bluuebunny/crossref_metadata_2025 huggingface dataset:
Herpes Simplex Virus Infections in Preterm Infants
Authors: O'Riordan Declan P. , Golden W. Christopher , Aucott Susan W.
Published: December 2006

OBJECTIVE. Neonatal herpes simplex virus infections cause significant neonatal mortality and morbidity, but the course and prognosis in preterm infants is not well documented. We performed a retrospective review of herpes simplex virus infections at out institution within the first 30 days after birth in infants who were born at <37 weeks to help better define the symptoms and signs of herpes simplex virus infections in preterm infants and to assist in prognosis.

METHODS. Hospital databases were reviewed to identify culture- or polymerase chain reaction–proven cases of herpes simplex virus-1 or herpes simplex virus-2 infections that occurred in preterm newborns between 1989 and 2003. Maternal and neonatal histories, clinical features, and laboratory results were reviewed systematically.

RESULTS. Ten preterm singletons and a set of twins were infected with herpes simplex virus-2 during the first month after birth. No mother had herpes simplex virus lesions at delivery, but a history of genital herpes simplex or other sexually transmitted infections was prevalent among the mothers. Infants presented with either disseminated disease or encephalitis. All infants with disseminated disease (n = 9) died, whereas the 3 infants with encephalitis survived. All infants in the cohort developed respiratory distress, and consistent with the prominence of respiratory symptoms, viral cultures of the respiratory tract were consistently positive. Ten of 12 infants received acyclovir, but despite treatment within 48 hours of symptoms, infants with disseminated disease deteriorated rapidly and died. Two of 3 infants who received high-dosage (60 mg/kg per day) acyclovir survived.

CONCLUSIONS. Herpes simplex virus infections in preterm infants usually present during the first 2 weeks of life with respiratory distress and a high incidence of disseminated disease. Viral respiratory cultures have a high yield for documentation of infection. The morbidity of herpes simplex virus in this population may be attributable to a relatively immature immune system in this population. Additional studies are necessary to delineate the evolution of herpes simplex virus disease in preterm infants and the role of antiviral therapy in mitigating the sequelae of herpes simplex virus infections in this population.
Brief Hospitalization and Pulse Oximetry for Predicting Amoxicillin Treatment Failure in Children with Severe Pneumonia
Authors: Fu Linda Y. , Ruthazer Robin , Wilson Ira , Patel Archana , Fox LeAnne M. , Tuan Tran Anh , Jeena Prakash , Chisaka Noel , Hassan Mumtaz , Lozano Juan , Maulen-Radovan I , Thea Donald M. , Qazi Shamim , Hibberd Patricia
Published: December 2006

OBJECTIVE. In settings with limited assessment tools, we sought to determine whether early clinical signs and symptoms and blood oxygen saturation would predict amoxicillin treatment failure in children with severe pneumonia (as defined by the World Health Organization).

METHODS. Data were from a previously reported, multinational trial of orally administered amoxicillin versus injectable penicillin for the treatment of World Health Organization–defined severe pneumonia in children 3 to 59 months of age. We assessed all 857 participants assigned randomly to the experimental amoxicillin arm. Six multivariate logistic regression models were created and evaluated for their ability to predict failure after 48 hours of therapy. Regression models included vital signs, symptoms, and laboratory data collected at baseline and after 12 or 24 hours of observation. Oxygen saturation data were included in 3 models.

RESULTS. Clinical treatment failure occurred for 18% of children. Younger age, increased initial respiratory rate, and baseline hypoxia predicted treatment failure in all models. Data available after 24 hours improved the ability to predict failure compared with data available at baseline or 12 hours. The inclusion of oximetry data improved the predictive ability at baseline, 12 hours, and 24 hours. The ability to predict failure after 12 hours of observation with oximetry data was similar to the predictive ability after 24 hours without pulse oximetry data.

CONCLUSIONS. Assessment of clinical parameters at presentation and after 24 hours improved the ability to predict clinical failure of oral amoxicillin therapy, compared with assessment at presentation alone or at presentation and after only 12 hours, for children with World Health Organization–defined severe pneumonia.
Pervasive Developmental Disorder, Behavior Problems, and Psychotropic Drug Use in Children and Adolescents With Mental Retardation
Authors: de Bildt Annelies , Mulder Erik J. , Scheers Tom , Minderaa Ruud B. , Tobi Hilde
Published: December 2006

OBJECTIVE. This study investigated the interrelationship between psychopharmacotherapy in general and the use of specific psychotropic drugs and pervasive developmental disorder and other behavior problems in children and adolescents with mental retardation.

METHODS. A total of 862 participants 4 to 18 years of age, including all levels of mental retardation, were recruited through facilities for children with mental retardation in Friesland, the Netherlands. Information on medication was collected through parent interviews. Behavior problems were investigated with a standardized parent questionnaire (Developmental Behavior Checklist). A pervasive developmental disorder classification was based on the Pervasive Developmental Disorder in Mental Retardation Scale, completed by psychologists or teachers. Logistic regression analysis was used to investigate the relationship between the use of psychotropic drugs and pervasive developmental disorder and other behavioral problems, in the presence of possible confounders.

