bluuebunny/crossref_metadata_2025 huggingface dataset:
Charges for Childhood Asthma by Hospital Characteristics
Authors: Meurer John R. , Kuhn Evelyn M. , George Varghese , Yauck Jennifer S. , Layde Peter M.
Published: August 2004

Background.

The ownership, location, and teaching status of hospitals affect their missions, policies, finances, and operations.

Objective.

This study assesses the relationship of hospital ownership, location, and teaching status with charges and length of stay for children with asthma, the most common reason for pediatric admission after birth.

Methods.

All 28 545 complete records of patients ≤18 years of age with the principal diagnosis asthma in 1994 were extracted from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, providing a stratified sample of 735 nonfederal, acute-care hospitals in 17 states. Multiple regression analysis on log transformed data was used to calculate mean total charges and average length of stay (ALOS) after adjusting for illness severity and mortality risk (four All Patient Refined–Diagnosis Related Group classes based on secondary diagnoses and procedures); payer (Medicaid, private, uninsured, other); patient age, sex, income (four categories based on ZIP code of residence); state; bed size (three categories varying by location); hospital ownership; location; teaching status; and admission month.

Results.

Asthma severity did not differ significantly by hospital location or teaching status. Nonprofit hospitals treated a slightly higher proportion of children with major or extreme severity asthma than either public or for-profit hospitals. Urban teaching hospitals treated more children with asthma who lived in low-income neighborhoods, were uninsured, or received Medicaid coverage than urban nonteaching hospitals. For-profit hospitals admitted fewer children with asthma from low-income areas than did public hospitals. The ALOS was 2.5 days and did not differ significantly by hospital ownership, location, or teaching status. However, the mean total charges, after adjusting for all other significant covariates, was higher at for-profit ($4203) than at nonprofit ($3640) or public hospitals ($3620). Average charges also were higher at urban teaching ($4230) and lower at rural institutions ($2910) compared with urban nonteaching hospitals ($3424).

Conclusions.

Despite similar ALOS, mean charges for childhood asthma varied significantly by hospital ownership, location, and teaching status.

Implications.

Additional clinical and outpatient data are needed to study variations in quality of care by hospital characteristics. With the proliferation of investor-owned hospitals, both the reasons for and the impact of higher average charges at for-profit institutions require additional investigation. With the expanding needs of the medically underserved, socially just policies are required for financing hospitals that care for a disproportionate share of economically disadvantaged children.
Measles Outbreak in Juneau, Alaska, 1996: Implications for Future Outbreak Control Strategies
Authors: Landen Michael G. , Beller Michael , Funk Elizabeth , Rolka Henry R. , Middaugh John
Published: August 2004

Objective.

To determine the most effective outbreak control strategy for school-based measles outbreaks as the proportion of children with two doses of measles-containing vaccine (MCV) increases.

Setting.

A school-based measles outbreak during 1996 involving 63 cases in Juneau, Alaska (population 29 288), where systematic revaccination with MCV was not implemented.

Design.

A retrospective evaluation using chain-of-transmission data of three possible outbreak control strategies: no school revaccination, targeted school revaccination (affected schools only), and community-wide school revaccination (all schools). Two-dose MCV coverage among students was estimated from school vaccination records and a survey issued to parents.

Primary Outcome Measures.

Potentially preventable cases of measles and doses of MCV administered per case prevented.

Results.

Two-dose MCV coverage among Juneau students was estimated to be 44% and 53% immediately before and after the outbreak, respectively. Of all the measles cases, an estimated 24 to 28 and 27 to 31 were potentially preventable by the targeted and community-wide school revaccination strategies, respectively. Either strategy might have optimally decreased the outbreak duration by 1 month, sparing one of seven affected schools and 10 of 12 unvaccinated children who had measles. Approximately 133 to 155 and 139 to 160 doses of MCV per case prevented would have been required for targeted and community-wide school revaccination, respectively.

Conclusions.

Either targeted or community-wide school revaccination would have been effective control strategies for this outbreak. Targeted school revaccination is probably the intervention of choice for school-based measles outbreaks in larger communities with higher two-dose MCV coverage. As two-dose MCV coverage continues to increase in the United States, public health control measures to respond to outbreaks need to be reevaluated.
Disclosure of Illness Status to Children and Adolescents With HIV Infection
Authors:   Committee on Pediatric AIDS
Published: August 2004

This Policy Statement was retired December 2015.

Many children with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome are surviving to middle childhood and adolescence. Studies suggest that children who know their HIV status have higher self-esteem than children who are unaware of their status. Parents who have disclosed the status to their children experience less depression than those who do not. This statement addresses our current knowledge and recommendations for disclosure of HIV infection status to children and adolescents.
Poliomyelitis Prevention: Revised Recommendations for Use of Inactivated and Live Oral Poliovirus Vaccines
Authors:   Committee on Infectious Diseases
Published: August 2004

