video camcorders and recorded visual narratives of how they lived with and managed their asthma over a 4- to 8-week period. These visual narratives were screened by a trained observer, who completed the initial comprehensive medical history based solely on viewing the video. Information from participants' medical history interviews was compared with observations of their visual narratives.

Results.

Twenty young people 8 to 25 years old completed the VIA Asthma study. Important variations were found between participants' medical history interviews and their visual narratives. All 20 participants reported specific environmental triggers for their asthma; 19 had 1 or more of these triggers documented on video in their daily living environments (video illustrations online, available at:www.pediatrics.org). Exposures to known triggers ranged from 25% (noxious fumes) to 91% (mold). Exposure to tobacco smoke that was denied in the interview was revealed on video in 63%. The 18 participants who revealed medication use in their visual narratives were assessed for adherence: 33% exceeded prescribed doses, 28% discontinued medications without consulting a clinician, and 72% used ineffective inhaler technique.

Conclusions.

VIA visual narratives extended a comprehensive, standard of care medical history, yielding a more complete and accurate understanding of exacerbating environmental exposures and inappropriate medication usage of children and adolescents with asthma. VIA is an effective tool for revealing the physical and psychosocial environments in which young people live with disease. Patient-created video can enrich our understanding of the illness experiences of children and adolescents. VIA has the potential to enhance clinical data gathering, guide the development of more effective and sensitive management strategies, and educate clinicians about the realities of the young person living with illness.
Outcome of Children in the Indomethacin Intraventricular Hemorrhage Prevention Trial
Authors: Ment Laura R. , Vohr Betty , Allan Walter , Westerveld Michael , Sparrow Sara S. , Schneider Karen C. , Katz Karol H. , Duncan Charles C. , Makuch Robert W.
Published: August 2004

Background.

For preterm infants, intraventricular hemorrhage (IVH) may be associated with adverse neurodevelopmental outcome. We have demonstrated that early low-dose indomethacin treatment is associated with a decrease in both the incidence and severity of IVH in very low birth weight preterm infants. In addition, we hypothesized that the early administration of low-dose indomethacin would not be associated with an increase in the incidence of neurodevelopmental handicap at 4.5 years of age in our study children.

Methods.

To test this hypothesis, we provided neurodevelopmental follow-up for the 384 very low birth weight survivors of the Multicenter Randomized Indomethacin IVH Prevention Trial. Three hundred thirty-seven children (88%) were evaluated at 54 months' corrected age, and underwent neurodevelopmental examinations, including the Wechsler Preschool and Primary Scale of Intelligence–Revised (WPPSI-R), the Peabody Picture Vocabulary Test–Revised (PPVT-R), and standard neurologic examinations.

Results.

Of the 337 study children, 170 had been randomized to early low-dose indomethacin therapy and 167 children had received placebo. Twelve (7%) of the 165 indomethacin children and 11 (7%) of the 158 placebo children who underwent neurologic examinations were found to have cerebral palsy. For the 233 English-monolingual children for whom cognitive outcome data follow, the mean gestational age was significantly younger for the children who received indomethacin than for those who received placebo. In addition, although there were no differences in the WPPSI-R or the PPVT-R scores between the 2 groups, analysis of the WPPSI-R full-scale IQ by function range demonstrated significantly less mental retardation among those children randomized to early low-dose indomethacin (for the indomethacin study children, 9% had an IQ <70, 12% had an IQ of 70–80, and 79% had an IQ >80, compared with the placebo group, for whom 17% had an IQ <70, 18% had an IQ of 70–80, and 65% had an IQ >80). Indomethacin children also experienced significantly less difficulty with vocabulary skills as assessed by the PPVT-R when compared with placebo children.

Conclusions.

These data suggest that, for preterm neonates, the early administration of low-dose indomethacin therapy is not associated with adverse neurodevelopmental function at 54 months' corrected age.
Predicting First-Year Relapses in Children With Nephrotic Syndrome
Authors: Constantinescu Alexandru R. , Shah Hetal B. , Foote Edward F. , Weiss Lynne S.
Published: August 2004

Objective.

More than half of the children diagnosed with nephrotic syndrome will have relapses. These can be infrequent relapses (IRs: <2 in 6 months or <3 in a year) or frequent relaspses (FRs: >2 in 6 months or >3 in a year). Patients who relapse while on alternate day steroids or within 1 month of discontinuation of steroid therapy are considered steroid-dependent (SD; J Pediatr. 1982; 101:514–518). Patients with an IR course have a better long-term prognosis, and many of them have minimal-change disease without mesangial hypercellularity or sclerosis. The purpose of our study was to identify factors at initial presentation that could predict the relapse pattern in the first year after diagnosis, without taking into consideration the histopathology found on renal biopsy.

Design.

We analyzed the medical records of children who were seen by us before March 1997 and followed for at least 1 year. Variables selected in the study were age, sex, race, presence or absence of hematuria, and days to remission (defined as protein-free) at the initial presentation, because they could relate to the pattern of relapses (ie, IR, FR, and SD).

