bluuebunny/crossref_metadata_2025_split huggingface dataset:
Morbidities and Hospital Resource Use During the First 3 Years of Life Among Very Preterm Infants
Authors: Korvenranta Emmi , Lehtonen Liisa , Peltola Mikko , Häkkinen Unto , Andersson Sture , Gissler Mika , Hallman Mikko , Leipälä Jaana , Rautava Liisi , Tammela Outi , Linna Miika 
Published: June 2009

OBJECTIVE: The objective of this study was to determine how the use of hospital resources during the first 3 years of life was associated with prematurity-related morbidity in very preterm infants (gestational age of &lt;32 weeks or birth weight of &lt;1501 g).
METHODS: The study was a retrospective, national register study including all very preterm infants born alive in Finland between 2000 and 2003 (N = 2148). Infants who died before the age of 3 years (n = 264) or who had missing register data (n = 88) were excluded from the study. The relationship between 6 morbidity groups and the need for hospital care during the first 3 years of life was studied by using a negative binomial model.
RESULTS: A total of 66.2% of the infants did not have any of the morbidities studied. Infants who were subsequently diagnosed as having cerebral palsy (6.1% of the study group), later obstructive airway disease (20.0%), hearing loss (2.5%), visual disturbances or blindness (3.8%), or other ophthalmologic problems (13.4%) had initial hospital stays that were a mean of 7, 8, 12, 17, and 3 days longer, respectively, than those for infants without these conditions. All morbidity groups were associated with increased numbers of hospital visits during either the second or third year of life, compared with infants without these morbidities. The need for hospitalizations and outpatient hospital care decreased with postnatal age for infants with later morbidities and for infants without later morbidities.
CONCLUSIONS: Most very preterm infants born in Finland survived without severe morbidities and required relatively little hospital care after the initial discharge. However, those with later morbidities had a long initial length of stay and more readmissions and outpatient visits during the 3-year follow-up period.
Triplets Across the First 5 Years: The Discordant Infant at Birth Remains at Developmental Risk
Authors: Feldman Ruth , Eidelman Arthur Isaac 
Published: June 2009

OBJECTIVES: To examine whether the risk posed to infant development by triplet birth persists into childhood and whether growth-discordant triplets are at a particularly high developmental risk.METHODS: Twenty-one sets of triplets were matched with 21 sets of twins and 21 singletons (N = 126) for medical and demographic conditions and were followed from birth to 5 years. At 6, 12, and 24 months, cognitive development was assessed and mother-infant interactions were coded for maternal sensitivity and child social engagement. At 5 years, the children's cognitive development and neuropsychological skills were tested, social engagement was coded from mother-child interactions, and behavior problems were examined. Maternal adjustment was assessed during interviews at 1 and 5 years.RESULTS: Although triplets showed lower cognitive performance at 6, 12, and 24 months as compared with singletons and twins, differences were attenuated by 5 years in both global IQ and executive functions. Similarly, the lower social engagement observed across infancy and the higher internalizing symptoms reported at 2 years for those in the triplet group were no longer found at 5 years. Difficulties in maternal adjustment among mothers of triplets decreased from 1 to 5 years. However, in 65.2% of the initial sample there was a weight discordance of &gt;15% at birth, and the discordant triplets showed poorer cognitive and social development as compared with their siblings across infancy. At 5 years, the discordant children demonstrated lower cognitive and executive functions performance, decreased social engagement, and higher internalizing symptoms as compared with both siblings and peers.CONCLUSIONS: Whereas most triplets catch up after an early developmental delay, the risk for discordant triplets seems to persist into childhood. Such infants, who are at both biological and environmental risk, should receive special and consistent professional care.
Prenatal Growth and Early Postnatal Influences on Adult Motor Cortical Excitability
Authors: Pitcher Julia B. , Robertson Alexandra L. , Cockington Richard A. , Moore Vivienne M. 
Published: June 2009

