bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiovascular Medication Errors in Children
Authors: Alexander Diana C. , Bundy David G. , Shore Andrew D. , Morlock Laura , Hicks Rodney W. , Miller Marlene R. 
Published: June 2009

OBJECTIVES: We sought to describe pediatric cardiovascular medication errors and to determine patients and medications with more-frequently reported and/or more-harmful errors.METHODS: We analyzed cardiovascular medication error reports from 2003–2004 for patients &lt;18 years of age, from the US Pharmacopeia MEDMARX database. Reports were stratified according to harm score (A, near miss; B–D, error, no harm; E–I, harmful error). Proportions of harmful reports were determined according to drug class and age group. “High-risk” drugs were defined as antiarrhythmics, antihypertensives, digoxin, and calcium channel blockers.RESULTS: A total of 147 facilities submitted 821 reports with community hospitals predominating (70%). Mean patient age was 4 years (median: 0.9 years). The most common error locations were NICUs, general care units, PICUs, pediatric units, and inpatient pharmacies. Drug administration, particularly improper dosing, was implicated most commonly. Severity analysis showed 5% “near misses,” 91% errors without harm, and 4% harmful errors, with no reported fatalities. A total of 893 medications were cited in 821 reports. Diuretics were cited most frequently, followed by antihypertensives, angiotensin inhibitors, β-adrenergic receptor blockers, digoxin, and calcium channel blockers. Calcium channel blockers, phosphodiesterase inhibitors, antiarrhythmics, and digoxin had the largest proportions of harmful events, although the values were not statistically significantly different from those for other drug classes. Infants &lt;1 year of age accounted for 50% of reports. Proportions of harmful events did not differ according to age.CONCLUSIONS: Infants &lt;1 year of age were most frequently reported in cardiovascular medication errors reaching inpatients, in a national, voluntary, error-reporting database. Proportions of harmful errors were not significantly different by age or cardiovascular medication. Most errors were related to medication administration, largely due to improper dosing.
Maternal Allopurinol During Fetal Hypoxia Lowers Cord Blood Levels of the Brain Injury Marker S-100B
Authors: Torrance Helen L. , Benders Manon J. , Derks Jan B. , Rademaker Carin M. A. , Bos Arie F. , Van Den Berg Paul , Longini Mariangela , Buonocore Giuseppe , Venegas MariaElena , Baquero Hernando , Visser Gerard H. A. , Van Bel Frank 
Published: June 2009

BACKGROUND: Fetal hypoxia is an important determinant of neonatal encephalopathy caused by birth asphyxia, in which hypoxia-induced free radical formation plays an important role.
HYPOTHESIS: Maternal treatment with allopurinol, will cross the placenta during fetal hypoxia (primary outcome) and reduce S-100B and free radical formation (secondary outcome).
METHODS: In a randomized, double-blind feasibility study, 53 pregnant women in labor (54 fetuses) with a gestational age of &gt;36 weeks and fetal hypoxia, as indicated by abnormal/nonreassuring fetal heart rate tracing or fetal scalp pH of &lt;7.20, received 500 mg of allopurinol or placebo intravenously. Severity of fetal hypoxia, brain damage and free radical formation were assessed by arterial cord blood lactate, S-100B and non-protein-bound-iron concentrations, respectively. At birth, maternal and cord blood concentrations of allopurinol and its active metabolite oxypurinol were determined.
RESULTS: Allopurinol and oxypurinol concentrations were within the therapeutic range in the mother (allopurinol &gt; 2 mg/L and/or oxypurinol &gt; 4 mg/L) but not always in arterial cord blood. We therefore created 3 groups: a placebo (n = 27), therapeutic allopurinol (n = 15), and subtherapeutic allopurinol group (n = 12). Cord lactate concentration did not differ, but S-100B was significantly lower in the therapeutic allopurinol group compared with the placebo and subtherapeutic allopurinol groups (P &lt; .01). Fewer therapeutic allopurinol cord samples had measurable non–protein-bound iron concentrations compared with placebo (P &lt; .01).
CONCLUSIONS: Maternal allopurinol/oxypurinol crosses the placenta during fetal hypoxia. In fetuses/newborns with therapeutic allopurinol/oxypurinol concentrations in cord blood, lower plasma levels of the brain injury marker protein S-100B were detected. A larger allopurinol trial in compromised fetuses at term seems warranted. The allopurinol dosage must be adjusted to achieve therapeutic fetal allopurinol/oxypurinol concentrations.
Teaching by Listening: The Importance of Adult-Child Conversations to Language Development
Authors: Zimmerman Frederick J. , Gilkerson Jill , Richards Jeffrey A. , Christakis Dimitri A. , Xu Dongxin , Gray Sharmistha , Yapanel Umit 
Published: June 2009