Results.

Of 70 patients, 14 were excluded because of insufficient data. There were 38 males (67.9%) and 18 females (32.1%), giving a male:female ratio of 1.8:1. Median age at presentation was 3.25 years (range: 1.5–13), and 76.9% were white, 8.9% black, 7.1% Hispanic, and 7.1% other. Of all the patients, 23 were IR (41.1%), 9 were FR (16.1%), and 24 were SD (42.9%). Median days to remission were 10 (range: 2–60), on Prednisone 60 mg/M2 daily. Hematuria was present initially in 26 patients (46.4%), and absent in 30 (53.6%). Age, sex, race, and hematuria, as independent variables, were not predictors of relapses in the first year. However, using a stratified analysis based on the presence or absence of hematuria, we found that if the remission occurred within the first week of therapy, the patients without hematuria were more likely to be IR. The sensitivity and specificity of this finding were 67% and 89%, respectively, with a positive predictive value of 94%.

Conclusion.

We conclude that of all the presenting features, the rapidity of initial response to steroid therapy combined with the presence of hematuria, could predict future relapses and should be well documented.
An Analysis of Clinical Outcomes Using Color Doppler Testicular Ultrasound for Testicular Torsion
Authors: Baker Linda A. , Sigman David , Mathews Ranjiv I. , Benson Jane , Docimo Steven G.
Published: August 2004

Objectives.

To delineate the clinical outcomes of color Doppler ultrasound (US) in the equivocal torsion patient.

Methods.

From 1992 to 1997, 130 patients (<23 years old) from 2 institutions underwent US imaging using a 7.5-mHz linear transducer to evaluate an acute scrotum equivocal, or of low suspicion, for torsion. The US reports and hospital charts of these patients were retrospectively reviewed.

Results.

After clinical and radiologic evaluation, torsion was excluded in 110 patients without surgical exploration. In 3 patients, intermittent testicular torsion was diagnosed and in 17 patients, emergent exploration was performed for US diagnosis of testicular torsion. Twenty-five patients (22.7%) were subsequently lost to follow-up. Follow-up of 85 patients with US negative for torsion (mean length of follow-up = 466.9 days) revealed no testicular atrophy in 83. Two patients underwent delayed orchiectomy/contralateral orchiopexy for missed testicular torsion. Of 17 patients with US positive for torsion, 9 underwent orchiectomy for a necrotic torsed testis, 7 viable torsed testes were found, and 1 torsed appendix testis was found. Therefore, color Doppler US for the equivocal acute scrotum yielded a 1% false-positive rate, sensitivity of 88.9%, and specificity of 98.8%.

Conclusion.

When faced with ruling out testicular torsion, it is necessary to integrate the multiple pieces of patient data, knowing that each piece of data may have inaccuracies. With this in mind, this analysis of outcomes verifies that color Doppler US is an excellent adjunctive study in the clinically real situation in which the clinical evaluation is equivocal or low suspicion.
Access to Pediatric Emergency Medical Care
Authors:   Committee on Pediatric Emergency Medicine
Published: August 2004

Hundreds of thousands of pediatric patients require some level of emergency care annually, and significant barriers limit access to appropriate services for large numbers of children. The American Academy of Pediatrics has a strong commitment to identify barriers to access to emergency care, work to surmount these obstacles, and encourage through education increased levels of emergency care available to all children. It is also crucial to involve and incorporate the child's medical home into emergency care, both during acute presentation when the medical home is identified and by assisting in locating a medical home for follow-up when none previously exists.
Changing Concepts of Sudden Infant Death Syndrome: Implications for Infant Sleeping Environment and Sleep Position
Authors:   Task Force on Infant Sleep Position and Sudden Infant Death Syndrome
Published: August 2004

The American Academy of Pediatrics has recommended since 1992 that infants be placed to sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS). Since that time, the frequency of prone sleeping has decreased from >70% to ∼20% of US infants, and the SIDS rate has decreased by >40%. However, SIDS remains the highest cause of infant death beyond the neonatal period, and there are still several potentially modifiable risk factors. Although some of these factors have been known for many years (eg, maternal smoking), the importance of other hazards, such as soft bedding and covered airways, has been demonstrated only recently. The present statement is intended to review the evidence about prone sleeping and other risk factors and to make recommendations about strategies that may be effective for further reducing the risk of SIDS. This statement is intended to consolidate and supplant previous statements made by this Task Force.
Safety in Youth Ice Hockey: The Effects of Body Checking
Authors:   Committee on Sports Medicine and Fitness
Published: August 2004

Ice hockey is a sport enjoyed by many young people. The occurrence of injury can offset what may otherwise be a positive experience. A high proportion of injuries in hockey appear to result from intentional body contact or the practice of checking. The American Academy of Pediatrics recommends limiting checking in hockey players 15 years of age and younger as a means to reduce injuries. Strategies such as the fair play concept can also help decrease injuries that result from penalties or unnecessary contact.