OBJECTIVE: Suboptimal prenatal growth may adversely influence motor neurophysiologic development and predispose the individual to greater risk of neurodegenerative disorders in later life. We investigated the influences of prenatal growth and the postnatal environment on motor cortical function in young adults.METHODS: Transcranial magnetic stimulation was used to construct corticospinal stimulus-response curves for 35 young adults (mean age: 28 ± 0.5 years; 19 males) born ≥37weeks' gestation. Birth weight centile was calculated relative to maternal size, parity, ethnicity, gender, and gestation. Handgrip strength and dexterity were measured separately. Regression analyses assessed the influence of prenatal (birth weight centile and gestation) and postnatal (socioeconomic indices and maternal education) factors on corticospinal parameters, strength, and dexterity scores.RESULTS: Lower birth weight was associated with increased interhemispheric asymmetry in motor threshold and increased cortical stimulus-response curve slope. A shorter gestation predicted a larger area under this curve in the right hand. High motor threshold was predicted by greater environmental adversity in early postnatal life, but not by prenatal factors. Higher birth weight centile and lower motor threshold were associated with greater educational achievement.CONCLUSIONS: Poor in utero growth and mild prematurity are associated with altered corticospinal excitability in adulthood. An early postnatal environment with less early postnatal socioeconomic disadvantage and having a mother with a completed high school education partly ameliorates this. While altered cortical development has some functional consequences already evident in early adulthood, it may have a later, additional adverse impact on aging-related changes in motor function.
Risk Factors Affecting School Readiness in Premature Infants With Respiratory Distress Syndrome
Authors: Patrianakos-Hoobler Athena I. , Msall Michael E. , Marks Jeremy D. , Huo Dezheng , Schreiber Michael D. 
Published: June 2009

OBJECTIVE: With advances in neonatal care, more children born prematurely are successfully reaching school age. It is unknown how many will be ready for school and what factors affect school readiness. Our objective was to assess readiness of children born prematurely for entry into public school, and determine risk factors associated with lack of school readiness in this population.METHODS: This was a single-center prospective cohort study. Follow- up data were collected for 135 of 167 (81%) surviving premature infants with RDS requiring surfactant-replacement therapy. The children were seen between July 2005 and September 2006 (average age: 5.7 ± 1.0 years) and underwent standardized neurodevelopmental and health assessments and socioeconomic status classification. A 4-level school-readiness score was constructed by using each child's standardized scores on assessments of basic concepts (Bracken School-Readiness Assessment), perceptual skills (Visual-Motor Integration Test), receptive vocabulary (Peabody Picture Vocabulary Test, Third Edition), daily living functional skills (Pediatric Functional Independence Measure), and presence of sensory impairments or autism. Proportional odds models were used to identify risk factors predicting lower school-readiness levels.RESULTS: Mean birth weight was 1016 ± 391 g, and mean gestational age was 27.5 ± 2.6 weeks. Ninety-one (67%) children were school-ready. Using multivariate analysis, male gender, chronic lung disease, and severe intraventricular hemorrhage or periventricular leukomalacia were associated with lower school-readiness levels. However, the most powerful factor determining school-readiness level was low socioeconomic status.CONCLUSION: Interventions targeting neonatal morbidities may be much less effective at improving overall performance at school age compared with the effect of the impoverished social environment.
Conflicts About End-of-Life Decisions in NICUs in the Netherlands
Authors: Verhagen A. A. Eduard , de Vos Mirjam , Dorscheidt Jozef H. H. M. , Engels Bernadette , Hubben Joep H. , Sauer Pieter J. 
Published: June 2009

