bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of a Videotape to Increase Use of Poison Control Centers by Low-Income and Spanish-Speaking Families: A Randomized, Controlled Trial
Authors: Kelly Nancy R. , Huffman Lynne C. , Mendoza Fernando S. , Robinson Thomas N.
Published: August 2004

Background. Poison control centers (PCCs) reduce health care costs for childhood poisonings by providing telephone advice for home management of most cases. Past research suggests that PCCs are underutilized by low-income minority and Spanish-speaking parents because of lack of knowledge and misconceptions about the PCC. A videotape intervention was designed to address these barriers to PCC use.

Objective. To evaluate the effectiveness of a videotape intervention (videotape, PCC pamphlet, and PCC stickers) in improving knowledge, attitudes, behaviors, and behavioral intention regarding use of the PCC in a low-income and predominantly Spanish-speaking population in Northern California.

Methods. Two hundred eighty-nine parents of children <6 years of age, attending educational classes at 2 Women, Infant, and Children (WIC) clinics participated in a randomized, controlled trial. WIC classes were randomized to receive the video intervention (video group) or to attend the regularly scheduled WIC class (control group). Participants completed a baseline questionnaire and 2 to 4 weeks later, a follow-up telephone interview. Changes from baseline to posttest were compared in the treatment and control groups using analysis of variance.

Results. Compared with the control group, the video group showed an increase in knowledge about the PCC’s function, its hours of operation, and staff qualifications; was more likely to feel confident in speaking with and carrying out recommendations made by the PCC; was less likely to believe the PCC would report a mother for neglect; was more likely to have the correct PCC phone number posted in their homes; and when presented with several hypothetical emergency scenarios, was more likely to correctly answer that calling the PCC was the best action to take in a poisoning situation.

Conclusions. This videotape intervention was highly effective in changing knowledge, attitudes, behaviors, and behavioral intentions concerning the PCC within this population. As a result, use of this video may help increase use of the PCC by low-income and Spanish-speaking families.
Early Age of First Drunkenness as a Factor in College Students’ Unplanned and Unprotected Sex Attributable to Drinking
Authors: Hingson Ralph , Heeren Timothy , Winter Michael R. , Wechsler Henry
Published: August 2004

Objective. Early age of drinking onset has been associated with a greater likelihood among adults of experiencing alcohol dependence, frequent heavy drinking even among nondependent drinkers, and an increased risk of motor vehicle crashes, unintentional injuries, and physical fights after drinking. This study explores whether first getting drunk at a younger age is associated with a greater likelihood of college students reporting that they had unplanned or unprotected sexual intercourse because of their drinking.

Methodology. In 1999 11 739 full-time 4-year college students from 128 randomly selected US colleges and universities completed a self-administered survey that asked them about their drinking practices and whether their drinking had caused them, since the beginning of the school year, to: 1) engage in unplanned sexual intercourse or 2) not use protection when having sex.

Results. Among college students who drink, those first drunk before age 13 compared with those never drank until age 19 or older had a 2.0 times greater odds of having unplanned sex and a 2.2 times greater odds of having unprotected sex reportedly because of drinking, even after controlling for age, race/ethnicity, marital status, parental drinking history, age of first smoking, and marijuana use. After further controlling for history of alcohol dependence and frequency of heavy drinking those first drunk before age 13 had a 1.5 times greater odds of unplanned sex and a 1.7 times greater odds of unprotected sex reportedly because of drinking.

Conclusions. Clinical, educational, legal, and community interventions to delay age of first getting drunk need to be coupled with efforts to prevent unplanned and unprotected sexual intercourse among US college students.
Are Pubertal Changes in Girls Before Age 8 Benign?
Authors: Midyett L. Kurt , Moore Wayne V. , Jacobson Jill D.
Published: August 2004

Objective. The Lawson Wilkins Pediatric Endocrine Society recently issued new recommendations for the age at which puberty should be considered precocious, lowering the prevailing standards from 8 years to 7 years for white girls and to 6 years for black girls. The new recommendations were based on a single epidemiologic study that focused on the conditions of premature thelarche and premature adrenarche (both characterized by a single sign of puberty). Although the data were available, the authors did not comment on the low incidence of true precocious puberty (characterized by breast and pubic hair development) in their population. The hypothesis for the present study is that the new recommendations lead to underdiagnosis of endocrine pathology

Methods. Using 29 International Classification of Diseases, Ninth Revision codes for diagnoses known to be associated with precocious puberty, we identified 1570 patient visits to our outpatient pediatric endocrinology clinic of white girls aged 7 to 8 and black girls aged 6 to 8 during a 5-year period

Results. Of the 1570 patient visits, 223 unique patients were identified as having been referred for the sole finding of precocious pubertal development. These 223 patients carried no other endocrine diagnoses. Eleven patients (4.9%) were found to have no true breast buds and no terminally differentiated pubic hair. A total of 105 (47.1%) of 223 patients were found to have 2 signs of puberty, consistent with true precocious puberty according to the conventional guidelines of precocity of 8 years in girls. Overall, 12.3% of patients also had diagnoses of other endocrine conditions that included congenital adrenal hyperplasia, McCune-Albright syndrome, growth hormone deficiency, hypothyroidism, hyperinsulinism, pituitary adenoma, and neurofibromatosis. A total of 35.2% of girls with true precocious puberty exhibited bone ages >3 standard deviations above the mean, indicating markedly diminished growth potential

