bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preliminary Experience With Intestinal Transplantation in Infants and Children
Authors: Langnas Alan N. , Shaw B. W. , Antonson Dean L. , Kaufman Stuart S. , Mack David R. , Heffron Thomas G. , Fox Ira J. , Vanderhoof Jon A. 
Published: December 2021

Objective. This report discusses the preliminary experience with intestinal transplantation in children at the University of Nebraska Medical Center.
Patients. During the past 4 years, 16 intestinal transplants have been performed in infants and children. Thirteen have been combined liver and bowel transplants, and the remainder were isolated intestinal transplants. Nearly half of the patients were younger than 1 year of age at the time of surgery, and the vast majority were younger than 5 years of age. All but one had short bowel syndrome.
Results. The 1-year actuarial patient and graft survival rates for recipients of liver and small bowel transplants were 76% and 61%, respectively. Eight of 13 patients who received liver and small bowel transplants remain alive at the time of this writing, with a mean length of follow-up of 263 (range, 7 to 1223) days. Six patients are currently free of total parenteral nutrition. All three patients receiving isolated intestinal transplants are alive and free of parenteral nutrition. The mean length of follow-up is 384 (range, 330 to 450) days. Major complications have included severe infections and rejection. Lymphoproliferative disease, graft-versus-host disease, and chylous ascites have not been major problems.
Conclusions. Although intestinal transplantation is in its infancy, these preliminary results suggest combined liver and bowel transplants and isolated intestinal transplantation may be viable options for some patients with intestinal failure caused by short bowel syndrome or other gastrointestinal disease in whom long-term total parenteral nutrition is not an attractive option.
Can Asphyxiated Infants at Risk for Neonatal Seizures Be Rapidly Identified by Current High-risk Markers?
Authors: Perlman Jeffrey M. , Risser Rick 
Published: December 2021

Objective. Markers currently used to identify infants at highest risk for perinatal hypoxicischemic cerebral injury are insensitive in predicting the subsequent occurrence of neonatal seizures and/or neurodevelopmental sequelae, ie, cerebral palsy. To facilitate therapeutic strategies, early identification of the infant at highest risk for developing seizures secondary to hypoxia ischemia or asphyxia is critical, particularly if novel but potentially toxic therapies currently under experimental investigation become available for clinical use.
Methods. Ninety-six inborn term infants considered at high risk for having neonatal seizures secondary to hypoxia ischemia or asphyxia and admitted to the neonatal intensive care unit directly after labor and delivery were prospectively evaluated. Markers of high risk included the presence of moderate to thick meconiumstained amniotic fluid (MSAF), fetal heart rate (FHRT) abnormalities abruptio placentae, intubation and positive pressure ventilation in the delivery room (DR), chest compressions and epinephrine administration as part of resuscitation, a 5-minute Apgar score of 5 or less, umbilical cord arterial pH of 7.00 or less, and/or a base deficit of -14 mEq/L or more negative.
Results. Seizures developed in 5 (5.2%) of the 96 infants. High-risk markers included FHRT abnormalities only (n = 36), FHRT abnormalities and MSAF (n = 20), MSAF only (n = 23), abruptio placentae (n = 6), intubation in the DR (n = 44), intubation in the neonatal intensive care unit (n = 22), chest compressions (n = 2), 5-minute Apgar scores of 5 or less (n = 21), umbilical cord arterial pH of 7.00 or less (n = 21), and base deficits of -14 mEq/L or more negative (n = 19). By univariate analysis, significant relationships with seizures were found with Apgar scores, the need for intubation in the DR, umbilical cord arterial pH, and base deficit. Combinations of the identified risk markers showed a strong relationship with seizures with the following odds ratios (ORs), 95% confidence limits, sensitivity, specificity, and positive predictive values (PPVs): (1) low cord pH and intubation, OR, 163 (confidence limits, 7.9 and 3343.7); sensitivity, 100%; specificity 94%; and PPV, 50%; (2) low cord pH and low 5-minute Apgar score, OR, 39 (confidence limits, 3.9 and 392.5); sensitivity, 80%; specificity, 91%; and PPV, 33.3%; and (3) low pH, intubation, and low 5-minute Apgar score, OR, 340 (confidence limits, 17.8 and 6480.6); sensitivity, 80%; specificity, 98.8%; and PPV, 80%.
Conclusions. A combination of high-risk postnatal markers, specifically, a low 5-minute Apgar score and intubation in the DR in association with severe fetal acidemia, facilitates the identification within the first hour of life of term infants at highest risk for developing seizures secondary to perinatal asphyxia.
The Efficacy of Nebulized Budesonide in Dexamethasone-treated Outpatients With Croup
Authors: Klassen Terry P. , Watters Lise K. , Feldman Mark E. , Sutcliffe Teresa , Rowe Peter C. 
Published: December 2021