Since 1997 when the American Academy of Pediatrics (AAP) issued revised guidelines for the prevention of poliomyelitis, substantial progress in global eradication of poliomyelitis has occurred and the use of inactivated poliovirus vaccine (IPV) has increased considerably in the United States with a corresponding decrease in the use of oral poliovirus vaccine (OPV). Surveys indicate that the majority of physicians now routinely immunize children with the sequential IPV-OPV or IPV-only regimens. Nevertheless, vaccine-associated paralytic poliomyelitis (VAPP) continues to occur, albeit infrequently, in children who have received the OPV-only regimen and their contacts. To reduce further the risk of VAPP, the AAP now recommends that children in the United States receive IPV for the first 2 doses of the polio vaccine series in most circumstances. Exceptions include a parent's refusal to permit the number of injections necessary to administer the other routinely recommended vaccines at the 2- and 4-month visits. Either IPV or OPV can be administered for the third and fourth doses. Assuming continuing progress toward global eradication, a recommendation of IPV-only immunization for children in the United States is anticipated by 2001.
Fruit Juice Intake Is Not Related to Children's Growth
Authors: Skinner Jean D. , Carruth Betty Ruth , Moran James , Houck Kelly , Coletta Frances
Published: August 2004

Background.

Excessive fruit juice intake (>12 ounces/day) has been reported to be associated with short stature and obesity in preschool children.

Objective.

To confirm whether excess fruit juice intake was associated with short stature and obesity in preschool children, we assessed growth parameters and fruit juice intake in 105 white children, ages 24 to 36 months.

Methodology.

Mothers were interviewed twice by a registered dietitian when children were age 24, 28, or 32 months (interview 1) and when children were age 28, 32, or 36 months (interview 2); interviews were assigned randomly. At each interview mothers provided 3 days of dietary data (one 24-hour recall and a 2-day food record) and the registered dietitian weighed the child and measured his/her height. Dietary data were analyzed using Nutritionist IV software. Each child's body mass index (wt/ht2) and ponderal index (wt/ht3) were calculated for each interview. Growth parameters of children consuming <12 ounces/day 100% fruit juice were compared with those consuming ≥12 ounces/day using the Student's t test, χ2, Fisher's exact test, and mixed model repeated measures analyses (PROC MIXED).

Results.

Results consistently indicated no statistically significant differences in children's height, body mass index, or ponderal index related to fruit juice intake. Intakes of soda pop were negatively related to intakes of milk and fruit juice although intakes of milk and fruit juice were not related.

Conclusions.

The consistent lack of relationship between children's fruit juice intake and growth parameters in our study does not support previous recommendations to limit the intake of 100% fruit juice to <12 ounces/day.
Osmoregulation and Desmopressin Pharmacokinetics in Enuretic Children
Authors: Nevéus Tryggve , Läckgren Göran , Tuvemo Torsten , Stenberg Arne
Published: August 2004

Objective.

The aim was to compare responders and nonresponders to antienuretic treatment with desmopressin with respect to pharmacokinetics and renal effects of the drug.

Methods.

Twelve children, aged 7.6 to 16.2 years, with nocturnal enuresis were examined. Six patients were nonresponders and 6 were responders to desmopressin treatment. The children were given 2 mg of desmopressin intravenously and plasma concentrations of the drug were monitored overnight. Urine parameters were followed for 24 hours after desmopressin administration. Ten patients also underwent a thirst provocation test.

Results.

Desmopressin pharmacokinetics did not differ between the groups. Neither nocturnal urine production nor morning urine osmolality after desmopressin injection differed between responders and nonresponders, whereas the responders produced significantly larger amounts of significantly less concentrated urine during the day after the injection compared with the nonresponders (urine production, 2.02 ± 0.84 and 0.77 ± 0.20 mL/kg/h; urine osmolality, 558 ± 271 and 883 ± 134 mOsm/kg). Nonresponders voided with smaller bladder volumes (2.43 ± 0.68 mL/kg body weight) than responders (4.70 ± 1.21 mL/kg). The responders produced significantly less concentrated urine than the nonresponders during the thirst provocation test (607 ± 185 and 922 ± 217 mOsm/kg, respectively).

Conclusion.

Intravenous desmopressin pharmacokinetics and desmopressin renal effects did not differ between responders and nonresponders to desmopressin treatment. Nonresponders had a smaller spontaneous bladder capacity and responders produced less concentrated urine.
Social, Emotional, and Behavioral Functioning of Children With Cancer
Authors: Noll Robert B. , Gartstein Maria A. , Vannatta Kathryn , Correll Judy , Bukowski William M. , Davies W. Hobart
Published: August 2004

Objective.

It was hypothesized that children with cancer would have more social problems and difficulties with emotional well-being than case control, same race/gender, similarly aged classmates.

Study Design.

Using a case controlled design, children with any type of cancer requiring chemotherapy except brain tumors (n = 76), currently receiving chemotherapy, ages 8 to 15, were compared with case control classroom peers (n = 76). Peer relationships, emotional well-being, and behavior were evaluated based on peer, teacher, parent, and self-report, and were compared using analysis of variance and structural equation modeling.

Results.

Relative to case controls, children with cancer were perceived by teachers as being more sociable; by teachers and peers as being less aggressive; and by peers as having greater social acceptance. Measures of depression, anxiety, loneliness, and self-concept showed no significant differences, except children with cancer reported significantly lower satisfaction with current athletic competence. There were also no significant differences in mother or father perceptions of behavioral problems, emotional well-being, or social functioning. Scores on all standardized measures were in the normal range for both groups. Comparisons of the correlation matrices of children with cancer and to the correlation matrix of the comparison children using structural equation modeling suggested they were not significantly different.