Conclusions. We conclude that signs of puberty in 6- to 8-year-old girls should not be considered normal or benign. Implementation of the new guidelines for the evaluation of puberty will result in failure to identify conditions that respond to early intervention.
Secular Changes in Sleep Position During Infancy: 1995–1998
Authors: Corwin Michael J. , Lesko Samuel M. , Heeren Timothy , Vezina Richard M. , Hunt Carl E. , Mandell Frederick , McClain Mary , Mitchell Allen A.
Published: August 2004

Objective. Prone sleeping among infants has been associated with an increased risk of sudden infant death syndrome. The objective of this study was to compare factors associated with sleep position in 1995–1996 and 1997–1998 and to assess secular trends in use of prone infant sleep position from 1995 through 1998 among families stratified by race and education.

Methods. A prospective cohort study was conducted in eastern Massachusetts and northwest Ohio of 12 029 mothers of infants who weighed ≥2500 g at birth. Descriptive statistics and multivariate odds ratios were used to relate maternal and infant characteristics to prone and supine sleeping.

Results. A total of 14 206 mothers (25% of those eligible) were enrolled. A total of 12 029 mothers (85% of enrolled) responded to the 1-month and 11 552 mothers (81% of enrolled) responded to the 3-month follow-up questionnaire. A decline in use of the prone sleep position and increase in use of the supine position was observed during the 4 years of the study. Factors associated with prone and supine sleep position were similar in 1995–1996 and 1997–1998. In 1997–1998, use of prone sleeping at 1 month of age reached the goal of ≤10% only among infants of white and Asian women, married women, women who were older than 25 years, women who were college graduates, and women with incomes >$55 000 per year. At 3 months of age, however, prone sleeping increased to 12% to 17% in these groups. These same groups were most likely to use the supine position; 38% to 45% were supine at 1 month, increasing to 56% to 64% by 3 months of age. However, as of the end of 1998, approximately 27% of infants of non-college-educated black and Hispanic mothers were placed to sleep in the prone position and only 20% to 30% were being placed to sleep in the supine position at 3 months of age.

Conclusions. Recommendations to avoid prone sleep position and especially the recommendation that supine sleep position is preferred have not been effectively delivered to black and Hispanic families and to families of low-income and less than a college education.
Errors in Medical Interpretation and Their Potential Clinical Consequences in Pediatric Encounters
Authors: Flores Glenn , Laws M. Barton , Mayo Sandra J. , Zuckerman Barry , Abreu Milagros , Medina Leonardo , Hardt Eric J.
Published: August 2004

Background. About 19 million people in the United States are limited in English proficiency, but little is known about the frequency and potential clinical consequences of errors in medical interpretation.

Objectives. To determine the frequency, categories, and potential clinical consequences of errors in medical interpretation.

Methods. During a 7-month period, we audiotaped and transcribed pediatric encounters in a hospital outpatient clinic in which a Spanish interpreter was used. For each transcript, we categorized each error in medical interpretation and determined whether errors had a potential clinical consequence.

Results. Thirteen encounters yielded 474 pages of transcripts. Professional hospital interpreters were present for 6 encounters; ad hoc interpreters included nurses, social workers, and an 11-year-old sibling. Three hundred ninety-six interpreter errors were noted, with a mean of 31 per encounter. The most common error type was omission (52%), followed by false fluency (16%), substitution (13%), editorialization (10%), and addition (8%). Sixty-three percent of all errors had potential clinical consequences, with a mean of 19 per encounter. Errors committed by ad hoc interpreters were significantly more likely to be errors of potential clinical consequence than those committed by hospital interpreters (77% vs 53%). Errors of clinical consequence included: 1) omitting questions about drug allergies; 2) omitting instructions on the dose, frequency, and duration of antibiotics and rehydration fluids; 3) adding that hydrocortisone cream must be applied to the entire body, instead of only to facial rash; 4) instructing a mother not to answer personal questions; 5) omitting that a child was already swabbed for a stool culture; and 6) instructing a mother to put amoxicillin in both ears for treatment of otitis media.

Conclusions. Errors in medical interpretation are common, averaging 31 per clinical encounter, and omissions are the most frequent type. Most errors have potential clinical consequences, and those committed by ad hoc interpreters are significantly more likely to have potential clinical consequences than those committed by hospital interpreters. Because errors by ad hoc interpreters are more likely to have potential clinical consequences, third-party reimbursement for trained interpreter services should be considered for patients with limited English proficiency.
Overeating Among Adolescents: Prevalence and Associations With Weight-Related Characteristics and Psychological Health
Authors: Ackard Diann M. , Neumark-Sztainer Dianne , Story Mary , Perry Cheryl
Published: August 2004

Objective. To assess the prevalence of overeating among adolescents and to examine associations between overeating and sociodemographic characteristics, weight status, dieting behaviors, body satisfaction, depressive mood, self-esteem, and suicide.

Method. A school-based sample of 4746 boys and girls in public middle and high schools in Minnesota completed the Project EAT (Eating Among Teens) survey and anthropometric measurements of height and weight.