Objective. To determine the added clinical benefit of nebulized budesonide in children with mild to moderate croup treated with 0.6 mg/kg oral dexamethasone.
Design. Randomized, double-blind, placebo-controlled trial.
Setting. Emergency department of a tertiary-care pediatric hospital with 47 000 visits per year.
Participants. Children 3 months to 5 years of age with a syndrome consisting of hoarseness, inspiratory stridor, and barking cough and a croup score of 3 or greater after at least 15 minutes of mist therapy. Patients were excluded from the study if they had diagnoses of epiglottitis, chronic upper or lower airway disease (not including asthma), or severe croup or had received corticosteroids within the preceding 2 weeks.
Intervention. All patients received 0.6 mg/kg oral dexamethasone and were randomly assigned to receive 4 mL (2 mg) of budesonide solution (n = 25) or 4 mL of 0.9% saline solution (n = 25) by updraft nebulizer with a continuous flow of oxygen at 5 to 6 L/min.
Main Outcome Measures. The primary outcome measure was the proportion of patients in each group who had clinically important changes (two points) in the croup score during the 4 hours after treatment.
Results. Eighty-four percent (n = 21) of the patients who received budesonide had clinically important responses, compared with 56% (n = 14) in the placebo group. The number of patients who would need to be treated with nebulized budesonide for one patient to have a clinically important response is four patients.
Conclusions. Despite receiving simultaneous oral dexamethasone, pediatric outpatients with mild to moderate croup have added, clinically important improvement in respiratory symptoms after treatment with budesonide.
Evaluation of the Effectiveness of a Pavement Stencil in Promoting Safe Behavior Among Elementary School Children Boarding School Buses
Authors: Burke Georgine S. , Lapidus Garry D. , Zavoski Robert W. , Wallace Lou , Banco Leonard I. 
Published: December 2021

Objective. The majority of school busrelated fatalities among children attending elementary school in the United States occur as children board or alight from buses. Injuries occur during boarding when children enter the street and are struck by buses or other vehicles. This study evaluated the effectiveness of a stencil in the shape of a school bus applied to the pavement at a bus stop in improving safe behaviors at bus stops. Specifically, we assessed the frequency of children running toward the bus as it approached or entered the street.
Methods. Elementary school bus stops with similar roadways, traffic profiles, and numbers of children boarding participated in the study. Stops were randomly assigned to an intervention group, in which children were instructed to remain within a safe area during boarding that was demarcated by a pavement stencil, or an education-only group, in which the safe area was demarcated by some existing environmental feature. Both groups received education about safe boarding procedures. Observers rated behavior at each stop daily for 5 consecutive weeks. Data were analyzed as bivariate odds of any unsafe behavior in the education-only group.
Results. One hundred forty-five observations from seven bus stops with stencils and 174 daily observations from six education-only stops were completed. Observations of children in the education-only group were twice as likely to show unsafe behavior while waiting (odds ratio [OR], 2.1;95% confidence interval [CI], 1.3-3.6) and during boarding (OR, 2.1; 95% CI, 1.2-3.9). ORs were significantly higher in the education-only group for boys, girls, and children in grades 4 through 6. When no adult was present, there was a greater likelihood of unsafe behavior among all children in the education-only group while waiting (OR, 16.1; 95% CI, 3.9-72.4) and during boarding (OR, 15.0;95% CI, 3.2-81.4). The presence of an adult at the stop did not have an independent effect on behavior. Children at education-only stops located on roadways with high traffic volume were more likely to engage in unsafe behavior while waiting (OR, 8.0;95% CI, 3.8-17.3) and during boarding (OR, 4.9; 95% CI, 2.2-11.0). No differences were observed during boarding between stencil and education-only groups when 10 or more children were at the stops.
Conclusion. The pavement stencil, when accompanied by education about safe boarding, may represent a cost-effective approach to reducing unsafe behavior at bus stops by children of elementary school age.
Respiratory Characteristics During Sleep in Healthy Small-for-Gestational Age Newborns
Authors: Curzi-Dascalova Lilia , Peirano Patricio , Christova Emilia 
Published: December 2021