Conclusions.

Children with cancer currently receiving chemotherapy were remarkably similar to case controls on measures of emotional well-being and better on several dimensions of social functioning. These findings are not supportive of disability/stress models of childhood chronic illness and suggest considerable psychologic hardiness.
Intractable Diarrhea From Cytomegalovirus Enterocolitis in an Immunocompetent Infant
Authors: Fox LeAnne M. , Gerber Michael A. , Penix Laurie , Ricci Andrew , Hyams Jeffrey S.
Published: August 2004

Infection with cytomegalovirus (CMV) in infants can be congenital or perinatal. Infected infants may be asymptomatic or present with pneumonia, rash, hepatosplenomegaly, or encephalitis.1 In the presence of an immunodeficiency, severe and sometimes fatal disease may occur. To our knowledge, CMV has not been identified previously as a cause of intractable diarrhea of infancy. We report the case of a 5-week-old immunocompetent infant with intractable diarrhea attributable to CMV-induced enterocolitis. Recognition of this infection and initiation of ganciclovir therapy was associated with a rapid improvement and resolution of the diarrhea.
Trends in Diarrhea-associated Hospitalizations Among American Indian and Alaska Native Children, 1980–1995
Authors: Holman Robert C. , Parashar Umesh D. , Clarke Matthew J. , Kaufman Stephen F. , Glass Roger I.
Published: August 2004

Objective. 

To describe trends in diarrhea- associated hospitalizations among American Indian and Alaska Native (AI/AN) children and to estimate the morbidity from rotavirus.

Design. 

Retrospective analysis of Indian Health Service hospital discharge records.

Patients. 

AI/AN children 1 month through 4 years of age with a diarrhea-associated diagnosis listed on the hospital discharge record.

Setting. 

Hospitals on or near US Indian reservations from 1980 through 1995.

Results. 

During 1980 through 1995, 21 669 diarrhea-associated hospitalizations were reported among AI/AN children. The annual incidence of diarrhea-associated hospitalizations declined by 76% from 276 per 10 000 in 1980 to 65 per 10 000 in 1995. The median length of hospital stay decreased from 4 days during 1980–1982 to 2 days during 1993–1995. Diarrhea-associated hospitalizations peaked during the winter months (October through March), especially among children 4–35 months of age, with the peaks appearing first in the Southwest during October and moving to the East in March. In the early years of the study (1980–1982), the rate of diarrhea-associated hospitalizations among AI/AN children (236 per 10 000) was greater than the national rate (136 per 10 000). By the end of the study period (1993–1995), the rate for AI/AN children (71 per 10 000) was similar to the national rate (89 per 10 000), although the rate for AI/AN infants remained higher than the national rate for infants.

Conclusions. 

Diarrhea-associated hospitalization rates for AI/AN children have declined to a level similar to that of the national population. Rotavirus may be an important contributor to diarrheal morbidity among AI/AN children, underscoring the need for vaccines against this pathogen.
Transalar Sphenoidal Encephalocele and Respiratory Distress in a Neonate: A Case Report
Authors: Mylanus Emmanuel A.M. , Marres Henry A.M. , Vlietman José , Kollée Louis A.A. , Freihofer Hans Peter M. , Thijssen Henk O.M. , de Vries Joost , Wesseling Pieter
Published: August 2004

We present a full-term newborn infant who suffered from immediate postpartum severe respiratory distress. The infant had an inspiratory stridor as a result of a swelling of the soft palate, extending from the roof of the nasopharynx. Transoral endotracheal intubation resulted in normal saturation levels. Histologic examination after an open biopsy showed mature neuroglial tissue. Radiology demonstrated the presence of a right parapharyngeal process obstructing the nasopharynx and oropharynx and extending to the right middle and posterior fossa, via the foramen ovale. After transoral debulking, the infant was extubated successfully. After an uneventful period of 5 months, the patient was readmitted at our hospital for treatment of meningitis. Subsequently, the inspiratory stridor recurred, and staged surgery was performed. First, a transcranial approach was used to remove a large intradural part of the process and close the defect at Meckel's cave. Two weeks later the retro- and parapharyngeal part of the process were removed transorally. Given the site of the defect of the skull base and the intradural location of the process, the diagnosis is a transalar sphenoidal encephalocele. This is a rare type of basal encephalocele, and has never been reported in an infant nor known to present with respiratory distress. The pathogenesis, clinical presentation, pathology, and therapeutic implications of basal encephaloceles are discussed.
Long-term Remission for Disseminated Mycobacterium avium-intracellulare Complex Associated With Antibody Deficiency
Authors: Grouhi Masoud , Wang Elaine , Reid Brenda , Roifman Chaim M.
Published: August 2004

Mycobacterium avium-intracellulare

(MAI) is a ubiquitous organism with limited virulence in the immunocompetent host. Disseminated disease is associated with a high mortality rate. Except for localized cervical adenitis, MAI disease is rare in immunocompetent children. We report a child with antibody deficiency (dysgammaglobulinemia) and disseminated MAI infection, in whom complete, long-term remission was attained with multiple antimycobacterial therapy.