RESULTS. One of 10 participants used psychotropic medication. The main factors associated with psychotropic drug use were pervasive developmental disorder and disruptive behavior. The level of functioning was also associated. Self-absorbed behavior was statistically significantly associated with clonidine use and disruptive behavior with stimulant use. Pervasive developmental disorder and communication problems were the main factors associated with the use of antipsychotic drugs. Age also played a role, whereas gender, living situation, and level of mental retardation did not.

CONCLUSIONS. Antipsychotic drugs were associated with pervasive developmental disorder, whereas clonidine and stimulants were associated with self-absorbed and disruptive behavior, respectively. Although clonidine and risperidone are not registered for the problems reported and the other nonstimulants were only sometimes used on-label, their use was associated with specific psychiatric or behavioral problems.
Earlier Apgar Score Increase in Severely Depressed Term Infants Cared for in Swedish Level III Units With 40% Oxygen Versus 100% Oxygen Resuscitation Strategies: A Population-Based Register Study
Authors: Hellström-Westas Lena , Forsblad Kristina , Sjörs Gunnar , Saugstad Ola Didrik , Björklund Lars J. , Maršál Karel , Källén Karin
Published: December 2006

OBJECTIVES. The aim of this study was to evaluate whether a resuscitation strategy based on administration of 40% oxygen influences mortality rates and rates of improvement in 5-minute Apgar scores, compared with a strategy based on 100% oxygen administration.

METHODS. A population-based study evaluated data from 4 Swedish perinatal level III centers during the period of 1998 to 2003. During this period, the centers used either of 2 resuscitation strategies (initial oxygen administration of 40% or 100%). Live-born, singleton, term infants with 1-minute Apgar scores of <4, with a birth weight appropriate for gestational age, and without major malformations were included in the study (n = 1223).

RESULTS. Infants born in hospitals using a 40% oxygen strategy had a more rapid Apgar score increase than did infants born in hospitals using a 100% oxygen strategy; however, no difference remained at 10 minutes. The mean Apgar score increased from 2.01 at 1 minute to 6.74 at 5 minutes in the 2 hospitals initiating resuscitation with 40% oxygen, compared with 2.01 to 6.38 in the 2 hospitals using 100% oxygen, with a mean difference in Apgar score increases of 0.36. At 5 minutes, 44.3% of infants born in the hospitals using 100% oxygen had an Apgar score of <7, compared with 34.0% of infants at the hospitals using 40% oxygen. At 10 minutes, the mean Apgar scores were 8.16 at the hospitals using 40% oxygen and 8.07 at the hospitals using 100% oxygen. There were no significant differences in rates of neonatal death, hypoxic ischemic encephalopathy, or seizures in relation to the 2 oxygen strategies.

CONCLUSION. Severely depressed term infants born in hospitals initiating resuscitation with 40% oxygen had earlier Apgar score recovery than did infants born in hospitals using a 100% oxygen strategy.
Absence of the Wild-type Allele (192 Base Pairs) of a Polymorphism in the Promoter Region of the IGF-I Gene but Not a Polymorphism in the Insulin Gene Variable Number of Tandem Repeat Locus Is Associated With Accelerated Weight Gain in Infancy
Authors: Landmann Eva , Geller Frank , Schilling Jutta , Rudloff Silvia , Foeller-Gaudier Eleonore , Gortner Ludwig
Published: December 2006

OBJECTIVE. Our goal was to investigate whether a polymorphism in the insulin-like growth factor I promoter gene (IGF-I, wild-type, 192 base pairs) and in the insulin gene (INS) variable number of tandem repeat locus influence birth weight and weight gain in infancy.

PATIENTS AND METHODS. We obtained genomic DNA from 768 children. Exclusion criteria were multiple births, gestational diabetes, maternal diabetes, gestational age <37 weeks, >42 weeks, or unclear, and any condition potentially influencing weight gain. SD scores were calculated and adjusted for gestational age and gender. A gain in SD scores for weight between birth and 1 year >0.67 SD scores was defined as accelerated weight gain. Genotyping was performed by fragment length analysis (IGF-I) and by fragment length analysis after using a restriction enzyme-based assay (INS variable number tandem repeat).

RESULTS. Accelerated weight gain was present in 205 of 768 children. IGF-I and INS variable number tandem repeat genotype were not associated with birth weight. The IGF-I 192-base pair allele was less frequent in children with accelerated weight gain and was shown to reduce the risk for accelerated weight gain in a logistic regression model.

CONCLUSION. The IGF-I 192-base pair allele may reduce the risk for rapid weight gain in early infancy.
Pediatric Residency Duty Hours Before and After Limitations
Authors: Cull William L. , Mulvey Holly J. , Jewett Ethan A. , Zalneraitis Edwin L. , Allen Carl E. , Pan Richard J.
Published: December 2006

OBJECTIVES. The goals were to examine pediatric resident and program director experiences implementing the Accreditation Council for Graduate Medical Education work hour limits and to compare duty hours, moonlighting, and fatigue before and after the limits became effective.

METHODS. National random samples of 500 pediatric residents who graduated in 2002 and in 2004 were surveyed to compare resident duty hours and fatigue before and after the Accreditation Council for Graduate Medical Education limits were implemented. In addition, all US pediatric residency program directors were surveyed at the end of the 2003/2004 academic year, to provide a complementary retrospective examination of limit implementation.