Objective. Small-for-gestational age (SGA) infants born with intrauterine growth retardation (IUGR) differ from appropriate-for-gestational age (AGA) infants by: a) alterations in a number of neurologic and neurophysiologic characteristics; b) modified heart rate variability during the neonatal period; and c) increased morbidity rates during the first months of life. However, there are no data on the impact of IUGR on respiratory function control at birth.
Methods. We studied 57 newborns who were 35 to 36, 37 to 38, and 39 to 41 weeks' conceptional age (CA): 31 were AGA and 26 were SGA. All were clinically and neurologically normal at birth and none exhibited abnormal events during the first year of life. Polygraphic recordings were performed between two meals during the normal postnatal stay in the maternity ward.
Results. During both active sleep (AS) and quiet sleep (QS), SGA infants in all CA groups had significently higher values for the incidence of 2 to 4.9 seconds and 5 to 9.9 seconds central respiratory pauses (RP), the apnea index (AI) [AI = % of nonbreathing time], and the time spent with periodic breathing (PB), as compared with AGA infants Respiratory frequency was usually similar in SGA and AGA infants. In addition, the trend of age-related respiratory modifications was disturbed in SGA infants, as compared with AGA infants: at 39 to 41 weeks CA, SGA infants had no significant decreases in RP, AI, or PB, and no increase in respiratory frequency. However, between-state differences were similar in both groups. In all AGA and SGA infant groups respiratory frequency seemed to be an individual characteristic: infants who breathed faster during AS breathed faster during QS, and vice-versa.
Conclusion. Our data demonstrate significant modifications in the establishment of respiratory rhythm control in SGA infants, whereas the patterns of state-related and subject-dependent breathing characteristics were similar in SGA and AGA infants. We speculate that the dysregulation of respiratory function control maturation observed in healthy SGA infants may be related to subtle brainstem modifications attributable to the decreased blood supply and chronic hypoxia associated with IUGR.
Morbidity and Mortality in Children Associated With the Use of Tobacco Products by Other People
Authors: DiFranza Joseph R. , Lew Robert A. 
Published: December 2021

Objective. To evaluate the impact of adult tobacco use on the health of children.
Design. A literature review identified relevant research reports. Meta-analysis was used to compute a pooled risk ratio for each condition studied. The risk ratios were combined with data on exposure rates to produce estimates of the population-attributable risk.
Results. Each year, among American children, tobacco is associated with an estimated 284 to 360 deaths from lower respiratory tract illnesses and fires initiated by smoking materials, more than 300 fire-related injuries, 354 000 to 2.2 million episodes of otitis media, 5200 to 165 000 tympanostomies, 14 000 to 21 000 tonsillectomies and/or adenoidectomies, 529 000 physician visits for asthma, 1.3 to 2 million visits for coughs, and in children younger than 5 years of age, 260 000 to 436 000 episodes of bronchitis and 115 000 to 190 000 episodes of pneumonia.
Conclusions. The use of tobacco products by adults has an enormous adverse impact on the health of children. Although more research is needed in several areas, action to reduce the morbidity and mortality among childdren should not be delayed. New laws and policies are needed to grant children protection from bodily injury and death attributable to the use of tobacco products by others.
PROTECTION OF PATIENTS' RIGHTS TO PRIVACY INTERNATIONAL COMMITTEE OF MEDICAL JOURNAL EDITORS
Authors: L. J. F. 
Published: December 2021