OBJECTIVE: To determine the frequency and background of conflicts about neonatal end-of-life (EoL) decisions.METHODS: We reviewed the medical files of 359 newborns who had died during 1 year in the 10 Dutch NICUs and identified 150 deaths that were preceded by an EoL decision on the basis of the child's poor prognosis. The attending neonatologists of 147 of the 150 newborns were interviewed to obtain details about the decision-making process.RESULTS: EoL decisions about infants with a poor prognosis were initiated mainly by the physician, who subsequently involved the parents. Conflicts between parents and the medical team occurred in 18 of 147 cases and were mostly about the child's poor neurologic prognosis. Conflicts within the team occurred in 6 of 147 cases and concerned the uncertainty of the prognosis. In the event of conflict, the EoL decision was postponed. Consensus was reached by calling additional meetings, performing additional diagnostic tests, or obtaining a second opinion. The chief causes of conflict encountered by the physicians were religious convictions that forbade withdrawal of life-sustaining treatment and poor communication between the parents and the team.CONCLUSIONS: The parents were involved in all EoL decision-making processes, and consensus was ultimately reached in all cases. Conflicts within the team occurred in 4% of the cases and between the team and the parents in 12% of the cases. The conflicts were resolved by postponing the EoL decision until consensus was achieved.
Maternal Perception of Weight Status and Health Risks Associated With Obesity in Children
Authors: Warschburger Petra , Kröller Katja 
Published: June 2009

OBJECTIVE: To examine factors associated with the maternal perception of the weight status in related and unrelated children and to examine whether associated health risks for children's physical and mental health are recognized.
PATIENTS AND METHODS: Two hundred nineteen mothers with children between 3 and 6 years of age took part in this study. The participating mothers were recruited from inpatient clinics and kindergartens. Parents were presented with 9 silhouettes representing different age- and gender-specific BMI percentiles. Demographic and weight-related variables were assessed with regard to their influence on the accuracy of the maternal weight estimation in general and for their own child.
RESULTS: Of the participating mothers, 64.5% identified the overweight silhouettes of preschool-aged children correctly. However, only 48.8% of the mothers identified the overweight silhouettes associated with an increased risk for physical health problems, and 38.7% identified the silhouettes associated with an increased mental health risk. Mothers with a lower educational background were more likely to misclassify the overweight silhouettes and underestimate the associated health problems. For their own child, only 40.3% of the mothers chose silhouettes that were in agreement with the objective weight status of their child. This underestimation was associated with a higher maternal and child weight status but not with a general inability to identify the weight status of children.
CONCLUSIONS: Identifying unrelated overweight silhouettes is influenced by maternal education level, whereas estimating their own child's weight status is influenced by the weight status of the mother and the child. Hence, feedback on the child's risk to become overweight is necessary to increase maternal risk awareness and willingness to take part in prevention programs.
Side Effects of Methylphenidate in Childhood Cancer Survivors: A Randomized Placebo-Controlled Trial
Authors: Conklin Heather M. , Lawford Joanne , Jasper Bruce W. , Morris E. Brannon , Howard Scott C. , Ogg Susan W. , Wu Shengjie , Xiong Xiaoping , Khan Raja B. 
Published: June 2009

OBJECTIVES: To investigate the frequency and severity of side effects of methylphenidate among childhood survivors of acute lymphoblastic leukemia and brain tumors and identify predictors of higher adverse effect levels.METHODS: Childhood cancer survivors (N = 103) identified as having attention and learning problems completed a randomized, double-blind, 3-week, home-crossover trial of placebo, low-dose methylphenidate (0.3 mg/kg; 10 mg twice daily maximum) and moderate-dose methylphenidate (0.6 mg/kg; 20 mg twice daily maximum). Caregivers completed the Barkley Side Effects Rating Scale (SERS) at baseline and each week during the medication trial. Siblings of cancer survivors (N = 49) were recruited as a healthy comparison group.RESULTS: There was a significantly higher number and severity of symptoms endorsed on the SERS when patients were taking moderate dose compared with placebo or low dose, but not low dose compared with placebo. The number of side effects endorsed on the SERS was significantly lower during all 3 home-crossover weeks (placebo, low dose, moderate dose) when compared with baseline symptom scores. The severity of side effects was also significantly lower, compared with baseline screening, during placebo and low-dose weeks but not moderate-dose weeks. Both the number and severity of symptoms endorsed at baseline were significantly higher for patients compared with siblings. Female gender and lower IQ were associated with higher adverse effect levels.CONCLUSIONS: Methylphenidate is generally well tolerated by childhood cancer survivors. There is a subgroup at increased risk for side effects that may need to be closely monitored or prescribed a lower medication dose. The seemingly paradoxical findings of increased “side effects” at baseline must be considered when monitoring side effects and designing clinical trials.
Intrapartum Antibiotic Exposure and Early Neonatal, Morbidity, and Mortality in Africa
Authors: Kafulafula George , Mwatha Anthony , Chen Ying Qing , Aboud Said , Martinson Francis , Hoffman Irving , Fawzi Wafaie , Read Jennifer S. , Valentine Megan , Mwinga Kasonde , Goldenberg Robert , Taha Taha E. 
Published: June 2009