RESULTS. Totals of 65%, 61%, and 83% of 2002 residents, 2004 residents, and program directors, respectively, responded. The proportion of residents who reported working >80 hours per week declined from 49% for NICU/PICU rotations before the limits to 18% after limit implementation. Resident well-being was the factor identified most often by both residents and program directors as being improved since the limitations. Multivariate modeling also showed reductions in the proportions of residents who reported falling asleep while driving from work or making errors in patient care because of fatigue. Overall, 89% of pediatric residents and program directors reported that the current system is effective in ensuring appropriate working hours.

CONCLUSIONS. Since the Accreditation Council for Graduate Medical Education duty hour limits went into effect, pediatric residents report working fewer hours and making fewer patient care errors because of fatigue. Although room for additional improvement remains, the experiences of residents and program directors suggest that implementation of the Accreditation Council for Graduate Medical Education limits in pediatric residency programs is improving resident well-being.
Compliance With Well-Child Visit Recommendations: Evidence From the Medical Expenditure Panel Survey, 2000–2002
Authors: Selden Thomas M.
Published: December 2006

OBJECTIVES. This study examines national compliance rates with well-child visit recommendations using the Medical Expenditure Panel Survey. The Medical Expenditure Panel Survey provides nationally representative information on preventative care for children, combining visit-level data over a 2-year period with a rich array of socioeconomic and health status measures.

METHODS. Visit-level data from 2000 to 2002 were used to construct a well-child visit “compliance” measure equal to well-child visits as a percentage of age-specific recommendations from the American Academy of Pediatrics. Compliance was examined across age, gender, race/ethnicity, health status, poverty, insurance coverage, eligibility for public coverage, family structure, parent education, insurance, citizenship and country of origin, language, urbanicity, and census division.

RESULTS. On average, 56.3% of all children aged 0 to 18 years had no well-child visits during a 12-month period, and 39.4% had no well-child visits over a 2-year period. The average compliance ratio was 61.4%. Large differences in compliance exist among children. High compliance rates were observed among infants (83.2%), children with special health care needs (86.6%), children with college-educated parents (74.3%), children with family incomes >4 times the poverty level (71.6%), and children in the New England (94.6%) and Middle Atlantic (83.2%) census divisions. Low levels of compliance were observed among uninsured children (35.3%) and especially uninsured children simulated to be eligible for public coverage (28.4%). Other groups with low compliance rates include teenagers (49.2%), noncitizen children (43.9%), and children in the West South Central (44.9%), East South Central (48.8%), and Mountain (49.7%) census divisions.

CONCLUSIONS. Well-child visit compliance in the Medical Expenditure Panel Survey is less than found in other househould surveys, yet consistent with or above results based on data from provider and claims data. Although experts dispute the optimal frequency of well-child visits, the disparities observed in compliance rates among population subgroups raise important public health concerns.
Intima-Media Thickness in Obese Children Before and After Weight Loss
Authors: Wunsch Rainer , de Sousa Gideon , Toschke André Michael , Reinehr Thomas
Published: December 2006

OBJECTIVE. Obesity in childhood is related to increased intima-media thickness, a noninvasive marker for early atherosclerotic changes. The objective of this study was to analyze the changes of intima-media thickness in obese children with weight loss.

METHODS. We analyzed the changes of intima-media thickness and, as markers of cardiovascular risk factor profile, systolic and diastolic blood pressure, triglycerides, high-density lipoprotein cholesterol, glucose, insulin, and insulin resistance index (homeostasis model analysis) in 56 prepubertal obese children (median: 9 years old) before and after a 1-year outpatient intervention program. The control group consisted of 10 nonobese children of the same age and gender. We determined the carotid intima-media thickness by B-mode ultrasound with a 14-MHz linear transducer. Substantial weight loss was defined by a reduction of overweight of at least 0.5 standard deviation scores in BMI.

RESULTS. Obese children demonstrated a significantly thicker intima-media compared with the control group. Furthermore, blood pressure, triglycerides, insulin, and insulin resistance index were significantly higher in obese children, whereas high-density lipoprotein cholesterol was significantly lower. In the 24 obese children with substantial weight loss, intima-media thickness, blood pressure, triglycerides, insulin, and insulin resistance index decreased significantly, whereas high-density lipoprotein cholesterol increased significantly. In the 32 obese children without substantial weight loss, there were no significant changes apart from an increase of insulin and insulin resistance index.

CONCLUSIONS. Because obese children demonstrated a thicker intima-media, vascular changes seemed to occur already in childhood obesity. Paralleling the improvement of the cardiovascular risk factor profile, intima-media thickness decreased in obese children with substantial weight loss, suggesting the reversibility of early atherosclerotic changes.
Safety, Efficacy, and Effectiveness of Cold-Adapted Influenza Vaccine-Trivalent Against Community-Acquired, Culture-Confirmed Influenza in Young Children Attending Day Care
Authors: Vesikari Timo , Fleming Douglas M. , Aristegui Javier F. , Vertruyen Andre , Ashkenazi Shai , Rappaport Ruth , Skinner Jonathan , Saville Melanie K. , Gruber William C. , Forrest Bruce D. ,   for the CAIV-T Pediatric Day Care Clinical Trial Network
Published: December 2006

OBJECTIVE. The goal was to evaluate the safety, tolerability, and efficacy of an investigational, refrigerator-stable formulation of live attenuated influenza vaccine (cold-adapted influenza vaccine-trivalent) against culture-confirmed influenza, acute otitis media, and effectiveness outcomes in young children in day care over 2 consecutive influenza seasons.