The following statement was agreed by the International Committee of Medical Journal Editors (the Vancouver Group) at its meeting last week in San Francisco. It is a complete revision of the initial guidelines on this subject issued in 1991.
Patients have rights to privacy that should not be infringed without informed consent. Identifying information should not be published in written descriptions, photographs, or pedigrees unless the information is essential for scientific purposes and the patient (or parent or guardian) gives written informed consent for publication. Informed consent for this purpose requires that the patient should be shown the manuscript to be published.
Identifying details should be omitted if they are not essential, but patient data should never be altered or falsified in an attempt to attain anonymity. Complete anonymity is difficult to achieve, and informed consent should be obtained if there is any doubt. For example, masking of the eye region in photographs of patients is inadequate protection of anonymity.
The requirement for informed consent should be included in the journal's instructions for authors. When informed consent has been obtained it should be indicated in the published article.
Members of the committee are: Frank Davidoff (Annals of Internal Medicine), Richard Smith (British Medical Journal), Bruce P. Squires (Canadian Medical Association Journal), George Lundberg, Richard Glass (JAMA), Richard Horton (Lancet), Martin Van Der Weyden (Medical Journal of Australia), Robert Utiger (New England Journal of Medicine), Richard G. Robinson (New Zealand Medical Journal), Magne Nylenna (Tidsskrift for den Norske Laegeforening), Linda Clever (Western Medical Journal), and Lois Ann Colaianni (National Library of Medicine).
Do Parents and Professionals Agree on the Developmental Status of High-risk Infants?
Authors: Kim M. Marie , O'Connor Kathleen Steel , McLean Jennifer , Robson Ann , Chance Graham 
Published: December 2021

Objectives. To examine the degree of agreement between parental reporting of the development of high-risk infants and professional assessment by a multidisciplinary team.
Methods. The developmental status of 196 infants discharged from neonatal intensive care units (NICUs) was assessed by their parents using the Infant Monitoring Questionnaire (IMQ) at 4, 8, or 12 months' corrected age. On the same day, a clinical assessment was done by a multidisciplinary team consisting of a developmental pediatrician, physical therapist, and psychologist. The κ statistic was used to measure agreement between the assessments. Logistic regression was used to investigate factors that might influence agreement.
Results. Both the IMQ and the multidisciplinary team classified infants as developing normally ("normal"), being at risk for abnormal development ("suspect"), or developing abnormally ("abnormal"). Although the same proportion of children fell into the three categories by both assessments, parents and the multidisciplinary team showed poor agreement with respect to the classification of individual infants (k = 0.276). No infant or family characteristic was found to have an influence on agreement.
Conclusions. For a group of high-risk infants discharged from NICUs, the agreement between parental assessment of developmental status using the IMQ and the professional assessment by a multidisciplinary team is poor in the first year of life. We do not recommend the use of this questionnaire as a substitute for clinical assessment of biologically at-risk infants discharged from NICUs. However, it may be useful for those groups of infants for whom no other information is available or as an adjunct to clinical assessment when infants are not behaving typically because of an unfamiliar setting or concurrent illness.
Growth and Physical Outcome of Children Conceived by In Vitro Fertilization
Authors: Saunders Kerryn , Spensley John , Munro Judith , Halasz George 
Published: December 2021

Objective. To determine the growth and physical outcome at 2 years of age for children born after assisted reproductive techniques in the state of Victoria.
Design. Using a case-matched control study between January 1991 and July 1993, 314 children (196 singletons, 47 sets of twins, 8 sets of triplets) conceived after in vitro fertilization (IVF) and related techniques at the Monash IVF and Royal Women's Hospital Reproductive Biology Unit and 150 control children (113 singletons, 17 sets of twins, 1 set of triplets) randomly selected from the general population using the Victorian Perinatal Data Collection Unit records were enrolled to be examined for minor dysmorphic and major organ abnormalities. Singleton and twin cases were matched for plurality and gestation and date of birth. Triplets were not matched.
Results. IVF status was not a significant independent factor for physical outcomes, including malformation rates, nor for days of hospitalization postdischarge and operations. There was no significant interaction between IVF status and mean percentiles for weight and head circumference. The IVF group had a greater mean length percentile. Twins in both groups had significantly poorer physical outcomes than singletons on some measures.
Conclusion. This study did not demonstrate an independent IVF effect on the growth and physical outcome of children at 2 years of age when matched for plurality and gestation. The poor outcomes where noted were related to the effects of multiple births. These findings must be viewed in context of the response rates and therefore representativeness of the data. The need for longitudinal studies is demonstrated.
Natural History of Human Immunodeficiency Virus Disease in Perinatally Infected Children: An Analysis From the Pediatric Spectrum of Disease Project
Authors: Barnhart Huiman X. , Caldwell M. Blake , Thomas Pauline , Mascola Laurene , Ortiz Idith , Hsu Ho-Wen , Schulte Joann , Parrott Robert , Maldonado Yvonne , Byers Robert ,   Pediatric Spectrum of Disease Clinical Consortium
Published: December 2021

