bluuebunny/crossref_metadata_2025_split huggingface dataset:
Simultaneous Administration of Haemophilus influenzae Type b Vaccine With Acellular or Whole-Cell Pertussis Vaccine: Effects on Reactogenicity and Immune Responses to Pertussis Vaccines
Authors: Rennels Margaret B. , Reed George F. , Decker Michael D. , Edwards Kathryn M. , Pichichero Michael E. , Deloria Maria A. , Englund Janet A. , Anderson Edwin L. , Steinhoff Mark C. , Deforest Adamadia , Meade Bruce D. 
Published: December 2021

Objective. To evaluate the effect of simultaneous Haemophilus influenzae type b conjugate (Hib) vaccination on the safety and immunogenicity of selected acellular (DTaP) and whole-cell (DTP) pertussis vaccines with diphtheria and tetanus toxoids combined.
Methods. Enrollment of infants into a large multicenter study of the safety and immunogenicity of 13 DTaP and 2 DTP vaccines was partially completed when the first Hib vaccine, HbOC (Haemophilus b oligosaccharide conjugate vaccine), was licensed for use in infants. Thereafter, at each immunization most infants received HbOC simultaneously with DTaP (or DTP), administered in opposite thighs. Postvaccination geometric mean titers or concentrations (GMTs) of pertussis antibodies as measured by six different assays were compared pairwise among groups of infants receiving 0, 1, 2, or 3 simultaneous HbOC immunizations. The incidence of reactions was compared between infants who received only DTaP or DTP and those who received HbOC simultaneously.
Results. Comparison of postvaccination GMTs was possible among groups of infants receiving different numbers of simultaneous immunizations for 10 of the 13 DTaP and both DTP vaccines. Increased HbOC exposure had no consistent dose-response effect on antibody titers for DTaP or DTP vaccines in any assay. Significant diferences between groups in postvaccination GMTs were observed with 4 DTaP vaccines in 1 to 2 assays each; the GMTs were higher with increasing HbOC exposure for 2 DTaP vaccines and lower for 2 others. There was no significant increase in reactions with simultaneous HbOC and DTaP immunization.
Conclusions. Based on these retrospective analyses, there did not seem to be an interference in pertussis immunogenicity or alteration in reactogenicity associated with the simultaneous administration of HbOC and DTaP. These findings are encouraging with respect to the development of DTaP-Hib combination vaccines.
Association of Reactions After Consecutive Acellular or Whole-Cell Pertussis Vaccine Immunizations
Authors: Deloria Maria A. , Blackwelder William C. , Decker Michael D. , Englund Janet A. , Steinhoff Mark C. , Pichichero Michael E. , Rennels Margaret B. , Anderson Edwin L. , Edwards Kathryn M. 
Published: December 2021

Objective. To evaluate the relative frequency of adverse reactions after initial and subsequent immunizations among infants receiving primary immunization with acellular (DTaP) or whole-cell (DTP) pertussis vaccine with diphtheria and tetanus combined.
Methods. We examined the occurrence of common reactions in 2127 infants within 48 hours after immunization at 2, 4, and 6 months with one of 13 DTaP or with Lederle DTP (WCL). Data on at least two consecutive immunizations were available for 357 WCL recipients and 1770 DTaP recipients. For these analyses, reactions evaluated included fever of 100.4°F (38°C) or greater, redness of 21 mm or larger, swelling of 21 mm or larger, moderate or severe pain, moderate or severe fussiness, loss of appetite, drowsiness, and vomiting.
Results. With one exception, reactions were approximately 1.5 to 8 times more likely to occur in WCL recipients if the same reaction had been observed at the previous immunization (the single exception was redness after the second immunization). Both initial and repeated reactions were less likely in DTaP than in WCL recipients. As with WCL recipients, risks of repeated reactions in DTaP recipients were higher than the risks of initial reactions (from 2.5 to 24 times as high).
Conclusion. Reactions after a second or third immunization with either WCL or DTaP vaccine are more likely to occur in infants who had the same reaction after the preceding immunization. Absolute risks of repeated reactions tended to be lower after DTaP vaccine than after the WCL vaccine.
Development of a Population-specific Risk Assessment to Predict Elevated Blood Lead Levels in Santa Clara County, California
Authors: Snyder David Clayton , Mohle-Boetani Janet C. , Palla Barbara , Fenstersheib Martin 
Published: December 2021