METHODS. Children 6 to <36 months of age who were attending day care were assigned randomly in year 1 to receive 2 doses of vaccine or placebo intranasally, 35 ± 7 days apart. In year 2, subjects received 1 dose of the same treatment as in year 1.

RESULTS. A total of 1616 subjects (vaccine: 951 subjects; placebo: 665 subjects) in year 1 and 1090 subjects (vaccine: 640 subjects; placebo: 450 subjects) in year 2 were able to be evaluated for efficacy. The mean age at first vaccination was 23.4 ± 7.9 months. In year 1, the overall efficacy of the vaccine against influenza subtypes similar to the vaccine was 85.4%; efficacy was 91.8% against A/H1N1 and 72.6% against B. In year 2, the overall efficacy was 88.7%; efficacy was 90.0% against H1N1, 90.3% against A/H3N2, and 81.7% against B. Efficacy against all episodes of acute otitis media associated with culture-confirmed influenza was 90.6% in year 1 and 97.0% in year 2. Runny nose or nasal discharge after dose 1 in year 1 was the only reactogenicity event that was significantly more frequent with cold-adapted influenza vaccine-trivalent (82.3%) than placebo (75.4%).

CONCLUSIONS. Cold-adapted influenza vaccine-trivalent was well tolerated and effective in preventing culture-confirmed influenza illness in children as young as 6 months of age who attended day care.
The Relationship Between Motor Proficiency and Physical Activity in Children
Authors: Wrotniak Brian H. , Epstein Leonard H. , Dorn Joan M. , Jones Katherine E. , Kondilis Valerie A.
Published: December 2006

OBJECTIVES. Youth with better motor abilities may find it easier to be physically active and may be more likely to engage in physical activity compared with peers with poorer motor competence. The purpose of this study was to examine the relationship between motor proficiency and physical activity in 8- to 10-year-old children. Self-efficacy toward physical activity was also assessed.

METHODS. Sixty-five children (34 girls and 31 boys) were studied. Children's physical activity was assessed by the Manufacturing Technologies Incorporated/Computer Science and Applications Incorporated model 7164 accelerometer, and their motor proficiency was determined by the Bruininks-Oseretsky Test of Motor Proficiency. The Children's Self-Perceptions of Adequacy in and Predilection for Physical Activity scale measured children's self-perceptions of adequacy in performing and desire to participate in physical activities.

RESULTS. Children's motor proficiency was positively associated with activity counts and percentage of time in moderate and moderate-to-vigorous intensity physical activity and inversely related to percentage of time in sedentary activity. Children in the greatest quartile of motor proficiency were the most physically active compared with children with lower levels of motor proficiency who had similar levels of physical activity. Children with greater standardized BMI were less physically active, more sedentary, and had poorer motor proficiency compared with children with a lower standardized BMI. Children's Self-Perceptions of Adequacy in and Predilection for Physical Activity scores were positively associated with Bruininks-Oseretsky Test of Motor Proficiency standard score for boys. Children's motor proficiency explained an additional 8.7% of the variance in physical activity in multiple linear regression after controlling for factors that may influence physical activity.

CONCLUSIONS. Motor proficiency is positively associated with physical activity and inversely associated with sedentary activity in children, but there may be a threshold of motor proficiency above which children may be the most physically active. Children's motor proficiency may be an appropriate target for increasing physical activity in youth.
Alterations in Neurobehavior at Term Reflect Differing Perinatal Exposures in Very Preterm Infants
Authors: Brown Nisha C. , Doyle Lex W. , Bear Merilyn J. , Inder Terrie E.
Published: December 2006

OBJECTIVES. Preterm infants have higher rates of cognitive and behavioral difficulties at school age than their term-born peers. We hypothesized that neurobehavior at term would be different in very preterm infants compared with term infants and that perinatal exposures would be associated with these alterations in neurobehavior.

PATIENTS AND METHODS. Two standardized neurobehavioral evaluations were completed on 207 infants at term equivalent, including 168 very preterm infants (<1250 g or <30 weeks' gestation) and 39 term control infants. The assessments used were the Neonatal Intensive Care Unit Network Neurobehavioral Scale and the revised Hammersmith Neonatal Neurologic Examination. The relationship of perinatal variables to preterm infant neurobehavioral scores for both evaluations was examined.

RESULTS. Compared with term-born infants, preterm infant neurobehavior was significantly altered for the Hammersmith Neonatal Neurologic Examination total score and all of the subtotals. Similarly, preterm infants displayed altered neurobehavior for the majority of the Neonatal Intensive Care Unit Network Neurobehavioral Scale summary scores. Complete perinatal data were available for 157 of 168 very preterm infants. The perinatal variables most strongly associated with altered preterm infant neurobehavior on multivariate regression analysis included the total number of days of assisted ventilation, intraventricular hemorrhage, and necrotizing enterocolitis. Positive perinatal influences on neurobehavioral performance at term on multivariate analysis included maternal antenatal steroids, female gender, and infants receiving breast milk at discharge home.