BACKGROUND: Infants born to women who receive intrapartum antibiotics may have higher rates of infectious morbidity and mortality than unexposed infants.
OBJECTIVE: Our goal was to determine the association of maternal intrapartum antibiotics and early neonatal morbidity and mortality.
METHODS: We performed secondary analysis of data from a multisite randomized, placebo-controlled clinical trial of antibiotics to prevent chorioamnionitis-associated mother-to-child transmission of HIV-1 and preterm birth in sub-Saharan Africa. Early neonatal morbidity and mortality were analyzed. In an intention-to-treat (ITT) analysis, infants born to women randomly assigned to antibiotics or placebo were compared. In addition, non-ITT analysis was performed because some women received nonstudy antibiotics for various clinical indications.
RESULTS: Overall, 2659 pregnant women were randomly assigned. Of these, 2466 HIV-1–infected and HIV-1–uninfected women delivered 2413 live born and 84 stillborn infants. In the ITT analysis, there were no significant associations between exposure to antibiotics and early neonatal outcomes. Non-ITT analyses showed more illness at birth (11.2% vs 8.6%, P = .03) and more admissions to the special care infant unit (12.6% vs 9.8%, P = .04) among infants exposed to maternal intrapartum antibiotics than among unexposed infants. Additional analyses revealed greater early neonatal morbidity and mortality among infants of mothers who received nonstudy antibiotics than of mothers who received study antibiotics.
CONCLUSIONS: There is no association between intrapartum exposure to antibiotics and early neonatal morbidity or mortality. The associations observed in non-ITT analyses are most likely the result of women with peripartum illnesses being more likely to receive nonstudy antibiotics.
Functional Status Scale: New Pediatric Outcome Measure
Authors: Pollack Murray M. , Holubkov Richard , Glass Penny , Dean J. Michael , Meert Kathleen L. , Zimmerman Jerry , Anand Kanwaljeet J. S. , Carcillo Joseph , Newth Christopher J. L. , Harrison Rick , Willson Douglas F. , Nicholson Carol ,   and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network
Published: June 2009

OBJECTIVE: The goal was to create a functional status outcome measure for large outcome studies that is well defined, quantitative, rapid, reliable, minimally dependent on subjective assessments, and applicable to hospitalized pediatric patients across a wide range of ages and inpatient environments.
METHODS: Functional Status Scale (FSS) domains of functioning included mental status, sensory functioning, communication, motor functioning, feeding, and respiratory status, categorized from normal (score = 1) to very severe dysfunction (score = 5). The Adaptive Behavior Assessment System II (ABAS II) established construct validity and calibration within domains. Seven institutions provided PICU patients within 24 hours before or after PICU discharge, high-risk non-PICU patients within 24 hours after admission, and technology-dependent children. Primary care nurses completed the ABAS II. Statistical analyses were performed.
RESULTS: A total of 836 children, with a mean FSS score of 10.3 (SD: 4.4), were studied. Eighteen percent had the minimal possible FSS score of 6, 44% had FSS scores of ≥10, 14% had FSS scores of ≥15, and 6% had FSS scores of ≥20. Each FSS domain was associated with mean ABAS II scores (P &lt; .0001). Cells in each domain were collapsed and reweighted, which improved correlations with ABAS II scores (P &lt; .001 for improvements). Discrimination was very good for moderate and severe dysfunction (ABAS II categories) and improved with FSS weighting. Intraclass correlations of original and weighted total FSS scores were 0.95 and 0.94, respectively.
CONCLUSIONS: The FSS met our objectives and is well suited for large outcome studies.
Cerebral Oxygen Saturation and Extraction in Preterm Infants With Transient Periventricular Echodensities
Authors: Verhagen Elise A. , Keating Paul , ter Horst Hendrik J. , Martijn Albert , Bos Arend F. 
Published: June 2009