Objectives. To determine: (1) the prevalence of a blood lead level (PbB) of 10 µg/dL or greaterand 20 µg/dL or greater among children aged 6 to 72 months attending the Santa Clara County (SCC), California, public clinics, (2) risk factors for elevated PbB in this population, and (3) whether an SCC public clinic population-specific risk-assessment tool and a five-question lead poisoning questionnaire developed by the Centers for Disease Control and Prevention are useful for prospectively identifying children at higher risk for elevated PbB.
Methods. We tested for PbB 3630 children aged 6 to 72 months attending SCC public outpatient clinics between August 8, 1991, and September 1, 1992. We then conducted two matched case-control studies. Five local riskfactor questions were combined with the CDC's five-question lead poisoning questionnaire, and from May 1, 1993, to June 30, 1993, we conducted risk assessments on 247 children tested for PbB.
Results. Two hundred twenty-two of 3630 children (6.1%) had a PbB of 10 µg/dL or greater. Thirty-nine (1.1%) had a PbB at least 20 µg/dL. Seventy-nine percent of the children screened and 91.0% of the children with PbB at least 10 µg/dL were Hispanic. Twenty percent of Mexican-born Hispanic children had a PbB of 10 µg/dL or greater, versus 7% of U.S.-born Hispanic children. Several factors were associated with elevated PbB among Hispanic children. For identifying children with a PbB of at least 10 µg/dL, the sensitivity and predictive value negative for the CDC's "high risk" definition were 30% and 93%, respectively, whereas for the SCC population-specific high-risk definition, the sensitivity was 90% and the predictive value negative was 98%.
Conclusions. Hispanic children attending SCC public clinics have risk factors for elevated PbB that were not included in the CDC's lead poisoning questionnaire. Methods for prioritizing the frequency of lead screening may be improved by combining the CDC's questions with a population-specific risk assessment.
Hidden Risks: Early Discharge and Bilirubin Toxicity Due to Glucose 6-Phosphate Dehydrogenase Deficiency
Authors: MacDonald Mhairi G. 
Published: December 2021

In the United States today it is common for a mother motherand her term newborn to leave the hospital at 12 to 48 hours postnatally. Current opinion varies widely regarding the desirability of this practice. Proponents of early discharge claim that it is safe and may be advantageous; opponents argue that detection of significant illness may be missed or delayed. Economic considerations often limit the choice of families and their physicians; as they fund progressively shorter hospital stays, managed care and health insurance companies constitute a major driving force toward earlier postpartum discharge.
The American Academy of Pediatrics (AAP)1,2 and the American College of Obstetricians and Gynecologists (ACOG) have published criteria to be met by early discharge candidates.2 These basic criteria include attendance at prenatal classes, instruction regarding common neonatal problems, uncomplicated term delivery, normal physical examination, thermal homeostasis, a negative Coombs test, demonstration of basic maternal skills, including successful infant feeding, and "physician-directed" follow-up within 48 to 72 hours after discharge.
NEONATAL MORBIDITY AND MORTALITY: RELATIONSHIP TO TIME OF DISCHARGE
Many neonatal problems do not become apparent for several days. However, the risks of early discharge remain poorly defined. Among published series of infants discharged early, mortality rates are low and not significantly different from those of control infants.3-6 Most studies have compared morbidity (rates of hospital readmission) between infants discharged early and late and have found similar rates of readmission between groups.7-9 There are few prospective, randomized studies; those that have been published have significant methodological flaws.3,10-16 For example, length of hospital stay varies, and length of stay and timing of follow-up overlap with control infants; study sample sizes are small, usually less than 100 per study.
Early Discharge: In the End, It Is Judgment
Authors: Kessel Woodie , Kiely Michele , Nora Audrey H. , Sumaya Ciro V. 
Published: December 2021