CONCLUSIONS. Preterm infants at term equivalent showed alterations in motor behavior and higher cortically integrated functions. The pattern of abnormality in neurobehavior differed in relation to perinatal exposures. Neurobehavioral examination at term equivalent age is useful in evaluating the impact of neonatal intensive care.
Longitudinal and Secular Trends in Physical Activity and Sedentary Behavior During Adolescence
Authors: Nelson Melissa C. , Neumark-Stzainer Dianne , Hannan Peter J. , Sirard John R. , Story Mary
Published: December 2006

OBJECTIVE. There is little epidemiologic research on longitudinal and secular trends in weight-related health behaviors throughout the stages of adolescence. In particular, few data are available to assess secular trends in various sedentary behaviors. The objective of this research was to investigate longitudinal and secular trends in physical activity and sedentary behavior in a large, diverse cohort of adolescents.

METHODS. Project EAT-II is a 5-year longitudinal study (N = 2516) that includes 2 cohorts that allow for the observation of longitudinal changes from early to midadolescence (junior high to high school; n = 806; mean baseline age: 12.8 ± 0.8 years) and mid- to late adolescence (high school to post–high school; n = 1710; mean baseline age: 15.8 ± 0.8 years). EAT-II also examined secular trends in health behavior from 1999 to 2004 in midadolescence. The main outcome measures of the mixed-model regression analyses used in this research were self-reported weekly hours of moderate to vigorous physical activity, television/video viewing, and leisure-time computer use.

RESULTS. Our findings indicate substantial longitudinal changes in moderate to vigorous physical activity, particularly among girls (decreasing 5.9–4.9 hours/week from early to midadolescence and 5.1–3.5 hours/week from mid- to late adolescence), and leisure-time computer use, particularly among boys (increasing 11.4–15.2 hours/week from early to midadolescence and 10.4–14.2 hours/week from mid- to late adolescence). Secular trends further indicate dramatic increases in midadolescent computer use from 1999 to 2004; girls increased from 8.8 to 11.1 hours/week, and boys increased from 10.4 to 15.2 hours/week.

CONCLUSIONS. These adolescents experienced unfavorable shifts in activity patterns, such as longitudinal decreases in moderate to vigorous physical activity, coupled with longitudinal and secular increases in leisure-time computer use. Developing effective health promotion strategies that address a wide array of changing behavioral patterns will be important in promoting long-term health and active lifestyles among adolescents and young adults.
Energy Expenditure of Sedentary Screen Time Compared With Active Screen Time for Children
Authors: Lanningham-Foster Lorraine , Jensen Teresa B. , Foster Randal C. , Redmond Aoife B. , Walker Brian A. , Heinz Dieter , Levine James A.
Published: December 2006

OBJECTIVE. We examined the effect of activity-enhancing screen devices on children's energy expenditure compared with performing the same activities while seated. Our hypothesis was that energy expenditure would be significantly greater when children played activity-promoting video games, compared with sedentary video games.

METHODS. Energy expenditure was measured for 25 children aged 8 to 12 years, 15 of whom were lean, while they were watching television seated, playing a traditional video game seated, watching television while walking on a treadmill at 1.5 miles per hour, and playing activity-promoting video games.

RESULTS. Watching television and playing video games while seated increased energy expenditure by 20 ± 13% and 22 ± 12% above resting values, respectively. When subjects were walking on the treadmill and watching television, energy expenditure increased by 138 ± 40% over resting values. For the activity-promoting video games, energy expenditure increased by 108 ± 40% with the EyeToy (Sony Computer Entertainment) and by 172 ± 68% with Dance Dance Revolution Ultramix 2 (Konami Digital Entertainment).

CONCLUSIONS. Energy expenditure more than doubles when sedentary screen time is converted to active screen time. Such interventions might be considered for obesity prevention and treatment.
A Novel Imaging Technique to Measure Capillary-Refill Time: Improving Diagnostic Accuracy for Dehydration in Young Children With Gastroenteritis
Authors: Shavit Itai , Brant Rollin , Nijssen-Jordan Cheri , Galbraith Roger , Johnson David W.
Published: December 2006

BACKGROUND. Assessment of dehydration in young children currently depends on clinical judgment, which is relatively inaccurate. By using digital videography, we developed a way to assess capillary-refill time more objectively.

OBJECTIVE. Our goal was to determine whether digitally measured capillary-refill time assesses the presence of significant dehydration (≥5%) in young children with gastroenteritis more accurately than conventional capillary refill and overall clinical assessment.

METHODS. We prospectively enrolled children with gastroenteritis,1 month to 5 years of age, who were evaluated in a tertiary-care pediatric emergency department and judged by a triage nurse to be at least mildly dehydrated. Before any treatment, we measured the weight and digitally measured capillary-refill time of these children. Pediatric emergency physicians determined capillary-refill time by using conventional methods and degree of dehydration by overall clinical assessment by using a 7-point Likert scale. Postillness weight gain was used to estimate fluid deficit; beginning 48 hours after assessment, children were reweighed every 24 hours until 2 sequential weights differed by no more than 2%. We compared the accuracy of digitally measured capillary-refill time with conventional capillary refill and overall clinical assessment by determining sensitivities, specificities, likelihood ratios, and area under the receiver operator characteristic curves.