The patient presented with progressive cervical lymphadenopathy and hepatomegaly at 7 years of age. A lymph node biopsy showed acid-fast bacilli and granulomas. Despite a transient response to conventional antituberculous therapy, including isoniazid and rifampin, his symptoms progressed. Cultures from blood, bone marrow, spleen, and cervical lymph node tissues revealed an MAI organism. Subsequent treatment using a combination of clarithromycin, amikacin, and ethambutol for 16 months resolved clinical symptoms, and subsequent blood culture results became negative. By the time of this report, the patient has been disease-free for 4 years.

Multiple-drug therapy is promising for the treatment of MAI in children with antibody deficiency; however, the selection of antiinfective drugs should include a member of the newer macrolide family. acquired immunodeficiency syndrome, clarithromycin, dysgammaglobulinemia, Mycobacterium avium-intracellulare, treatment.
Epidemic of Gastrointestinal Tract Infection Including Hemorrhagic Colitis Attributable to Shiga Toxin 1-producingEscherichia coli O118:H2 at a Junior High School in Japan
Authors: Hashimoto Hiroyuki , Mizukoshi Kumiko , Nishi Masami , Kawakita Tadashi , Hasui Seiryo , Kato Yasuhiro , Ueno Yoshiki , Takeya Ryohei , Okuda Norihiko , Takeda Tae
Published: August 2004

Background. 

An epidemic of gastrointestinal disturbances related to food ingestion occurred at a junior high school in Komatsu, Japan, and was caused by specifically Shiga toxin (Stx) 1-producing Escherichia coli O118:H2, which has not been reported previously in humans. No outbreak ofE coli-producing Stx 1 alone had occurred.

Methods. 

A total of 526 students and 35 adult staff members who ate the same food at lunch in the school were investigated. Questionnaires about food consumption at lunch were given to all 561 subjects as well as to clinics and hospitals that had treated 79 patients. Stool specimens from 525 subjects, and food, water, and environmental specimens, including cooking utensils, were collected in an attempt to identify the pathogen.

Results. 

A total of 126 subjects (22.5%) developed a diarrheal illness. The pathogen was isolated from the stool in 131 subjects, 49 of which were asymptomatic, and from a dipper. Salads served over several days were identified as high-risk from food analysis. Gastrointestinal symptoms resembled those associated with previous infections of Stx-producing E coli, but were mild. No cases of the hemolytic–uremic syndrome developed. Headache was present in 87 patients. Three patients underwent surgery for acute appendicitis during this epidemic. Four of five carriers had received an antibiotic effective against the pathogen.

Conclusions. 

This outbreak of E coliO118:H2 demonstrated the clinical and epidemiologic features of infection by E coli that produces Stx 1 alone. Infections with such organisms are being recognized increasingly, and the pattern of disease observed may differ from the pattern observed with E coli O157:H7.
Preschoolers With Syphilis
Authors: Christian Cindy W. , Lavelle Jane , Bell Louis M.
Published: August 2004

Syphilis in preschoolers is rarely described in current medical literature, despite the rise in syphilis in both the adult and the pediatric populations during the past decade. Since that time, 3 children between 3 and 4 years of age have been diagnosed with syphilis at the Children's Hospital of Philadelphia. The presentations and clinical manifestations of syphilis in these 3 children are described, and the difficulty in identifying the source of infection is discussed. The presentations of these children included nephrosis and secondary syphilis, the corymbiform and palmar rash of syphilis, and subtle signs of late congenital infection in an otherwise asymptomatic child. One child had documented congenital infection, 1 had probable congenital infection that went untreated, and 1 did not have appropriate neonatal testing documented. None of the children gave a verbal history of sexual abuse, although it is likely that all three cases resulted from sexual abuse. The evaluation of preschool children with syphilis is confounded by the interpretation of acquired infection in consideration of a history of possible or documented congenital disease. The assessment is complicated further by problems with recognition of clinical disease, the inability of young children to provide a history, prenatal and neonatal testing methods used, changes in treatment recommendations made during the past decade, and inadequate follow-up to document cure of congenitally infected infants. With the increase in syphilis seen in recent years, physicians are more likely to encounter preschoolers with syphilis. Our ability to document acquired infection, however, is hampered by the difficulties encountered in following recommended guidelines for evaluation and follow-up and by limitations in interviewing young victims of sexual abuse, which may impair our ability to protect children from additional harm. Understanding the pathophysiology and progression of this disease remains challenging even in this modern era.
Prevalence, Patterns, and Correlates of Voluntary Flunitrazepam Use
Authors: Rickert Vaughn I. , Wiemann Constance M. , Berenson Abbey B.
Published: August 2004

Objective. 

To determine prevalence, patterns, and correlates of voluntary flunitrazepam use in a sample of sexually active adolescent and young adult women 14 to 26 years of age.

Design. 

Cross-sectional survey.

Setting. 

University-based ambulatory reproductive health clinics.

Patients or Other Participants. 

There were 904 women self-identified as white, African-American, or Mexican-American.

Interventions. 

None.

Main Outcome Measure. 

Lifetime, frequency, patterns, and physical effects of flunitrazepam use.

Results. 