Objective. To describe the progression of human immunodeficiency virus (HIV) disease through clinical stages from birth to death among a large number of perinatally infected children.
Methods. The Pediatric Spectrum of Disease (PSD) project, coordinated by the Centers for Disease Control and Prevention (CDC), has conducted active surveillance for HIV disease since 1988 in seven geographic regions. PSD data are collected from medical and social service records every 6 months through practitioners at each participating hospital clinic. We analyzed data from perinatally HIV-infected children born between 1982 and 1993. The natural history of HIV disease was divided into five progressive stages using the clinical categories in the CDC 1994 pediatric HIV classification system: stage N, no signs or symptoms; stage A, mild signs or symptoms; stage B, moderate signs or symptoms; stage C, severe signs or symptoms; and stage D, death. A five-stage Markov model was fitted to the PSD data. To compare the estimates from the PSD project with the published estimates, we also fitted an alternative Markov model using acquired immunodeficiency syndrome (AIDS; 1987 case definition) in place of stage C and also calculated standard Kaplan-Meier estimates.
Results. A total of 2148 perinatally HIV-infected children were included in the analysis. The estimated mean times spent in each stage were: N, 10 months; A, 4 months; B, 65 months; and C, 34 months. We estimated that a child born with HIV infection has a 50% (95% confidence interval [CI], 40%-60%) chance of severe signs or symptoms developing by 5 years of age and a 75% (95% CI, 68%-82%) chance of surviving to 5 years of age. For a child in stage B, there is a 60% (95% CI, 49%-71%) chance of severe signs or symptoms developing within the next 5 years and a 65% (95% CI, 56%-73%) chance of surviving 5 more years. The estimated mean time from birth to stage C was 6.6 (95% CI, 5.7-7.5) years, and the estimated mean survival time from birth was 9.4 (95% CI, 8.1-10.7) years. From the alternative Markov model, the estimated mean time from birth to AIDS was 4.8 (95% CI, 4.5-5.2) years.
Conclusion. Markov modeling using the revised pediatric classification system allowed us to describe the natural history of HIV disease in children before diagnosis of AIDS. On average, children progress to moderate symptoms in the second year of life and then remain moderately symptomatic for more than half of their expected lives, underscoring their need for clinical care before the onset of AIDS. The results from the Markov model are useful in family counseling, health care planning, and clinical trial designs.
Methylene Blue-induced Phototoxicity: An Unrecognized Complication
Authors: Porat Rachel , Gilbert Steve , Magilner David 
Published: December 2021

Objective. To describe photosensitization after prenatal exposure to a toxic amount of methylene blue and to alert pediatricians that, in a review of the literature, photosensitization (which this dye is capable of) has not been reported as a complication of prenatal exposure.
Design and Patients. A descriptive report of physical findings and significant laboratory tests in a very low birth weight preterm infant with prenatal exposure to methylene blue and a comparison of this reported case with previously described patients' complications and treatment.
Setting. Neonatal intensive care unit.
Intervention. Monitoring of laboratory tests to assess for methylene blue toxicity: two exchange transfusions for methemoglobinemia, hemolytic anemia, and hyperbilirubinemia; phototherapy for hyperbilirubinemia; and pathologic examination of skin bullae.
Results. Within hours of exposure to phototherapy, redness developed on all exposed areas of the patient's skin (which was initially deep blue), followed by bullae and desquamation of about 35% of the total skin surface area. The desquamation of erythematous areas continued even after discontinuation of phototherapy. Complete re-epithelialization was attained by 3 weeks of age. In addition to this newly observed complication, the patient had other previously described toxic effects.
Conclusion. We have reported a previously unrecognized complication associated with high prenatal exposure to methylene blue and treatment with phototherapy. Methylene blue phototoxicity may be related to the high prenatal dose of the dye relative to patient's small size and young gestational age.