OBJECTIVE: Our aim was to determine regional cerebral tissue oxygen saturation and fractional tissue oxygen extraction in preterm infants with transient periventricular echodensities. We hypothesized that as a result of reduced cerebral perfusion, regional cerebral tissue oxygen saturation will be lower and fractional tissue oxygen extraction will be higher during the first days after birth.PATIENTS AND METHODS: This was a prospective, observational study of 49 preterm infants (gestational age median: 30.1 weeks [26.0–31.8 weeks]; birth weight median: 1220 g [615–2250 g]). We defined transient periventricular echodensities as echodensities that persisted for &gt;7 days. Regional cerebral tissue oxygen saturation was measured on days 1–5, 8, and 15 after birth. Fractional tissue oxygen extraction was calculated as (transcutaneous arterial oxygen saturation − regional cerebral tissue oxygen saturation)/transcutaneous arterial oxygen saturation.RESULTS: Transient periventricular echodensities were found in 25 of 49 infants. During the first week we found no difference between the 2 groups for cerebral tissue oxygen saturation and fractional tissue oxygen extraction values. On day 15 after birth, cerebral tissue oxygen saturation was lower in preterm infants with transient periventricular echodensities (66%) compared with infants without echodensities (76%) (P = .003). Fractional tissue oxygen extraction in infants with transient periventricular echodensities (0.30) was higher than fractional tissue oxygen extraction in infants without transient periventricular echodensities (0.20) (P &lt; .001). The differences could not be explained by confounding variables.CONCLUSIONS: Persistent transient periventricular echodensities may be associated with increased cerebral oxygen demand after the first week after birth, which is contrary to our hypothesis. Cerebral oxygenation may be involved in the recovery of perinatal white matter damage.
Clinical Predictors of Pneumonia Among Children With Wheezing
Authors: Mathews Bonnie , Shah Sonal , Cleveland Robert H. , Lee Edward Y. , Bachur Richard G. , Neuman Mark I. 
Published: June 2009

OBJECTIVE: The goal was to identify factors associated with radiographically confirmed pneumonia among children with wheezing in the emergency department (ED) setting.
METHODS: A prospective cohort study was performed with children ≤21 years of age who were evaluated in the ED, were found to have wheezing on examination, and had chest radiography performed because of possible pneumonia. Historical features and examination findings were collected by treating physicians before knowledge of the chest radiograph results. Chest radiographs were read independently by 2 blinded radiologists.
RESULTS: A total of 526 patients met the inclusion criteria; the median age was 1.9 years (interquartile range: 0.7–4.5 years), and 36% were hospitalized. A history of wheezing was present for 247 patients (47%). Twenty-six patients (4.9% [95% confidence interval [CI]: 3.3–7.3]) had radiographic pneumonia. History of fever at home (positive likelihood ratio [LR]: 1.39 [95% CI: 1.13–1.70]), history of abdominal pain (positive LR: 2.85 [95% CI: 1.08–7.54]), triage temperature of ≥38°C (positive LR: 2.03 [95% CI: 1.34–3.07]), maximal temperature in the ED of ≥38°C (positive LR: 1.92 [95% CI: 1.48–2.49]), and triage oxygen saturation of &lt;92% (positive LR: 3.06 [95% CI: 1.15–8.16]) were associated with increased risk of pneumonia. Among afebrile children (temperature of &lt;38°C) with wheezing, the rate of pneumonia was very low (2.2% [95% CI: 1.0–4.7]).
CONCLUSIONS: Radiographic pneumonia among children with wheezing is uncommon. Historical and clinical factors may be used to determine the need for chest radiography for wheezing children. The routine use of chest radiography for children with wheezing but without fever should be discouraged.