Lifetime use was reported by 5.9% (n = 53) of subjects, with frequency of use ranging from 1 to 40 times. Flunitrazepam was taken most often with alcohol (74%), and 49% took this substance with other illicit drugs. Logistic regression analyses controlling for age and race/ethnicity found that users were significantly more likely than were nonusers to report lifetime use of marijuana (odds ratio [OR] = 3.6) or LSD (OR = 5.2), having a peer or partner who used flunitrazepam (OR = 21.7), pressure to use flunitrazepam when out with friends (OR = 2.7), and a mother who had at least a high school education (OR = 2.6). Finally, 10% of voluntary users reported experiencing subsequent physical or sexual victimization.

Conclusions. 

Voluntary use of flunitrazepam is becoming a health concern to sexually active young women who reside in the southwestern United States. Young women who have used LSD or marijuana in the past or who have a peer or partner who used this drug appear to be at the greatest risk.
How Does Home Management of Asthma Exacerbations by Parents of Inner-city Children Differ From NHLBI Guideline Recommendations?
Authors: Warman Karen L. , Silver Ellen Johnson , McCourt Mary P. , Stein Ruth E. K.
Published: August 2004

Objectives.

1) To describe the asthma morbidity, primary care practices, and asthma home management of inner-city children with asthma; 2) to determine the responses of parental caretakers to asthma exacerbations in their child; and 3) to compare these responses to the recommendations of the National Heart, Lung, and Blood Institute (NHLBI) asthma guidelines for home management of acute exacerbations of asthma.

Design and Methods.

A 64-item telephone survey was administered between July 1996 and June 1997 to 220 parental caretakers of 2- to 12-year-old children who had been hospitalized with asthma at an inner-city medical center from January, 1995 to February, 1996. Sociodemographics, primary care practices, asthma morbidity, and asthma home management were assessed. Parents were asked what they would do if their child “began wheezing and breathing faster than usual.”

Results.

Morbidity measures indicated that there were an average of 2.5 ± 4.5 emergency department visits for asthma in the last 6 months, 1.6 ± 2.2 hospitalizations for asthma in the last 12 months, and 18.1 ± 17.9 asthma-related school absences in the previous school year. Most, but not all, of the families had primary care providers and most had phone access to them. Half of the families (51%) reported having been given a written asthma action plan. Only 30% of families with children age 5 years and older had peak flow meters. In contrast, almost all families (97%) had equipment for inhalation of β-agonists. Only 39% of the 181 children with persistent symptoms were receiving daily antiinflammatory agents as recommended in the guidelines of the NHLBI. In response to the scenario of an acute exacerbation of asthma, no one mentioned that they would refer to a written plan, only 1 caretaker would measure peak flow and 36% would give β-agonists. Two percent would give oral steroids initially, and 1 additional person would do so if wheezing continued 40 minutes later. Only 4% responded that they would contact their clinician. Reports of actual practice differed from the scenario responses in that more people began β-agonists and oral steroids in response to an exacerbation in the past 6 months than said they would in response to the scenario.

Conclusion.

In this population of previously hospitalized inner-city children with asthma, the NHLBI guidelines for the home management of asthma exacerbations are not being followed. Interventions are needed to affect both clinician and caretaker practices.
Clinical Use of Continuous Arterial Blood Gas Monitoring in the Pediatric Intensive Care Unit
Authors: Weiss Irwin K. , Fink Stan , Harrison Rick , Feldman Jonathan D. , Brill Judith E.
Published: August 2004

Context.

Continuous arterial blood gas monitoring is a new technology based on the combination of opto-chemical and fiber-optic detectors that can measure pH, Pco2, Po2, and temperature on a continuous basis via a sensor placed in an artery.

Objective.

To evaluate this technology in pediatric patients who would normally require frequent arterial blood gas sampling.

Design.

A criterion standard study in which the results of arterial blood gas samples measured by the laboratory analyzer were compared with the sensor readings.

Setting.

A pediatric intensive care unit of a tertiary referral center.

Patients.

Children with severe respiratory failure who required frequent arterial blood gas sampling and who had a 20-gauge arterial line in either a radial or femoral site.

Results.

Twenty-four patients with a mean age of 6.4 years (range 1–21 years) had a sensor placed. Sensors were in place for a mean of 101 ± 62 hours. Eighteen patients underwent continuous monitoring for at least 24 hours or until no longer clinically necessary. There were 414 pairs of blood gas samples obtained. The bias/precision for pH was 0.005/0.030; for Pco2, −1.8/6.3 mm Hg; and for Po2, 1.2/24 mm Hg. The correlation (r value) between the sensor readings and the blood gases were pH 0. 960, Pco2 0.927, Po2 0.813 (P < .01 for all values). The bias and precision for Po2levels < 70 mm Hg were 0.057/9.34 mm Hg. There were no complications from sensor placement. Continuous blood gas monitoring allowed immediate recognition of clinical changes.

Conclusion.

The continuous arterial blood gas sensor is capable of clinically accurate blood gas measurements. This technology provides the clinician with immediate data that can allow rapid interventions in unstable patients.
Planning for Children Whose Parents Are Dying of HIV/AIDS
Authors:   Committee on Pediatric AIDS
Published: August 2004

This Policy Statement was retired January 2012.