Results. Overall, 17.3% of girls and 7.8% of boys reported objective overeating in the past year. Youths who engaged in overeating were more likely to be overweight or obese, to have dieted in the past year, to be trying to lose weight currently, and to report that weight and shape are very important to their overall feelings about self. Youths who met criteria for binge eating syndrome (high frequency of objective overeating with loss of control and distress regarding the binge eating) scored significantly lower on measures of body satisfaction and self-esteem and higher on a measure of depressive mood than those who reported either subclinical or no binge eating. Overeating was associated with suicide risk; more than one fourth of girls (28.6%) and boys (27.8%) who met criteria for binge eating syndrome reported that they had attempted suicide.

Conclusions. Overeating among adolescents is associated with a number of adverse behaviors and negative psychological experiences. As the current study is cross-sectional, it is not possible to ascertain cause and effect. Future research should seek to identify whether objective overeating is an early warning sign of additional psychological distress or is a potential consequence of compromised psychological health. Clinical implications are discussed.
Community Norms on Toy Guns
Authors: Cheng Tina L. , Brenner Ruth A. , Wright Joseph L. , Sachs Hari Cheryl , Moyer Patricia , Rao Malla
Published: August 2004

Objective. Toy gun play has been associated with aggressive behavior, and it has been suggested that child health professionals counsel families on limiting exposure. Effective violence prevention counseling requires an understanding of norms regarding parental attitudes, practices, and influencing factors. Both theories of reasoned action and planned behavior emphasize that subjective norms and attitudes affect people’s perceptions and intended behavior. Few normative data exist on this issue from a cross-section of families. By establishing behavioral norms and understanding the spectrum of parental attitudes, community-sensitive and community-specific interventions for violence prevention can be developed. The objective of this study was to assess community norms on the topic of toy gun play from the perspective of parents.

Methods. An anonymous self-report assisted survey was administered to a convenience sample of parents/guardians who visited child health providers at 3 sites: an urban children’s hospital clinic, an urban managed care clinic, and a suburban private practice. The parent questionnaire included questions on child rearing attitudes, practice, and sociodemographic information.

Results. A total of 1004 eligible participants were recruited for the study; 922 surveys were completed (participation rate 92%). The 830 (90%) respondents who were parents and had complete child data were the focus of additional analysis. Regarding toy guns, 67% of parents believed that it was never “OK for a child to play with toy guns,” and 66% stated that they never let their children play with toy guns. Parents who thought that it was okay for children to play with toy guns and allowed them to play with toy guns were more likely to be male parents, have male children, and be white.

Conclusions. There is variability in norms regarding toy gun play among parents, with most discouraging toy gun play. Norms varied based on gender of the child, gender of the parent, and race. Understanding norms is a first step in designing effective community-sensitive interventions.
Breast Deformity in Adolescence as a Result of Pneumothorax Drainage During Neonatal Intensive Care
Authors: Rainer Christian , Gardetto Alexander , Frühwirth Martin , Trawöger Rudolf , Meirer Romed , Fritsch Helga , Piza-Katzer Hildegunde
Published: August 2004

Objective. During intensive care of newborns, a number of invasive techniques may be necessary for resuscitation. The margin of safety between effective treatment and iatrogenic damage is narrow. The objective of this study was to identify and discuss iatrogenic damage in females resulting from treatment of pneumothorax and to give neonatologists anatomically based advice for prevention.

Patients and Methods. We report 2 female patients (aged 13 and 16 years) born prematurely in whom breast deformity occurred caused by drainage of multiple pneumothoraces during intensive care. In an additional anatomic study, both hemithoraces of 5 newborn female cadavers (n = 10) were dissected to measure the extension of the breast tissue.

Results. The anatomic investigations in newborns demonstrate that breast tissue extends vertically from the second or third rib to the sixth rib and from close to the sternal edge medially, almost to the anterior axillary line laterally.

Conclusion. Psychological distress and corrective surgery because of deformed breasts in adolescent girls who have undergone drainage of pneumothoraces as newborns can be avoided by placing the skin incision in the anterior axillary line, maintaining a distance of 4 to 5 cm inferior to the nipple, and by inserting the chest drain through the fifth or sixth intercostal space during neonatal treatment.
Iron Overload in Children Who Are Treated for Acute Lymphoblastic Leukemia Estimated by Liver Siderosis and Serum Iron Parameters
Authors: Halonen Päivi , Mattila Jorma , Suominen Pauli , Ruuska Tarja , Salo Matti K. , Mäkipernaa Anne
Published: August 2004

Objective. To evaluate a secondary liver iron overload and its fate in children who are treated conventionally for acute lymphoblastic leukemia and to assess whether serum soluble transferrin receptor (sTfR) is useful in detecting iron load.

Methods. Liver siderosis was estimated histologically from liver biopsy specimens of 30 children (aged 2.6–17.6 years) close to or at the end of therapy using total iron score (TIS). Serum iron parameters and sTfR were measured at the same time and in 22 patients 1 to 3 years after therapy.

Results. In 19 (63%) of 30 patients, liver TIS was >15, indicating at least moderate iron overload. Serum ferritin, iron, and transferrin iron saturation levels were highest and transferrin level lowest in the patients with the highest liver iron content. Serum sTfR levels did not differ significantly between the patients with varying amounts of liver iron. TIS correlated most significantly positively with serum ferritin (rS = 0.899), transferrin iron saturation (rS = 0.764), and the amount of transfused red blood cells (rS = 0.783). Serum iron parameters normalized in most patients during the follow-up. In 3 (14%) of 22 patients, serum ferritin level remained high (>1000 μg/L).