OBJECTIVE: To test the independent association of adult language input, television viewing, and adult-child conversations on language acquisition among infants and toddlers.
METHODS: Two hundred seventy-five families of children aged 2 to 48 months who were representative of the US census were enrolled in a cross-sectional study of the home language environment and child language development (phase 1). Of these, a representative sample of 71 families continued for a longitudinal assessment over 18 months (phase 2). In the cross-sectional sample, language development scores were regressed on adult word count, television viewing, and adult-child conversations, controlling for socioeconomic attributes. In the longitudinal sample, phase 2 language development scores were regressed on phase 1 language development, as well as phase 1 adult word count, television viewing, and adult-child conversations, controlling for socioeconomic attributes.
RESULTS: In fully adjusted regressions, the effects of adult word count were significant when included alone but were partially mediated by adult-child conversations. Television viewing when included alone was significant and negative but was fully mediated by the inclusion of adult-child conversations. Adult-child conversations were significant when included alone and retained both significance and magnitude when adult word count and television exposure were included.
CONCLUSIONS: Television exposure is not independently associated with child language development when adult-child conversations are controlled. Adult-child conversations are robustly associated with healthy language development. Parents should be encouraged not merely to provide language input to their children through reading or storytelling, but also to engage their children in two-sided conversations.
Apolipoprotein E Genotype Modifies the Risk of Behavior Problems After Infant Cardiac Surgery
Authors: Gaynor J. William , Nord Alex S. , Wernovsky Gil , Bernbaum Judy , Solot Cynthia B. , Burnham Nancy , Zackai Elaine , Heagerty Patrick J. , Clancy Robert R. , Nicolson Susan C. , Jarvik Gail P. , Gerdes Marsha 
Published: June 2009

OBJECTIVE: The goal was to evaluate polymorphisms of the APOE gene as modifiers of neurobehavioral outcomes for preschool-aged children with congenital heart defects, after cardiac surgery.
METHODS: A prospective observational study with neurodevelopmental evaluation between the fourth and fifth birthdays was performed. Attention and behavioral skills were assessed through parental report.
RESULTS: Parents of 380 children completed the neurobehavioral measures. Child Behavior Checklist scores for the pervasive developmental problem scale were in the at-risk or clinically significant range for 15% of the cohort, compared with 9% for the normative data (P &lt; .00001). Attention problem scores were in the at-risk or clinically significant range for 12% of the cohort, compared with 7% for the normative data (P = .0002). The Attention-Deficit/Hyperactivity Disorder Rating Scale-IV, Preschool Version, was completed for 378 children; 30% scored in the clinically significant range for inattention and 22% for impulsivity. After adjustment for covariates, the APOE ε2 allele was significantly associated with higher scores (worse problems) for multiple Child Behavior Checklist indices, including somatic complaints (P = .009), pervasive developmental problems (P = .032), and internalizing problems (P = .009). In each case, the ε4 allele was associated with a better outcome. APOE ε2 carriers had impaired social skills, compared with ε4 carriers (P = .009).
CONCLUSIONS: For preschool-aged children with congenital heart defects requiring surgery, parental rating scales showed an increased prevalence of restricted behavior patterns, inattention, and impaired social interactions. The APOE ε2 allele was associated with increased behavior problems, impaired social interactions, and restricted behavior patterns.
Functioning at School Age of Moderately Preterm Children Born at 32 to 36 Weeks' Gestational Age
Authors: van Baar Anneloes L. , Vermaas John , Knots Edwin , de Kleine Martin J. K. , Soons Paul 
Published: June 2009