RESULTS. A total of 83 patients were enrolled and had complete follow-up; 13 of these patients had significant dehydration (≥5% of body weight). The area under the receiver operator characteristic curves for digitally measured capillary-refill time and overall clinical assessment relative to fluid deficit (<5% vs ≥5%) were 0.99 and 0.88, respectively. Positive likelihood ratios were 11.7 for digitally measured capillary-refill time, 4.5 for conventional capillary refill, and 4.1 for overall clinical assessment.

CONCLUSIONS. Results of this prospective cohort study suggest that digitally measured capillary-refill time more accurately predicts significant dehydration (≥5%) in young children with gastroenteritis than overall clinical assessment.
Psychiatric Symptomatology and Disorders in Caregivers of Children With Asthma
Authors: Brown E. Sherwood , Gan Vanthaya , Jeffress Jala , Mullen-Gingrich Kacy , Khan David A. , Wood Beatrice L. , Miller Bruce D. , Gruchalla Rebecca , Rush A. John
Published: December 2006

OBJECTIVE. The prevalence of asthma and asthma-related mortality has increased in recent years. Data suggest an association between psychiatric symptoms in the caregiver and asthma-related hospitalizations in the child. We examined the prevalence of psychiatric symptoms and disorders and their relationship to asthma-related service utilization in caregivers of children hospitalized for asthma.

PATIENTS AND METHODS. Caregivers (n = 175) were assessed during the child’s hospitalization. The number of asthma-related hospitalizations, emergency department visits, and unscheduled clinic visits in the past 12 months was obtained. The Brief Symptom Inventory, an assessment of psychiatric symptoms including somatic, anxiety, and depression subscales, and the Mini International Neuropsychiatric Interview, a structured clinical interview for psychiatric disorders, were administered.

RESULTS. Mean age of the caregivers was 34.2 ± 7.3 years; 96.0% were women; 15.4% were white, 57.7% were black, and 26.3% were Hispanic. A total of 47.9% had incomes less than $25000/year. Caregivers with clinically significant elevations in 2 or more Brief Symptom Inventory subscales reported more asthma-related child hospitalizations in the past 12 months than did caregivers with lower Brief Symptom Inventory scores. Asthma-related hospitalizations correlated with Brief Symptom Inventory total, somatic, anxiety, and depression subscale scores. Caregiver diagnosis of an anxiety disorder (n = 36) was associated with more asthma-related hospitalizations in the child. Children of caregivers with current depression (n = 44) had more unscheduled clinic visits than children of caregivers without depression.

CONCLUSION. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition–defined psychiatric disorders, particularly depressive disorders, were common in caregivers and associated with a greater frequency of asthma-related hospitalizations in the child.
Hyponatremia, Hypophosphatemia, and Hypouricemia in a Girl With Macrophage Activation Syndrome
Authors: Yamazawa Kazuki , Kodo Kazuki , Maeda Jun , Omori Sayu , Hida Mariko , Mori Tetsuya , Awazu Midori
Published: December 2006

Macrophage activation syndrome, a life-threatening complication of rheumatic disorders, is accompanied by the overproduction of cytokines. We describe a girl with macrophage activation syndrome complicating systemic-onset juvenile arthritis who developed hyponatremia, hypophosphatemia, and hypouricemia associated with a high level of serum tumor necrosis factor α. Renal proximal tubule dysfunction was considered to be the cause, which may be attributable to tumor necrosis factor α.
Development and Validation of the Rapid Estimate of Adolescent Literacy in Medicine (REALM-Teen): A Tool to Screen Adolescents for Below-Grade Reading in Health Care Settings
Authors: Davis Terry C. , Wolf Michael S. , Arnold Connie L. , Byrd Robert S. , Long Sandra W. , Springer Thomas , Kennen Estela , Bocchini Joseph A.
Published: December 2006

OBJECTIVE. The magnitude and consequences of low literacy in adolescent health and health care are unknown. The purpose of this study was to validate the Rapid Estimate of Adolescent Literacy in Medicine (REALM-Teen), a word-recognition test in English that can be used as a brief literacy-screening tool in health care settings.

PATIENTS AND METHODS. A total of 1533 adolescents aged 10 to 19 years attending 1 of 5 middle schools, 3 high schools, 1 pediatric clinic, or 2 summer programs in Louisiana and North Carolina participated in face-to-face interviews. Demographic information was solicited, and participants were administered a battery of reading tests, including the REALM-Teen, Wide Range Achievement Test–Revised (WRAT-3), and Slosson Oral Reading Test–Revised (SORT-R). Internal consistency for the REALM-Teen was determined using Cronbach’s α, and criterion validity was established through correlations with both the WRAT-R and SORT-R. Using reading below grade level (according to SORT-R scores) as an outcome, instrument accuracy and corresponding cutoff scores were calculated by plotting receiver operating characteristic curves and stratum-specific likelihood ratios.