Conclusions. Long-term iron overload is detected in at least 14% of children after therapy for acute lymphoblastic leukemia. Serum sTfR is an inappropriate marker for liver iron overload, whereas ferritin seems to be the most useful serologic marker for it.
Sustaining and Broadening Intervention Impact: A Longitudinal Randomized Trial of 3 Adolescent Risk Reduction Approaches
Authors: Wu Ying , Stanton Bonita F. , Galbraith Jennifer , Kaljee Linda , Cottrell Lesley , Li Xiaoming , Harris Carole V. , D’Alessandri Dawn , Burns James M.
Published: August 2004

Objective. To determine whether the addition of a parental monitoring intervention (Informed Parents and Children Together [ImPACT]) alone or with “boosters” could enhance (either broaden or sustain or both) the effect of a small group, face-to-face adolescent risk reduction intervention Focus on Kids (FOK).

Methods. A longitudinal, randomized, community-based cohort study was conducted of 35 low-income, community-based, in-town settings. A total of 817 black youths aged 12 to 16 years at baseline were studied. After completion of baseline measures, youths were randomized to receive a face-to-face intervention alone (FOK only), a face-to-face intervention and a parental monitoring intervention (FOK plus ImPACT), or both of the above plus boosters (FOK plus ImPACT plus boosters). Risk and protective behaviors were assessed at 6 and 12 months after intervention.

Results. At 6 months’ follow-up, youths in families that were assigned to FOK plus ImPACT reported significantly lower rates of sexual intercourse, sex without a condom, alcohol use, and cigarette use and marginally lower rates of “risky sexual behavior” compared with youths in families that were assigned to FOK only. At 12 months after intervention, rates of alcohol and marijuana use were significantly lower and cigarette use and overall risk intention were marginally lower among FOK plus ImPACT youths compared with FOK only youths. With regard to the boosters delivered at 7 and 10 months, 2 risk behaviors—use of crack/cocaine and drug selling—were significantly lower among the youths who were assigned to receive the additional boosters compared with youths without the boosters. The rates of the other risk behaviors and intentions did not differ significantly.

Conclusions. The results of this randomized, controlled trial indicate that the inclusion of a parental monitoring intervention affords additional protection from involvement in adolescent risk behaviors 6 and 12 months later compared with the provision of an intervention that targets adolescents only. At the same time, the results of the present study do not provide sufficient evidence that booster sessions further improve targeted behaviors enough to include them in a combined parent and youth intervention.
Bronchiolitis Management Preferences and the Influence of Pulse Oximetry and Respiratory Rate on the Decision to Admit
Authors: Mallory Michael D. , Shay David K. , Garrett Joanne , Bordley W. Clayton
Published: August 2004

Objective. High incidence, rising admission rates, and relatively ineffective therapies make the management of bronchiolitis controversial. Since 1980, the rate of hospitalization for children with bronchiolitis has increased by nearly 250%, whereas mortality rates for the disease have remained constant. It has been speculated that the increasing use of pulse oximetry has lowered the threshold for admission and may have contributed to the rise in bronchiolitis-related admissions. The objective of this study was to describe pediatric emergency medicine physicians’ management preferences regarding infants with moderately severe bronchiolitis and to assess the influence of specific differences in oxygen saturation as measured by pulse oximetry (Spo2) and respiratory rate (RR) on the decision to admit.

Methods. Physicians who are members of the American Academy of Pediatrics Section of Emergency Medicine and living in the United States were randomized into 4 groups and mailed a survey that contained 1 of 4 vignettes. Vignettes were identical except for given Spo2 values (94% or 92%) and RR (50/min or 65/min). Subjects were asked to answer questions regarding laboratory tests, treatment options, and the decision to admit for the patient in their vignette.

Results. We received completed surveys from 519 (64%) of the 812 physicians contacted. Most respondents recommended use of bronchodilators (96%), nasal suction (82%), and supplemental oxygen (57%). Few respondents recommended decongestants (9%), steroids (8%), or antibiotics (2%). When asked to rank therapies, respondents gave nasal suction 182 number 1 votes; bronchodilators received 164. The decision to admit varied with Spo2 and RR. Forty-three percent of respondents who received a vignette featuring Spo2 of 94% and a RR of 50/min recommended admission for the infant in their vignette. Fifty-eight percent recommended admission when the vignette Spo2 was 94% and RR was 65/min (χ2 = 5.021). Respondents who received a vignette with Spo2 of 92% were nearly twice as likely to recommend admission: 83% recommended admission when vignette RR was 50/min, and 85% recommended admission when vignette RR was 65/min (χ2 = 0.126).

Conclusions. When treating infants with moderately severe bronchiolitis, pediatricians who work in emergency departments frequently use bronchodilators and nasal suction, 2 practices for which supporting data are either conflicting (bronchodilators) or nonexistent (nasal suction). In addition, their decisions to admit differ markedly on the basis of only a 2% difference in Spo2. It is possible that increased reliance on pulse oximetry has contributed to the increase in bronchiolitis hospitalization rates seen during the past 2 decades.
Spiritual Care Needs of Hospitalized Children and Their Families: A National Survey of Pastoral Care Providers’ Perceptions
Authors: Feudtner Chris , Haney Jeff , Dimmers Martha A.
Published: August 2004

Objective. Although spirituality is viewed as a vital aspect of the illness experience by most Americans, little is known about this domain of pediatric health care. The objective of this study was to profile pastoral care providers’ perceptions of the spiritual care needs of hospitalized children and their parents, barriers to better pastoral care, and quality of spiritual care in children’s hospitals.