Although the character of acquired immunodeficiency syndrome is changing into a chronic illness, it is estimated that by the end of this century, 80 000 children and adolescents in the United States will be orphaned by parental death caused by human immunodeficiency virus infection. Plans for these children need to be made to ensure not only a stable, consistent environment that provides love and nurturing, but also the medical and social interventions necessary to cope with the tragic loss. Pediatricians should become aware of local laws and community resources and initiate discussion early in the course of parental illness to facilitate planning for the future care and custody of the children. States need to adopt laws and regulations that provide flexible approaches to guardianship and placement of children orphaned by acquired immunodeficiency syndrome.
Adolescent Pregnancy—Current Trends and Issues: 1998
Authors:   Committee on Adolescence
Published: August 2004

Although the prevention of unintended adolescent pregnancy is a primary goal of the American Academy of Pediatrics and society, many adolescents continue to become pregnant. Since the last statement on adolescent pregnancy was issued by the Academy in 1989, new observations have been recorded in the literature. The purpose of this new statement is to review current trends and issues on adolescent pregnancy to update practitioners on this topic.
The Hospital Record of the Injured Child and the Need for External Cause-of-Injury Codes
Authors:   Committee on Injury and Poison Prevention
Published: August 2004

Proper record-keeping of emergency department visits and hospitalizations of injured children is vital for appropriate patient management. Determination and documentation of the circumstances surrounding the injury event are essential. This information not only is the basis for preventive counseling, but also provides clues about how similar injuries in other youth can be avoided. The hospital records have an important secondary purpose; namely, if sufficient information about the cause and mechanism of injury is documented, it can be subsequently coded, electronically compiled, and retrieved later to provide an epidemiologic profile of the injury, the first step in prevention at the population level. To be of greatest use, hospital records should indicate the “who, what, when, where, why, and how” of the injury occurrence and whether protective equipment (eg, a seat belt) was used. The pediatrician has two important roles in this area: to document fully the injury event and to advocate the use of standardized external cause-of-injury codes, which allow such data to be compiled and analyzed.
Recombinant Human Erythropoietin Treatment for Chemotherapy-related Anemia in Children
Authors: Varan Ali , Büyükpamukçu Münevver , Kutluk Tezer , Akyüz Canan
Published: August 2004

Objective. 

The efficacy and safety of recombinant human erythropoietin (rHuEPO) treatment in chemotherapy-induced anemia in children were investigated. rHuEPO is used to treat chemotherapy-induced anemia. Several studies recommend 150 to 300 IU/kg rHuEPO for 2 to 8 months. There are only a few controlled trials in children and no precise data about the optimal dose and duration of rHuEPO treatment is available.

Patients and Methods. 

Thirty-four patients receiving chemotherapy for treatment of their solid tumors between October 1996 and June 1997 were included in this study. Patients were randomly selected for each group. The male/female ratio was 20/14, and the median age was 5 years (range, 1–16 years). They had normal hemoglobin levels at the time of diagnosis. When hemoglobin levels decreased to levels lower than 10 g/dL, rHuEPO (150 IU/kg/d, 3 times a week, subcutaneously) was given to 17 patients for 2 months. Their renal, liver, and pulmonary functions were normal. None of the patients had hematologic disease. We did not use any other drugs such as iron or granulocyte colony-stimulating factor. There were 17 patients in the control group. Fifteen patients got chemotherapy regimens including cisplatin (CDDP), but 19 were treated with regimens without CDDP. At the end of rHuEPO treatment, all patients were examined in terms of transfusion requirements and rate of change in hemoglobin levels.

Results. 

One patient in the study group needed a blood transfusion, whereas 8 patients needed a transfusion in the control group. Patients in the study group had less transfusion requirements compared with the control group. The mean hemoglobin levels before and after the study were 8.48 ± 0.98 g/dL and 8.41 ± 1.65 g/dL in the control group and 8.50 ± 0.85 g/dL and 10.21 ± 2.14 g/dL in the rHuEPO group, respectively. Optimal hemoglobin increments began in 4 weeks and continued during treatment. CDDP-receiving and CDDP-nonreceiving groups did not have any difference in pretreatment serum erythropoietin levels. rHuEPO treatment was more effective in patients treated with non-CDDP regimens. Mean hemoglobin level increased from 8.68 ± 0.73 g/dL to 10.26 ± 1.84 g/dL in 9 patients treated with non-CDDP chemotherapy regimens in the erythropoietin group, although it increased from 8.28 ± 0.97 g/dL to 10.15 ± 2.5 g/dL in 8 patients treated with CDDP-containing regimens in the erythropoietin group. rHuEPO caused high blood pressure in only 1 patient that resolved spontaneously after cessation of erythropoietin treatment for a week.

Conclusion. 

rHuEPO treatment (150 IU/kg/d 3 times a week) is effective and safe in children with chemotherapy-induced anemia. It decreases blood transfusion requirements in solid tumor patients. Our results show that the response to rHuEPO in CDDP-induced anemia is less than the response in non-CDDP receiving patients. Higher doses may be necessary in patients using CDDP.
Lipoid Pneumonia: A Silent Complication of Mineral Oil Aspiration
Authors: Bandla Hari P. R. , Davis Scott H. , Hopkins Nancy Eddy
Published: August 2004

Introduction. 