OBJECTIVE: To study outcome of low-risk moderately preterm birth between 32 and 36/7 weeks' gestation.
METHODS: 377 Moderately preterm children (M: 34.7, SD: 1.2 complete weeks), without need for neonatal intensive care and without dysmaturity or congenital malformations, were compared with 182 term children and assessed at eight years (M: 8.9, SD: 0.54). School situation, IQ, sustained attention, behavior problems, and attention-deficit/hyperactivity characteristics were studied.
RESULTS: Special education was attended by 7.7% of the moderately preterm children, more than twice the rate of 2.8% in the general Dutch population of this age. Additional exploration for two preterm subgroups of 32 to 33 versus 34 to 36 weeks' gestation showed a need for special education in 9.7% versus 7.3% and a significant difference in grade retention for 30% versus 17%, respectively. Of the children attending mainstream primary schools, grade retention was found in 19% of the preterm versus 8% of the comparison children. Adjusting for maternal education, a group difference of 3 points was found in IQ. The preterm children needed more time for the sustained attention task. The preterm children had more behavior problems (specifically internalizing problems with 27% scoring above the borderline cut-off), as well as more attention-deficit/hyperactivity disorder characteristics (specifically attention deficits).
CONCLUSIONS: Cognitive and emotional regulation difficulties affect functioning of moderately preterm children, as school problems, a slightly lower IQ, attention and behavioral problems are found when they are compared with term-born children. Identification and monitoring of precursors of these problems at younger age is needed in view of prevention purposes.
Sleep-Disordered Breathing and Behaviors of Inner-City Children With Asthma
Authors: Fagnano Maria , van Wijngaarden Edwin , Connolly Heidi V. , Carno Margaret A. , Forbes-Jones Emma , Halterman Jill S. 
Published: June 2009

OBJECTIVE: To explore the relationship between sleep-disordered breathing (SDB) and behavioral problems among inner-city children with asthma.METHODS: We examined data for 194 children (aged 4–10 years) who were enrolled in a school-based asthma intervention program (response rate: 72%). SDB was assessed by using the Sleep-Related Breathing Disorder Questionnaire that contains 3 subscales: snoring, sleepiness, and attention/hyperactivity. For the current study, we modified the Sleep-Related Breathing Disorder Questionnaire by removing the 6 attention/hyperactivity items. A sleep score of &gt;0.33 was considered indicative of SDB. To assess behavior, caregivers completed the Behavior Problem Index (BPI), which includes 8 behavioral subdomains. We conducted bivariate analyses and multiple linear regression to determine the association of SDB with BPI scores.RESULTS: The majority of children (mean age: 8.2 years) were male (56%), black (66%), and insured by Medicaid (73%). Overall, 33% of the children experienced SDB. In bivariate analyses, children with SDB had significantly higher (worse) behavior scores compared with children without SDB on total BPI (13.7 vs 8.8) and the subdomains externalizing (9.4 vs 6.3), internalizing (4.4 vs 2.5), anxious/depressed (2.4 vs 1.3), headstrong (3.2 vs 2.1), antisocial (2.3 vs 1.7), hyperactive (3.0 vs 1.8), peer conflict (0.74 vs 0.43), and immature (2.0 vs 1.5). In multiple regression models adjusting for several important covariates, SDB remained significantly associated with total BPI scores and externalizing, internalizing, anxious/depressed, headstrong, and hyperactive behaviors. Results were consistent across SDB subscales (snoring, sleepiness).CONCLUSIONS: We found that poor sleep was independently associated with behavior problems in a large proportion of urban children with asthma. Systematic screening for SDB in this high-risk population might help to identify children who would benefit from additional intervention.
What Is the Correct Depth of Chest Compression for Infants and Children? A Radiological Study
Authors: Kao Pei-Chieh , Chiang Wen-Chu , Yang Chih-Wei , Chen Shyh-Jye , Liu Yueh-Ping , Lee Chien-Chang , Hsidh Ming-Ju , Ko Patrick Chow-In , Chen Shyr-Chyr , Ma Matthew Huei-Ming 
Published: June 2009