RESULTS. Participants were 50% black and 53% female; 34% were enrolled in middle school and 66% in high school. The average time required to administer the REALM-Teen was 3 minutes. Internal consistency was excellent, as was test-retest reliability. The REALM-Teen is strongly correlated with both the WRAT-R and SORT-R. Five reading level categories were identified: 3rd grade and below, 4th to 5th grade, 6th to 7th grade, 8th to 9th grade, and 10th grade and above. Forty-six percent of participants were reading below grade level according to the SORT-R and 28% had repeated at least 1 grade.

CONCLUSION. The REALM-Teen is a brief, reliable instrument for assessing adolescent literacy skills and reading below grade level.
A Case-Control Study of the Epidemiology of SporadicSalmonellaInfection in Infants
Authors: Jones Timothy F. , Ingram L. Amanda , Fullerton Kathleen E. , Marcus Ruthanne , Anderson Bridget J. , McCarthy Patrick V. , Vugia Duc , Shiferaw Beletshachew , Haubert Nicole , Wedel Stephanie , Angulo Frederick J.
Published: December 2006

OBJECTIVE. Rates of Salmonella infection are highest in infants, but little is known about potential sources of infection in this high-risk population. We performed a case-control study to identify dietary and environmental risk factors for sporadic salmonellosis among infants.

PATIENTS AND METHODS. In 2002–2004, the Foodborne Diseases Active Surveillance Network conducted a population-based, case-control study of sporadic salmonellosis among infants <1 year of age in 8 states. Cases were identified via active laboratory-based surveillance. Healthy controls were frequency matched by age and identified through birth registries or published birth announcements. We assessed diet and environmental exposures in the 5 days before illness onset or interview. Data were analyzed by using logistic regression adjusting for age.

RESULTS. The study enrolled 442 subjects and 928 controls. Compared with healthy controls, infants with Salmonella infection were less likely to have been breastfed and more likely to have had exposure to reptiles, to have ridden in a shopping cart next to meat or poultry, or to have consumed concentrated liquid infant formula during the 5-day exposure period. Travel outside the United States was associated with illness in infants 3 to 6 and >6 months of age. Attending day care with a child with diarrhea was associated with salmonellosis in infants >6 months of age.

CONCLUSIONS. We identified a number of modifiable protective and risk factors for salmonellosis in infants. Attention should be directed at developing effective preventive measures for this high-risk population.
Risk Factors for Progression to Invasive Fungal Infection in Preterm Neonates With Fungal Colonization
Authors: Manzoni Paolo , Farina Daniele , Leonessa MariaLisa , d'Oulx Elisa Antonielli , Galletto Paolo , Mostert Michael , Miniero Roberto , Gomirato Giovanna
Published: December 2006

OBJECTIVE. Colonization by Candida spp is a major risk factor for development of fungal sepsis, but little is known about the variables associated with progression to invasive disease in already colonized neonates. We investigated such variables in a large number of colonized preterm neonates in an NICU.

SETTING. This study was conducted in the Department of Neonatology and the NICU at Sant'Anna Hospital in Torino, Italy.

DESIGN AND PATIENTS A database search of clinical charts and weekly surveillance cultures was used to identify all neonates with birth weights <1500 g (very low birth weight) who were admitted to our NICU during 1998–2005 and were colonized (≥1 site) by Candida spp during their stay, as well as infants with invasive fungal infection. The association between a number of factors with progression to invasive fungal infection was evaluated. Those shown to be significantly associated by univariate analysis were cross-checked by logistic regression.

RESULTS. Colonization occurred in 201 infants (32.1% of very low birth weight admitted neonates), and invasive fungal infection occurred in 51 (8.1%) of them, with an overall progression rate of 0.25. At univariate analysis, 10 factors (namely low birth weight, low gestational age, use of third-generation cephalosporins, endotracheal intubation, duration of stay in the NICU, bacterial sepsis, colonization of central venous catheter, of endotracheal tube, of gastric aspirate, or in ≥3 [multiple] sites) were associated with an increased risk of progression, whereas prophylaxis with fluconazole was associated to a decreased risk. After logistic regression, only colonization of central venous catheter and colonization in multiple sites remained significantly associated with invasive fungal infection. Fluconazole prophylaxis remained an independent protective factor.

CONCLUSIONS. Central venous catheter colonization and multiple-site colonization are independent risk factors and predictors of progression to fungal sepsis in preterm very low birth weight neonates colonized by Candida spp during their stay in the NICU. Fluconazole prophylaxis is an independent protective factor. These findings can be used to improve the surveillance, prophylaxis, or preemptive measures in neonates at high risk.
Survival Rates and Mode of Delivery for Vertex Preterm Neonates According to Small- or Appropriate-for-Gestational-Age Status
Authors: Lee Henry Chong , Gould Jeffrey B.
Published: December 2006

OBJECTIVE. The goal was to characterize the relationship between cesarean section delivery and death for preterm vertex neonates according to intrauterine growth.