Methods. A cross-sectional mail survey was conducted of pastoral care providers at children’s hospitals throughout the United States, with a 67% response rate from 115 institutions.

Results. Respondents estimated that, among patients they visited, 34% were chronically ill and 21% were clearly dying. Half or more of patients were thought to have spiritual care needs regarding feeling fearful or anxious, coping with pain or other physical symptoms, and regarding their relationship to their parents or the relationship between their parents. Among patients’ parents, 60% to 80% were estimated to have felt fearful or anxious, had difficulty coping with their child’s pain or other symptoms, sought more medical information about their child’s illness, questioned why they and their child were going through this experience, asked about the meaning or purpose of suffering, and felt guilty. Respondents agreed on 3 barriers to providing spiritual care: inadequate staffing of the pastoral care office, inadequate training of health care providers to detect patients’ spiritual needs, and being called to visit with patients and families too late to provide all the care that could have been provided. Overall, respondents judged that their hospitals were providing 60% of what they deemed as ideal spiritual care.

Conclusions. Pastoral care providers believe that the spiritual care needs of hospitalized children and their parents are diverse and extensive. With system-level barriers cited as limiting the quality of spiritual care, considerable improvement may be possible.
Slow Blood Sampling From an Umbilical Artery Catheter Prevents a Decrease in Cerebral Oxygenation in the Preterm Newborn
Authors: Schulz Gabriele , Keller Esther , Haensse Daniel , Arlettaz Romaine , Bucher Hans Ulrich , Fauchère Jean-Claude
Published: August 2004

Objective. Blood sampling from an umbilical artery catheter (UAC) placed in a high position (thoracal 6–9) has the potential to produce clinically significant changes in cerebral blood flow and, thereby, in cerebral oxygenation. This may contribute to cerebral impairment in preterm newborn infants. Therefore, we set up a study to determine the effects of different sampling speeds through a UAC on cerebral oxygenation in preterm infants.

Methods. Thirty pairs of measurements were conducted on 20 preterm infants (median gestational age: 30.14 weeks; median birth weight: 1170 g). For each infant, 2 blood samplings (both 2.3 mL, including flush volume) through the UAC in high position were taken at 2 different speeds (20 and 40 seconds) in alternating sequence. Cerebral oxygenation was measured noninvasively by near-infrared spectroscopy. Concentration changes in cerebral oxygenated hemoglobin (O2Hb) and deoxygenated hemoglobin (HHb), along with the tissue oxygenation index (TOI; O2Hb/[O2Hb + HHb] × 100), were recorded while blood was withdrawn and subsequently reinfused.

Results. A significant decrease in O2Hb and TOI occurred during blood sampling within 20 seconds (median ΔO2Hb: −1.5 μmol/L; range: −4.1–2.3; median ΔTOI: −0.6%; range: −6.3–2.3), whereas HHb increased (median ΔHHb: 0.4 μmol/L, range: −1.1–3.9). No significant change was found in O2Hb, HHb, and TOI when sampling time was extended to 40 seconds.

Conclusion. Our results show that blood withdrawal over 20 seconds from a UAC in high position significantly decreases cerebral O2Hb and TOI in preterm infants. Prolonging sampling time to 40 seconds can prevent this phenomenon.
Low-Dose Aspirin in Pregnancy: Maternal and Neonatal Aspirin Concentrations and Neonatal Prostanoid Formation
Authors: Leonhardt Andreas , Bernert Stefanie , Watzer Bernhard , Schmitz-Ziegler Gabriele , Seyberth Hannsjörg W.
Published: August 2004

Objective. To evaluate maternal and neonatal plasma concentrations of acetylsalicylic acid and salicylic acid and the neonatal endogenous prostanoid formation during low-dose aspirin prophylaxis (LDA; 100 mg daily) in pregnant women.

Methods. Concentrations of acetylsalicylic acid and salicylic acid in maternal plasma after at least 4 weeks of LDA (n = 14) and in umbilical cord plasma of newborns after maternal LDA (n = 7) were determined by gas chromatography–mass spectrometry. Platelet and renal formation of thromboxane A2 and the formation of prostaglandin E2 and prostacyclin were evaluated in vivo by quantification of index metabolites in plasma and urine by gas chromatography–mass spectrometry in neonates after maternal LDA (n = 14) and in a control group.

Results. In the pregnant women, acetylsalicylic acid and salicylic acid concentrations rapidly increased after ingestion of LDA. Acetylsalicylic acid was completely eliminated within 4 hours, whereas salicylic acid was detected with low concentrations at 18 and 21 hours after dosing. In the neonates, acetylsalicylic acid was not detected. Salicylic acid was detected in 1 infant only. Platelet thromboxane A2 formation in the newborn infants was significantly suppressed but recovered within 2 to 3 days after discontinuation of LDA. Renal thromboxane A2 formation and the formation of prostaglandin E2 and prostacyclin were not affected by LDA.