"Early to bed and early to rise, Makes a man healthy, wealthy and wise," proclaimed Benjamin Franklin.1 Early warning, early detection, early periodic screening, diagnosis and treatment, early dismissal, early filing—the litany goes on. Indeed, early has always connoted an astuteness, a positive gain of some sort. Yet recent newspaper and magazine articles have challenged that adage by calling attention to observations of untoward consequences resulting from early discharge of newborns and their mothers from the hospital (Sugg DK. Giving moms, newborns more time in the hospital. Baltimore Sun. April 4, 1995:1; Cost cuts shrink hospital stays for children. The New York Times. May 6, 1995; Nordheimer J. Broad coalition fights insurer limits on hospital maternity stays. The New York Times. June 6, 1995; Lord M. Check in, deliver, go home. us News and World Report. December 5, 1994:98-100). In anticipation of the need to address those observations, the Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration has taken the lead in assessing and tracking this issue nationally. This article describes the MCHB-supported investigations related to early discharge, including findings and recommending next steps.
BACKGROUND
The MCHB focus on length of hospital stay for newborns and their mothers began with an observation regarding rehospitalization of recently discharged newborns. Wallace et al of the San Diego County, CA, 1985 Cohort Infant Mortality Study Group,2 in work sponsored by the MCHB, reported that infants who died in the postneonatal period were significantly more likely to have been rehospitalized (excluding the hospitalization during which death occurred) than infants in the control group (surviving infants matched for plurality and month of birth).
Summary of Workshop: Early Discharge and Neonatal Hyperbilirubinemia
Authors: Catz Charlotte , Hanson James W. , Simpson Lisa , Yaffe Sumner J. 
Published: December 2021

The National Institute of Child Health and Human Development and the Agency for Health Care Policy and Research convened a workshop addressing the issues related to early discharge and hyperbilirubinemia on March 28, 1995. Recent reports have suggested that a high proportion of hospital readmissions in the neonatal period are related to hyperbilirubinemia.1-3 In addition, a growing number of anecdotal reports have raised concern about a resurgence of kernicterus and other hyperbilirubinemia-related morbidity, much of which may be preventable with improved neonatal discharge practices, monitoring technologies, and/or new pharmacologic therapies.4
Cost-containment strategies, such as managed care, have resulted in a continued trend toward shorter lengths of stay for all hospitalizations in all age groups. As a part of this trend, early discharge of neonates has also become common. The potential effects of these policies on subsequent outcomes for neonates and their mothers have generated concern. (In fact, Maryland has recently passed, and other states have introduced, legislation mandating at least 2 days postnatal hospital care.5) In addition to hyperbilirubinemia, other health issues related to early discharge that have been identified were discussed. These are reviewed in this issue of Pediatrics.6 They include potential adverse effects on newborn screening, poor preparation for breast-feeding, inadequate surveillance of mothers and neonates for health problems in the postpartum/neonatal period, reduced opportunities for parent training in "at-risk" populations, disruption of immunization practices, and shifting of economic burdens to families and nonhospital-based providers.
The objectives of this workshop were: a) to review the present status of knowledge regarding hyperbilirubinemia requiring clinical intervention in the newborn and its prevention, and b) in the context of current practices, to begin outlining an agenda for research needs, practice guidance, and policy formulation related to morbidity and mortality associated with early discharge and neonatal jaundice.
Hospital Stay for Healthy Term Newborns
Authors:   Committee on Fetus and Newborn
Published: December 2021

The timing of discharge of the mother and infant after birth was, until recently, a mutual decision between the physician and the mother. Discharge soon after birth began as a consumer-initiated movement and as an alternative to home delivery in the 1980s. Today, financial rather than family or medical considerations frequently drive the decision. Increasingly, insurers are refusing payment for a hospital stay that extends beyond 24 hours after an uncomplicated vaginal delivery,1 which has placed increasing pressure on physicians to discharge infants shortly after birth.
Few scientific data support the insurer's mandate. Several clinical studies have examined the effects of short hospital stay on infant outcomes.2-24 Unfortunately, these studies have methodologic flaws that make it difficult to draw definite conclusions,25 including their 1) retrospective nature, 2) lack of comparison groups, 3) insufficient sample sizes, and 4) study design.
The pediatrician's primary role is to ensure the health and well-being of the baby in the context of the family. It is within this context that this statement addresses the short hospital stay (&lt; 48 hours of age) for healthy term newborns.
The hospital stay of the mother-infant dyad should be long enough to allow identification of early problems and to ensure that the family is able and prepared to care for the baby at home. Many cardiopulmonary problems related to the transition from an intrauterine to an extrauterine environment usually become apparent during the first 12 hours after birth.26 However, other problems, such as jaundice, ductal-dependent cardiac lesions, and gastrointestinal obstruction, may require a longer period of observation by skilled and experienced personnel.
Impact of Prenatal Diagnosis on the Birth Prevalence of Neural Tube Defects, Atlanta, 1990-4991
Authors: Roberts Helen E. , Moore Cynthia A. , Cragan Janet D. , Fernhoff Paul M. , Khoury Muin J. 
Published: December 2021