Chronic constipation is a common symptom in pediatrics, and physicians often use mineral oil to treat chronic constipation in children. Mineral oil, a hydrocarbon, may not elicit a normal protective cough reflex and may impair mucociliary transport. These effects can increase the likelihood of its aspiration and subsequent impaired clearance from the respiratory tract. We report a case of a child with neurodevelopmental delay with chronic constipation and a history of chronic mineral oil ingestion presenting as asymptomatic exogenous lipoid pneumonia (ELP).

Case History. 

A 6-year-old white boy with a history of developmental delay was found to have an infiltrate in his right upper lobe on a chest radiograph obtained during evaluation for thoracic scoliosis. The patient had a long history of constipation with daily use of mineral oil. He was fed by mouth and had occasional episodes of coughing and choking during feeding. He was asymptomatic at presentation and physical examination was unremarkable. The patient was advised to stop administration of the mineral oil and was treated empirically with antibiotics during a 3-month period. At follow-up examination the patient continued to be asymptomatic, with the radiologic persistence of the infiltrate. Diagnosis of lipoid pneumonia was made by diagnostic bronchoscopy with bronchoalveolar lavage (BAL). The exogenous origin of the lipid in the BAL fluid was confirmed by gas chromatography/mass spectrometry.

Discussion. 

The clinical presentation of ELP is nonspecific and ranges from the totally asymptomatic patient with incidental radiologic finding, like our patient, to the patient with acute or chronic symptoms attributable to pneumonia, pulmonary fibrosis, or cor pulmonale. Bronchoscopy with BAL can be successful in establishing the diagnosis of ELP by demonstration of a high lipid-laden macrophage index. Treatment of ELP in children is generally supportive, with the symptoms and roentgenographic abnormalities resolving within months after stopping the use of mineral oil.

Conclusion. 

Lipoid pneumonia as a result of mineral oil aspiration still occurs in the pediatric population. It can mimic other diseases because of its nonspecific clinical presentation and radiographic signs. In patients with swallowing dysfunction and pneumonia, a history of mineral oil use should be obtained and a diagnosis of ELP should be considered in the differential diagnoses if mineral oil use has occurred. Our case points to the need for increased awareness by the general pediatricians of the potential hazards of mineral oil use for chronic constipation.
Renal Medullary Carcinoma in an Adolescent With Sickle Cell Trait
Authors: Warren Katherine E. , Gidvani-Diaz Vinod , Duval-Arnould Bertrand
Published: August 2004

We describe the complex presentation of a patient with renal medullary carcinoma, a newly described entity primarily affecting young patients with sickle cell trait. Renal medullary carcinoma is an aggressive, rapidly destructive tumor associated with a delayed diagnosis and a poor outcome. The most common presenting signs and symptoms include hematuria, abdominal or flank pain, and weight loss. Sickle cell trait as the sole cause of hematuria in young black patients is a diagnosis of exclusion. Hemoglobin electrophoresis, intravenous pyelography, and computed tomography scans should be the minimal studies performed in young black patients with hematuria.
Indications for Surfactant Therapy—The aAPo2 Coming of Age
Authors: Hall Robert T.
Published: August 2004

Indications for administration of surfactant to infants with established respiratory distress syndrome (RDS; rescue therapy) remains an area of continued investigation. Current recommendations vary from use in infants who are intubated and have an aAPo2 <0.22 to use in infants receiving ≥40% oxygen administered in a hood when the Pao2 is <80 TORR (aAPo2 approximately <0.36).

This commentary is written in response to the article by Verder et al, in this issue of Pediatrics, who evaluated early versus late treatment of RDS in 60 preterm infants <30 weeks' gestation receiving nasal continuous positive airway pressure (CPAP). Early-treated infants (aAPo2, 0.22 to 0.35; mean, 0.26) had a lower incidence of mechanical ventilation or death (21%) than did late-treated infants (63%), who did not receive surfactant treatment until the aAPo2 was <0.22 (0.15 to 0.21; mean, 0.16). The authors conclude that although approximately half of infants <30 weeks' gestation with RDS can be treated with nasal CPAP alone, early treatment with surfactant when the aAPo2 is 0.22 to 0.36 reduced significantly the need for mechanical ventilation.

Limitations of applicability of the study to widespread use include determination of Po2 values from transcutaneous measurements, which may vary from those obtained from arterial samples and affect significantly aAPo2 ratios. Likewise, use of nasal CPAP significantly affects oxygenation, and interpretation of results cannot be extrapolated to intubated infants or those receiving oxygen delivered under a hood. Nonetheless, the use of the aAPo2 ratio and early administration of surfactant are supported by this study.
The Effect of Dust Lead Control on Blood Lead in Toddlers: A Randomized Trial
Authors: Rhoads George G. , Ettinger Adrienne S. , Weisel Clifford P. , Buckley Timothy J. , Goldman Karen Denard , Adgate John , Lioy Paul J.
Published: August 2004

Background. 

Contaminated household dust is believed to be a major source of exposure for most children with elevated blood lead levels. To determine if a vigorous dust clean-up effort would reduce this exposure we conducted a randomized controlled field trial.

Methods. 

We randomized 113 urban children between the ages of 6 and 36 months: 56 children to a lead dust intervention composed of maternal education and biweekly assistance with household cleaning and 57 children to a control group. Household cleaning was done by two trained lay workers who focused their efforts on wet mopping of floors, damp-sponging of walls and horizontal surfaces, and vacuuming with a high-efficiency particle accumulating vacuum. Household dust lead levels, child blood lead levels, and maternal knowledge of lead poisoning and sources of exposure were measured before and after the intervention.