METHODS. Maternal and infant data from the National Center for Health Statistics for 1999 and 2000 were analyzed. Neonates with gestational ages of 26 to 36 weeks were characterized as small for gestational age (<10th percentile) or appropriate for gestational age (10th to 90th percentile). Mortality rates at 28 days and relative risks were calculated for each gestational age group according to mode of delivery.

RESULTS. Cesarean section rates were higher for small-for-gestational-age neonates compared with appropriate-for-gestational-age neonates, most prominently from 26 weeks to 32 weeks of gestation, at which small-for-gestational-age neonates had cesarean section rates of 50% to 67%, whereas appropriate-for-gestational-age neonates had rates of 22% to 38%. Small-for-gestational-age neonates at gestational ages of <31 weeks had increased survival rates associated with cesarean section, whereas small-for-gestational-age neonates at >33 weeks and appropriate-for-gestational-age neonates overall had decreased survival rates associated with cesarean section. After adjustment for sociodemographic and medical factors, the survival advantage for small-for-gestational-age neonates at gestational ages of 26 to 30 weeks persisted.

CONCLUSIONS. Cesarean section delivery was associated with survival for preterm small-for-gestational-age neonates but not preterm appropriate-for-gestational-age neonates. We speculate that vaginal delivery may be particularly stressful for small-for-gestational-age neonates. We found no evidence that prematurity alone is a valid indication for cesarean section for preterm appropriate-for-gestational-age neonates.
Clinical Deterioration Among Patients With Fever and Erythroderma
Authors: Byer Robyn L. , Bachur Richard G.
Published: December 2006

BACKGROUND. Some children who present with fever and erythroderma have rapid clinical deterioration or progress to toxic shock syndrome. Our primary objective was to determine whether specific clinical features of those who present with fever and erythroderma can predict who will develop hypotension or progress to toxic shock syndrome. Our secondary objective was to describe the clinical presentation, course, and outcome of children with fever and erythroderma.

METHODS. We conducted a medical chart review of children ≤19 years of age with fever and erythroderma who presented to an urban pediatric emergency department over 60 months. Historical, clinical, and laboratory data were abstracted from the medical chart.

RESULTS. Fifty-six patients with fever and erythroderma were studied. Eighteen percent of patients presented with hypotension. Thirty-three percent of the remaining patients who were normotensive on arrival developed shock. Fifty-two percent of patients with hypotension required vasopressor support. The most important predictors of developing hypotension after presentation were: age ≥3 years, ill appearance, vomiting, glucose ≥110 mg/dL, calcium ≤8.6 mg/dL, platelets ≤300000/μL, elevated creatinine, polymorphonuclear leukocytes ≥80%, and presence of a focal infection. Among all patients studied, 4 variables were determined to be the most important predictors of developing toxic shock syndrome: age ≥3 years, ill appearance, elevated creatinine, and hypotension on arrival.

CONCLUSIONS. Overall, 45% of patients with fever and erythroderma developed shock, including 33% of those who were normotensive on presentation. Older age, presence of vomiting, identification of a focal bacterial source, as well as specific laboratory parameters can be used to help predict which patients are likely to have hemodynamic deterioration. Given the high rate of clinical decompensation, all of the patients with fever and erythroderma should be hospitalized, closely monitored, and managed aggressively.
Risk Profiles for Metabolic Syndrome in a Nonclinical Sample of Adolescent Girls
Authors: Ventura Alison K. , Loken Eric , Birch Leann L.
Published: December 2006

OBJECTIVES. The purpose of this work was to describe risk profiles for metabolic syndrome during adolescence and identify the childhood antecedents for these profiles among a nonclinical sample of non-Hispanic, white girls.

METHODS. Participants were part of a longitudinal study (n = 154) and were assessed at 5, 7, 9, 11, and 13 years of age. At 13 years, girls were grouped based on values for the 6 metabolic syndrome factors (blood pressure, high-density lipoprotein, triglycerides, waist circumference, and blood glucose) using a mixture model approach. Fat mass was measured by dual-energy radiograph absorptiometry. Dietary intake was assessed by a 24-hour recall. Mothers reported family demographics and disease history. Girls' physical activity, sedentary behaviors, and fitness levels were also assessed.

RESULTS. Statistical support was strongest for a 4-group solution: (1) lower metabolic syndrome risk (n = 62), (2) lower dyslipidemia risk (n = 36), (3) lower hypertension risk (n = 33), and (4) higher metabolic syndrome risk (n = 21). At 13 years, the hypertension and higher metabolic syndrome risk groups had significantly higher weight status and percentage of body fat compared with the lower metabolic syndrome and dyslipidemia risk groups. In addition, the higher metabolic syndrome and hypertension risk groups had greater increases in both BMI and fat mass across childhood. The hypertension and higher metabolic syndrome risk groups had significantly more family history of type 2 diabetes and obesity. The higher metabolic syndrome risk group consumed significantly more servings of sweetened beverages during childhood. The dyslipidemia risk group had the lowest physical activity participation during childhood, and the lower metabolic syndrome risk group had the highest fitness levels at age 13 years.

CONCLUSIONS.A risk typology consisting of 4 groups was identified based on the components of metabolic syndrome. Findings on the antecedents of this risk typology suggest ways to identify those at higher risk for chronic disease and point to potential opportunities for intervention during childhood to prevent the development of metabolic syndrome.