OBJECTIVE: For infant and child resuscitation, current basic life support guidelines recommend a compression depth of one third to one half of the anteroposterior chest diameter. This study was conducted to assess the actual compression depths in infants and children when current guidelines are strictly followed.
PATIENTS AND METHODS: Chest computed tomography scans of 36 infants (&lt;1 year old) and 38 children (1–8 years old) were reviewed. Patient demographic data were collected from medical records. Measurements of the anteroposterior diameter from chest computed tomography scans were taken from the anterior skin at either the internipple line or the middle of the lower half of the sternum, perpendicular to the skin on the posterior thorax.
RESULTS: In the infant group (25 boys, 11 girls), the mean age was 3.6 months. In the child-age group (21 boys, 17 girls), the mean age was 4.0 years. Compression depths were 3.4 to 5.1 cm in the infant group and 4.4 to 6.6 cm in the child group when current guidelines were followed. There was no difference in compression depths measured at internipple line versus in the lower half of the sternum. The intrathoracic structures observed beneath these 2 suggested that compression landmarks were similar.
CONCLUSIONS: Radiological assessment of infants' and children's chests indicates similar or higher compression depths for infants and children versus the recommended compression depths for adults (3.8–5.1 cm) according to current guidelines. More evidence is needed to guide the proper depth of chest compression in pediatric populations.
Trajectories of Receptive Language Development From 3 to 12 Years of Age for Very Preterm Children
Authors: Luu Thuy Mai , Vohr Betty R. , Schneider Karen C. , Katz Karol H. , Tucker Richard , Allan Walter C. , Ment Laura R. 
Published: June 2009

OBJECTIVES: The goal was to examine whether indomethacin use, gender, neonatal, and sociodemographic factors predict patterns of receptive language development from 3 to 12 years of age in preterm children.METHODS: A total of 355 children born in 1989–1992 with birth weights of 600 to 1250 g were evaluated at 3, 4.5, 6, 8, and 12 years with the Peabody Picture Vocabulary Test-Revised. Hierarchical growth modeling was used to explore differences in language trajectories.RESULTS: From 3 to 12 years, preterm children displayed catch-up gains on the Peabody Picture Vocabulary Test-Revised. Preterm children started with an average standardized score of 84.1 at 3 years and gained 1.2 points per year across the age period studied. Growth-curve analyses of Peabody Picture Vocabulary Test-Revised raw scores revealed an indomethacin-gender effect on initial scores at 3 years, with preterm boys assigned randomly to receive indomethacin scoring, on average, 4.2 points higher than placebo-treated boys. However, the velocity of receptive vocabulary development from 3 to 12 years did not differ for the treatment groups. Children with severe brain injury demonstrated slower gains in skills over time, compared with those who did not suffer severe brain injury. Significant differences in language trajectories were predicted by maternal education and minority status.CONCLUSION: Although indomethacin yielded an initial benefit for preterm boys, this intervention did not alter the developmental trajectory of receptive language scores. Severe brain injury leads to long-term sequelae in language development, whereas a socioeconomically advantaged environment supports better language development among preterm children.
Improved Outcomes Associated With Medical Home Implementation in Pediatric Primary Care
Authors: Cooley W. Carl , McAllister Jeanne W. , Sherrieb Kathleen , Kuhlthau Karen 
Published: June 2009

OBJECTIVE: The medical home model with its emphasis on planned care, care coordination, family-centered approaches, and quality provides an attractive concept construct for primary care redesign. Studies of medical home components have shown increased quality and reduced costs, but the medical home model as a whole has not been studied systematically. This study tested the hypothesis that increased medical homeness in primary care practice is associated with decreased utilization of health services and increased patient satisfaction.
METHODS: Forty-three primary care practices were identified through 7 health plans in 5 states. Using the Medical Home Index (MHI), each practice's implementation of medical home concepts “medical homeness” was measured. Health plans provided the previous year's utilization data for children with 6 chronic conditions. The plans identified 42 children in each practice with these chronic conditions and surveyed their families regarding satisfaction with care and burden of illness.
RESULTS: Higher MHI scores and higher subdomain scores for organizational capacity, care coordination, and chronic-condition management were associated with significantly fewer hospitalizations. Higher chronic-condition management scores were associated with lower emergency department use. Family survey data yielded no recognizable trends with respect to the medical home measurement.
CONCLUSIONS: Developing an evidence base for the value of the primary care medical home has importance for providers, payers, policy makers, and consumers. Reducing hospitalizations through enhanced primary care provides a potential case for new reimbursement strategies supporting medical home services such as care coordination. Larger-scale studies are needed to further develop/examine these relationships.
Nocturnal Enuresis and Overweight Are Associated With Obstructive Sleep Apnea
Authors: Barone Joseph G. , Hanson Christopher , DaJusta Daniel G. , Gioia Kevin , England Sandra J. , Schneider Dona 
Published: June 2009