Conclusion. In pregnant women who are treated with LDA, acetylsalicylic acid is not completely inactivated in the portal circulation but reaches the uteroplacental circulation and exerts antiplatelet effects in the fetus and newborn.
Opisthotonic Posturing With Neuromuscular Irritability Attributable to 4-Aminopyridine Ingestion by a Healthy Pediatric Patient
Authors: Velez Larissa , Shirazi Farshad , Goto Collin , Shepherd Greene , Roth Brett A.
Published: August 2004

Introduction. 4-Aminopyridine (4-AP) is a potassium channel blocker used to increase muscle strength in the treatment of demyelinating diseases such as multiple sclerosis. We describe a case of ingestion by an 8-month-old child that resulted in severe but transient symptoms.

Case Report. An 8-month-old boy was found with greenish saliva, and a capsule with green 4-AP powder was missing. On arrival to an emergency department, he was jittery, tachycardic, and tachypneic. Activated charcoal, a cathartic, and midazolam (0.5 mg/kg) were administered before transfer to a tertiary pediatric hospital. On arrival, the infant remained tachycardic and tachypneic. His eyes deviated upward and he was noted to have 3+ deep tendon reflexes bilaterally. He was administered 0.9% normal saline (20 mL/kg) for a wide pulse pressure with low diastolic blood pressure. The patient developed dramatic opisthotonic posturing and vermiform tongue fasciculations. The symptoms responded well to repeated intravenous doses of benzodiazepines. In this case, we used 2 doses of lorazepam (0.05 mg/kg each). During opisthotonic posturing, an electroencephalogram performed in the intensive care unit revealed no evidence of seizure activity. Within 20 hours after admission, the patient became asymptomatic.

Conclusion. This case is, to our knowledge, the first documented pediatric 4-AP ingestion. Clinical signs and symptoms are described as well as the response to therapy with benzodiazepines. The electroencephalogram performed while the patient was symptomatic was negative for seizures.
Pyogenic Liver Abscess and Papillon-Lefèvre Syndrome: Not a Rare Association
Authors: Almuneef Maha , Al Khenaizan Sultan , Al Ajaji Sulaiman , Al-Anazi Abdullah
Published: August 2004

Papillon-Lefèvre syndrome is a rare, autosomal recessive disease comprising palmoplantar keratoderma and periodontitis. Pyogenic liver abscess is an increasingly recognized complication. We report a new case of this association and review the current literature.
Classification and Definition of Disorders Causing Hypertonia in Childhood
Authors: Sanger Terence D. , Delgado Mauricio R. , Gaebler-Spira Deborah , Hallett Mark , Mink Jonathan W. ,   Task Force on Childhood Motor Disorders
Published: August 2004

Objective. This report describes the consensus outcome of an interdisciplinary workshop that was held at the National Institutes of Health in April 2001. The purpose of the workshop and this article are to define the terms “spasticity,” “dystonia,” and “rigidity” as they are used to describe clinical features of hypertonia in children. The definitions presented here are designed to allow differentiation of clinical features even when more than 1 is present simultaneously.

Methods. A consensus agreement was obtained on the best current definitions and their application in clinical situations.

Results. “Spasticity” is defined as hypertonia in which 1 or both of the following signs are present: 1) resistance to externally imposed movement increases with increasing speed of stretch and varies with the direction of joint movement, and/or 2) resistance to externally imposed movement rises rapidly above a threshold speed or joint angle. “Dystonia” is defined as a movement disorder in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both. “Rigidity” is defined as hypertonia in which all of the following are true: 1) the resistance to externally imposed joint movement is present at very low speeds of movement, does not depend on imposed speed, and does not exhibit a speed or angle threshold; 2) simultaneous co-contraction of agonists and antagonists may occur, and this is reflected in an immediate resistance to a reversal of the direction of movement about a joint; 3) the limb does not tend to return toward a particular fixed posture or extreme joint angle; and 4) voluntary activity in distant muscle groups does not lead to involuntary movements about the rigid joints, although rigidity may worsen.

Conclusion. We have provided a set of definitions for the purpose of identifying different components of childhood hypertonia. We encourage the development of clinical rating scales that are based on these definitions, and we encourage research to relate the degree of hypertonia to the degree of functional ability, change over time, and societal participation in children with motor disorders.
Prevention of Hospital-Acquired Hyponatremia: A Case for Using Isotonic Saline
Authors: Moritz Michael L. , Ayus Juan Carlos
Published: August 2004

Objective. The current standard of care in pediatrics is to administer hypotonic saline in maintenance parenteral fluids. The safety of this approach has never been evaluated.

Methods. A review of the literature reveals that the administration of hypotonic fluids is potentially dangerous and may not be physiologic for the hospitalized child.

Results. There have been >50 reported cases of neurologic morbidity and mortality, including 26 deaths, in the past 10 years resulting from hospital-acquired hyponatremia in children who were receiving hypotonic parenteral fluids. Common childhood conditions requiring parenteral fluids, such as pulmonary and central nervous system infections, dehydration, and the postoperative state, are associated with a nonosmotic stimulus for antidiuretic hormone production, which can lead to free water retention and hyponatremia. Children are at particularly high risk of developing symptomatic hyponatremia as they have a larger brain-to-skull size ratio.