Results. 

Ninety-nine children were successfully followed for 12 ± 3 months: 46 children in the lead group and 53 children in the control group. Age and blood lead were similar in the two groups at baseline and averaged 20 months and 12.0 μg/dL, respectively. Blood lead fell 17% in the intervention group and did not change among controls. Household dust and dust lead measures also fell significantly in the intervention group. Children in homes cleaned 20 or more times throughout the year had an average blood lead reduction of 34%.

Conclusions. 

Regular home cleaning, accompanied by maternal education, is a safe and partially effective intervention that should be recommended for the large majority of lead-exposed children for whom, unfortunately, removal to lead-safe housing is not an option.
Prevalence and Characteristics of Children With Serious Hearing Impairment in Metropolitan Atlanta, 1991–1993
Authors: Van Naarden Kim , Decouflé Pierre , Caldwell Kimberly
Published: August 2004

Objectives. 

There is a paucity of data describing the epidemiology of serious hearing impairment among children in the United States. This report provides information on the prevalence of serious hearing impairment among children born in the 1980s and living in the metropolitan Atlanta area in 1991–1993 and on the characteristics of children with serious hearing impairment.

Methods. 

Data for this report are drawn from the Metropolitan Atlanta Developmental Disabilities Surveillance Program, an ongoing, active case-ascertainment system for mental retardation, cerebral palsy, hearing impairment, and vision impairment among children 3 to 10 years of age. Hearing impairment was defined as a bilateral, pure-tone hearing loss at frequencies of 500, 1000, and 2000 Hz averaging 40 decibels or more, unaided, in the better ear. Both severity and type of hearing loss were examined. Cross-sectional as well as birth cohort prevalence rates of serious hearing impairment were computed by sex and by race. The presence of mental retardation, cerebral palsy, vision impairment, or a seizure disorder was also assessed. An attempt was made to determine the probable etiology of a subset of the cases.

Results. 

The average, annual prevalence rate for moderate to profound hearing loss was 1.1 per 1000. The prevalence rate increased steadily with age. Ninety percent of all cases for which the type of loss was recorded were sensorineural. The highest rate was seen among black male children (1.4 per 1000). Thirty percent of case children had another neurodevelopmental condition, most frequently mental retardation. Black male children also experienced the highest rate of presumed congenital hearing impairment. The mean age at which children with presumed congenital hearing impairment first met the surveillance case definition was 2.9 years. A probable etiology could only be found for 22% of cases born in the study area.

Conclusions. 

The data presented here provide information on the descriptive epidemiology of serious hearing impairment among United States children. The reasons for the higher rates among black children, especially males, may be a fruitful direction for further research.
Once- Versus Twice-daily Gentamicin Dosing in Neonates ≥34 Weeks' Gestation: Cost-effectiveness Analyses
Authors: Thureen Patti J. , Reiter Pamela D. , Gresores Adrian , Stolpman Nancy M. , Kawato Kerry , Hall Daniel M.
Published: August 2004

Objectives.

To compare performance and cost analysis of two gentamicin regimens in infants ≥34 weeks' gestation requiring antibiotics for a 72-hour rule-out sepsis evaluation. A once-daily dosing (ODD) regimen of 4 mg/kg was compared with a standard twice-daily dosing (TDD) regimen of 2.5 mg/kg every 12 hours.

Setting and Design.

Infants at two university-affiliated Level III nurseries were prospectively temporally allocated to receive ODD (n = 27) or TDD (n = 28) as part of their 72-hour empirical antibiotic regimen. Performance of dosing regimens was based on target serum gentamicin concentrations (SGC) established prospectively as a peak of 5 to 10 μg/mL and a trough of ≤2 μg/mL. SGC were determined by fluorescence polarization immunoassay on day 3 of therapy. Cost data were obtained by distributing a questionnaire to 15 pediatric pharmacy practice sites. Inquiries were made regarding hospital cost of drug acquisition, drug supplies, drug preparation and administration, and serum concentration analysis. Performance and cost data were then used to do a cost-effectiveness analysis.

Results.

Mean peak concentrations were higher with ODD (7.9 ± 0.2 μg/mL) than TDD (6.7 ± 0.3 μg/mL). Half of the patients in the TDD group had trough concentrations >2 μg/mL, compared with none in the ODD group. Overall, 57% of the SGCs in the TDD group were outside the target concentration range versus 7% in the ODD group. Based on questionnaire results, a total 72-hour process cost of ODD versus TDD was compared for regimens with and without use of SGC analysis. If SGCs are obtained, more than 75% of the cost associated with gentamicin therapy is attributable to SGC analysis. Based on a cost-effectiveness analysis, ODD was the dominant dosing strategy in all categories analyzed.

Conclusions.

ODD of gentamicin at 4 mg/kg in neonates ≥34 weeks' gestation is the preferable treatment strategy based on: 1) significantly improved SGC performance compared with TDD; 2) elimination of the need for routine SGC collection in infants on short courses of therapy; and 3) significant antibiotic-associated hospital cost savings when compared with conventional therapy of TDD and SGC analysis.