Objective. To determine the impact of prenatal diagnosis on the birth prevalence of neural tube defects (NTDs) in Atlanta during 1990 through 1991.
Methods. Live-born and stillborn infants with NTDs who were at least 20 weeks' gestation were ascertained by the Metropolitan Atlanta Congenital Defects Program (MACDP), a population-based birth defects registry. Prenatally diagnosed NTD-affected pregnancies were ascertained from the four perinatal centers and the three genetic laboratories operating in Atlanta during 1990 through 1991. Fetal death certificates were also reviewed for potential cases.
Results. During 1990 through 1991, MACDP ascertained 59 NTD cases, for a birth prevalence of 0.77/1000 live births. During this period, an additional 28 NTD-affected pregnancies were detected prenatally and terminated before 20 weeks' gestation. The adjusted NTD rate during 1990 through 1991, which includes prenatally diagnosed cases, was 1.13/1000 live births.
Conclusions. Prenatal diagnosis is making a substantial impact on the birth prevalence of NTDs in Atlanta. However, since NTD rates in Atlanta were 2 to 2.5 per 1000 live births in 1970, prenatal diagnosis and termination of pregnancy does not completely account for the declining rate of NTDs.
A Pacifier Increases the Risk of Recurrent Acute Otitis Media in Children in Day Care Centers
Authors: Niemelä Marjo , Uhari Matti , Möttönen Merja 
Published: December 2021

Objective. To follow up a previous retrospective analysis in which we found the use of a pacifier to be a risk factor for recurrent acute otitis media (AOM).
Method. In the present prospective study, the occurrence of AOM and the use of a pacifier were recorded in 845 children attending day care centers during a 15-month period.
Results. More than three attacks of AOM occurred in 29.5% of the children younger than 2 years using pacifiers and in 20.6% of those not doing so (relative risk, 1.6; 95% confidence interval [CI], 0.6, 4.1); in children 2 to 3 years of age, the figures were 30.6% and 13.2%, respectively (relative risk, 2.9; 95% CI, 1.2, 7.3). Logistic modeling with adjustment for age and the duration of monitoring showed the occurrence of AOM to be associated with the time during which a pacifier was used. The use of a pacifier increased the annual incidence of AOM from 3.6 (95% CI, 2.5, 4.9) to 5.4 episodes (4.4, 6.6) in children younger than 2 years and from 1.9 (1.4, 2.5) to 2.7 (2.2, 3.3) in children 2 to 3 years of age. The population-attributable risk of AOM attacks due to the use of a pacifier was 176 attacks, ie, 459 to 635 attacks per year, in the youngest children and 69 attacks, ie, from 264 to 333 attacks per year, in those 2 to 3 years of age. It can be calculated that the use of a pacifier was responsible for 25% of the attacks in children younger than 3 years. Breastfeeding, parental smoking, thumb sucking, using a nursing bottle, and the social class of the family failed to show such strong associations with the occurrence of AOM.
Conclusion. We conclude that the use of a pacifier is a significant risk factor for recurrent AOM and suggest that pacifiers should be used only during the first 10 months of life, when need for sucking is strongest, and AOM is uncommon.
Annual Summary of Vital Statistics-1994
Authors: Guyer Bernard , Strobino Donna M. , Ventura Stephanie J. , Singh Gopal K. 
Published: December 2021