Conclusions. The administration of isotonic saline in maintenance parenteral fluids is the most important prophylactic measure that can be taken to prevent the development of hyponatremia in children who receive parenteral fluids.
Misconceptions About Colds and Predictors of Health Service Utilization
Authors: Lee Grace M. , Friedman Jennifer F. , Ross-Degnan Dennis , Hibberd Patricia L. , Goldmann Donald A.
Published: August 2004

Objective. Colds accounted for 1.6 million emergency department (ED) visits and 25 million ambulatory visits by children and adults in 1998. Although most colds are caused by viruses and do not require medical intervention, many families seek health care for the treatment of colds. Parental misconceptions about the cause and appropriate treatment of colds may contribute to unnecessary health service utilization. The objective of this study was to determine predictors of reported ED use and ambulatory care use for colds among families with young children.

Methods. This study was an observational, prospective cohort study to determine attack rates for respiratory illnesses within families that have at least 1 child who is 6 months to 5 years of age and enrolled in out-of-home child care. Families were randomly selected from 5 pediatric practices in Massachusetts and were considered eligible when the child was enrolled in child care with at least 5 other children for ≥10 hours per week. Enrolled families were asked to complete a survey that assessed knowledge about colds, antibiotic indications, and frequency of health service utilization. Predictors of self-reported use of health care services were assessed in multivariate logistic regression models.

Results. Of the 261 families enrolled in the study, 197 families (75%) returned completed surveys. Although 93% of parents understood that viruses caused colds, 66% of parents also believed that colds were caused by bacteria. Fifty-three percent believed that antibiotics were needed to treat colds. Parents reported that they would visit the ED (23%) or their doctor’s office (60%) when their child had a cold. Predictors of ED use on multivariate analysis included Medicaid insurance (odds ratio [OR]: 17.6 [2.2–139.3]), history of wheezing (OR: 18.3 [4.4–75.8]), and belief that antibiotics treat colds (OR: 4.2 [1.4–12.9]). Predictors of ambulatory care use included parent younger than 30 years (OR: 10.0 [1.6–64.3]), history of wheezing (OR: 5.6 [1.1–29.7]), and belief that antibiotics treat colds (OR: 3.8 [1.7–8.5]).

Conclusions. Misconceptions about the appropriate treatment of colds are predictive of increased health service utilization. Targeted educational interventions for families may reduce inappropriate antibiotic-seeking behavior and unnecessary health service utilization for colds.
Geographic Variation in the Prevalence of Stimulant Medication Use Among Children 5 to 14 Years Old: Results From a Commercially Insured US Sample
Authors: Cox Emily R. , Motheral Brenda R. , Henderson Rochelle R. , Mager Doug
Published: August 2004

Objective. The purpose of this study was to evaluate geographic variation in the prevalence of prescription stimulant use and predictors of use among a nationally representative, commercially insured population 5 to 14 years old.

Methods. Prescription claims activity from January 1, 1999 through December 31, 1999 for a continuously eligible population 5 to 14 years old was evaluated. Age-gender adjusted prevalence rates were estimated for each state. Multivariate logistic regression using hierarchical linear modeling was used to evaluate the impact of age, gender, number of child dependents, and region of the country on stimulant prevalence. The contextual effects of urban or rural residence, median income, percent white, and physician rate per 100 000 residents were also controlled for.

Results. The 1-year prevalence of stimulant treatment for the entire study sample was 4.2%. Multivariate logistic regression indicated that stimulant prescription use was positively associated with age, male gender, fewer child dependents, living in higher income communities, and living in communities with greater percent white. Compared with children living in the Western region of the country, children living in the Midwest and South were 1.55 (99% confidence interval: 1.28–1.87) and 1.71 (99% confidence interval: 1.42–2.06) times more likely to consume at least 1 stimulant medication, respectively. Differences in stimulant prevalence across urban and rural residence were also noted.

Conclusions. Geographic variation in the prevalence of stimulant use exists nationally, despite controlling for important predictors of use including age and gender. Possible reasons for the variation are discussed as are calls for additional research.
Treatment of Term Infants With Head Cooling and Mild Systemic Hypothermia (35.0°C and 34.5°C) After Perinatal Asphyxia
Authors: Battin Malcolm R. , Penrice Juliet , Gunn Tania R. , Gunn Alistair J.
Published: August 2004

Objective. To assess the safety of selective head cooling in birth-asphyxiated term newborn infants while maintaining the rectal temperature at 35.0°C or 34.5°C.

Methods. Twenty-six term infants with Apgar ≤6 at 5 minutes or cord/first arterial pH <7.1, plus evidence of encephalopathy, were studied. After parental consent had been obtained, 13 infants received selective head cooling with the rectal temperature maintained at 35.0°C in 6 infants and at 34.5°C in 7 infants. The remaining 13 infants were normothermic. Cooling was achieved by circulating water at 10°C through a cap placed around the head. Rectal, fontanelle, and nasopharyngeal temperatures were monitored.

Results. One cooled infant died 2 days after rewarming, and 3 control infants died. Seizures occurred in 9 (69%)of 13 cooled infants and 5 (38%) of 13 control infants. Respiratory support within the first 72 hours of life was required in 10 of 13 infants in both the cooled and control groups. Three cooled infants and 1 control infant received nitric oxide for persistent pulmonary hypertension. During the same interval, 6 of the cooled infants and 4 of the control infants had episodes in which their blood pressure fell to <40 mm Hg; in 2 infants in each group, the lowest blood pressure was below 35 mm Hg. No requirement for volume expansion or increased inotropic support was seen in any infant during stepwise rewarming. All of the cooled infants demonstrated a fall in heart rate during cooling, but the rate was <80/min in only 2 cases and no infant had a rate <70/min. No infant demonstrated an abnormal rhythm or was clinically compromised by the change in heart rate. One infant cooled to a rectal temperature of 34.5°C had a prolonged QT interval of 570 ms associated with a heart rate of 85/min on electrocardiogram aged 34 hours. This returned to normal after rewarming. Platelet counts below 150 × 109/L, hypoglycemia below 2.6 mmol/L, and highest creatinine were not statistically different between cooled and control infants. Positive precooling blood cultures were found in 1 cooled and 1 control infant. The mean cap water input temperature used during cooling was 10 ± 1°C. During active cooling, the mean difference between rectal and nasopharyngeal temperature was 1.4°C in the infants who were not receiving respiratory support, but this gradient could not be measured in those who were receiving respiratory support that involved delivery of warmed gases to the nasopharynx.

Conclusions. This study suggests that selective head cooling combined with mild systemic hypothermia of 34.4°C or 35.0°C is a stable, well-tolerated method of reducing cerebral temperature in term newborn infants after perinatal asphyxia.
Blood Pressure in Late Adolescence and Very Low Birth Weight
Authors: Doyle Lex W. , Faber Brenda , Callanan Catherine , Morley Ruth
Published: August 2004

Objectives. To determine whether blood pressure (BP) differed between very low birth weight (VLBW; birth weight ≤1500 g) subjects and normal birth weight (NBW; birth weight >2499 g) subjects in late adolescence, and to determine whether growth restriction in utero was related to BP in VLBW survivors at this age.

Methods. This was a cohort study of 210 preterm survivors with birth weights <1501 g born from January 1, 1977, to March 31, 1982, and 60 randomly selected NBW subjects from the Royal Women’s Hospital, Melbourne. BP was measured at 18+ years of age in 156 (74%) VLBW subjects and 38 (63%) NBW subjects with both a standard mercury sphygmomanometer and an ambulatory BP monitor.

Results. VLBW subjects had higher sphygmomanometer systolic and diastolic BPs than NBW subjects (mm Hg; mean difference [95% confidence interval]; systolic, 8.6 [3.4, 13.9]; diastolic, 4.3 [1.0, 7.6]). VLBW subjects also had significantly higher mean systolic ambulatory BPs (mm Hg; mean difference [95% confidence interval]) for the 24-hour period (4.7 [1.4, 8.0]), and for both the awake (5.0 [1.6, 8.5]) and asleep (3.6 [0.04, 7.1]) periods. There were no significant differences between the birth weight groups for any ambulatory diastolic BPs. Within the VLBW subjects, there was no significant relationship between birth weight standard deviation score and any measure of BP.

Conclusions. BP was significantly higher in late adolescence in VLBW survivors than in NBW subjects. Growth restriction in utero was not significantly related to BP in VLBW survivors.
Childhood Behavior Disorders and Injuries Among Children and Youth: A Population-Based Study
Authors: Brehaut Jamie C. , Miller Anton , Raina Parminder , McGrail Kimberlyn M.
Published: August 2004

Context. While an association between pediatric behavioral disorders and injuries is generally acknowledged, no studies have measured the risk for injury in the context of a large, population-based study that is free of cohort biases.

Objectives. To examine the association between childhood behavior disorders ([CBDs] as indicated by prescription for methylphenidate [MPH]) and a variety of injury outcomes, and to evaluate the risk for injury among these children after controlling for known demographic correlates.

Design. Population-based database analysis of all children in British Columbia (BC) under the age of 19 as of December 31, 1996; comparison of those who had been prescribed MPH and therefore placed in the CBD group (n = 16 806) and those who were not (n = 1 010 067). Demographic information collected was as follows: age, sex, measures of socioeconomic status, and region of residence.

Outcome Measures. Common types of childhood injury in BC: International Classification of Diseases, Ninth Revision N-codes (fractures, open wounds, poisoning/toxic effect, concussion, intracranial, burns) and E-codes (falls, postoperative complications, motor vehicle accidents, struck by object, adverse effects of drugs, suffocation, drowning).

Data Source. BC Linked Health Data Set and the BC Triplicate Prescription Program.

Results. After controlling for known demographic correlates, odds for injury was greater among those treated with MPH and presumed to have a behavioral disorder, when injury was characterized either by type (1.67; 99% confidence interval: 1.54–1.81) or cause (1.52; 99% confidence interval: 1.40–1.66) of injury. This increased risk extended to unexpected categories of injury such as postoperative complications and adverse effects of drugs.

Conclusions. Children with CBDs have >1.5 times the odds of sustaining injuries of a variety of types from a variety of causes, even after controlling for known demographic correlates, than those without behavioral disorders. The risks for these children extend beyond those that might be directly associated with impulsivity and overactivity. Injury prevention strategies aimed at this group of children and youth would be beneficial. Policy-makers should account for increased risk of a wide variety of injuries in this group of children and youth.