Recent trends in the vital statistics of the United States continued in 1994, including decreases in the number of births, the birth rate, the age-adjusted death rate, and the infant mortality rate. Life expectancy increased slightly to 75.7 years. Only marriages reversed the recent trend with a slight increase in 1994. An estimated 3 979 000 infants were born during 1994, a decline of &lt;1% from 1993. The birth rate was 15.3 live births per 1000 population, a 1% decline. These decreasing rates reflect a decline in the fertility rate to 67.1 live births per 1000 women aged 15 to 44 years. Final figures for 1993 indicate that fertility rates declined for all racial groups, by 1% for white women (to 65.4) and 3% for black women (to 80.5). The fertility rate for Hispanic women (106.9) was 84% higher than that for non-Hispanic white women and 31% higher than for non-Hispanic black women.
Between 1991 and 1993, birth rates for teenage mothers remained virtually unchanged, and abortion rates have steadily declined, suggesting that teenage pregnancy rates are levelling off. The number and proportion of births to women over age 30, however, continued to rise. The rate of births to all unmarried women (45.3 per 1000 in 1993) has been stable for 3 years. Prenatal care utilization improved in 1993; 79% of women initiated care in the first trimester and &lt;5% had delayed care or no care. Improvements occurred among nearly all racial and ethnic groups. Reported smoking during pregnancy declined to 15.8% in 1993 from 16.9% in 1992. The proportion of babies delivered by cesarean section was 21.8% in 1993, a 2% decrease from 1992. Between 1992 and 1993, the rate of low birth weight (LBW) rose slightly to 7.2%, while very low birth weight (VLBW) remained stable at 1.3%. Most of the increase in LBW occurred among white infants and reflected, primarily, an increase in the proportion of multiple births. The black/white ratio in LBW continued to increase to more than two-fold with the largest difference recorded among term and postterm infants. Age-adjusted death rates in 1994 were lower for heart disease, malignant neoplasm, pulmonary diseases, other accidents, and homicides. The age-adjusted death rate for human immunodeficiency virus disease Continued to rise to 15.1 in 1994. The infant mortality rate declined 4% in 1994, to 7.9 per 1000, the lowest rate ever recorded in the United States. The decline was primarily in neonatal mortality. Among the states, Massachusetts (5.4) and Washington (5.7) had the lowest rates. The overall national trend appears to be related to declines in respiratory distress and sudden infant death syndrome deaths. Over the next 25 years, the number of children in the United States is expected to rise by only 10 million, and the composition of the child population will become more ethnically and radally diverse.
Neurological Correlates of Fetal Cocaine Exposure: Transient Hypertonia of Infancy and Early Childhood
Authors: Chiriboga Claudia A. , Vibbert Martha , Malouf Renée , Suarez Maria S. , Abrams Elaine J. , Heagarty Margaret C. , Brust John C. M. , Hauser W. Allen 
Published: December 2021

Objective. To assess whether prenatal cocaine exposure has any long-term effects on neuro-development.
Design. A prospective cohort study with examiners blind to drug exposure and human immunodeficiency virus (HIV) status.
Subjects. Of 144 high-risk infants enrolled in a perinatal HIV neurodevelopmental study, 119 (83%) infants with both neurological and urine toxicology measures were followed up to age 24 months.
Methods. Neurological and developmental assessments were analyzed at 6-month intervals grouped according to the presence of cocaine in urine toxicology: 51 infants were cocaine-positive. Adjusted odds ratios (ORs) and 95% confidence interval (CI) were obtained by logistic regression equations that adjusted for perinatal variables, including measures of fetal growth, gestation, HIV status, and infant toxicology results.
Setting. Harlem Hospital Center from 1988 to 1992.
Results. At age 6 months, 21 of 51 (41%) cocaine-positive children exhibited hypentonia of any type (hypertonic tetraparesis, hypertonic diparesis, and hypertonic hemiparesis) compared with 17 of 68 (25%) cocaine-negative infants (OR = 2.1, CI = 1.0-4.6). Cocaine-positive infants were four times more likely to show hypertonic tetraparesis (HTP) than cocaine-negative infants (OR = 4.0; CI = 1.5-10.8). The association remained significant in multivariate analyses. Hypertonia, consistent with cerebral palsy, diminished over time in both groups. In 97% of affected infants hypertonia resolved by 24 months. Arm hypertonia abated first; leg hypertonia remained in some children up to age 18 months. No differences in development scores between cocaine-positive and cocaine-negative were noted at any age interval. However, among cocaine-positive infants those with early HTP showed significantly lower mean developmental scores at 6 and 12 month compared to infants without HTP.
Conclusion. Cocaine positivity urine toxicology at birth is associated with hypertonia during infancy. Such cocaine-induced effects are usually symmetrical, transient, and the majority of exposed children outgrow hypertonia by 24 months of life. Among cocaine-positive infants, HTP may be a marker for later developmental impairments.