OBJECTIVE: The objective of this study was to examine the relationship of obstructive sleep apnea (OSA), body weight (BMI percentage [BMI%]), and monosymptomatic nocturnal enuresis (MNE) in children.
METHODS: A case-control study design was used. All children were 5 to 15 years of age; case patients were recruited from a comprehensive sleep disorders center (n = 149), and control subjects were recruited from a general pediatric practice in the same catchment area (n = 139). Case patients were subject to overnight polysomnograms and grouped into apnea severity categories (minimal, mild, moderate, or severe) on the basis of respiratory disturbance index and minimum arterial oxygen saturation levels. Data for all children included age; gender; height; weight; and history of MNE, snoring, diabetes, nasal allergies, and/or enlarged tonsils. BMI% was used to group children into weight categories as suggested by the Centers for Disease Control and Prevention (underweight, normal weight, at risk for overweight, and overweight). Two age groupings were created (5–10 years and 11–15 years). Descriptive statistics provided the prevalence of OSA, weight category, and MNE among case patients and control subjects. Cross-tabulations examined the relationship of severity of OSA with weight categories and MNE, stratified by age and gender. A series of logistic regression models explored the interrelationship of the grouping variables.
RESULTS: A large majority (79.9%) of control subjects were at risk for overweight, and a large majority (80.0%) of children with MNE also had some degree of OSA. Logistic regression demonstrated that both MNE (odds ratio: 5.29) and overweight (odds ratio 4.16) were significantly associated with OSA but not with each other.
CONCLUSIONS: Overweight and MNE are associated with OSA but not with each other. OSA should be considered in overweight children with MNE, especially when they display other symptoms of OSA or fail to respond to standard MNE treatment programs.
Effect of a High-Flow Open Nasal Cannula System on Obstructive Sleep Apnea in Children
Authors: McGinley Brian , Halbower Ann , Schwartz Alan R. , Smith Philip L. , Patil Susheel P. , Schneider Hartmut 
Published: June 2009

OBJECTIVE: Obstructive sleep apnea syndrome in children is associated with significant morbidity. Continuous positive airway pressure (CPAP) treats obstructive apnea in children, but is impeded by low adherence. We, therefore, sought to assess the effect of warm humidified air delivered through an open nasal cannula (treatment with nasal insufflation [TNI]) on obstructive sleep apnea in children with and without adenotonsillectomy.METHODS: Twelve participants (age: 10 ± 1 years; BMI: 35 ± 14 kg/m2), with obstructive apnea-hypopnea syndrome ranging from mild to severe (2–36 events per hour) were administered 20 L/min of air through a nasal cannula. Standard sleep architecture, sleep-disordered breathing, and arousal indexes were assessed at baseline, on TNI, and on CPAP. Additional measures of the percentage of time with inspiratory flow limitation, respiratory rate, and inspiratory duty cycle were assessed at baseline and on TNI.RESULTS: TNI reduced the amount of inspiratory flow limitation, which led to a decrease in respiratory rate and inspiratory duty cycle. TNI improved oxygen stores and decreased arousals, which decreased the occurrence of obstructive apnea from 11 ± 3 to 5 ± 2 events per hour (P &lt; .01). In the majority of children, the reduction in the apnea-hypopnea index on TNI was comparable to that on CPAP.CONCLUSIONS: TNI offers an alternative to therapy to CPAP in children with mild-to-severe sleep apnea. Additional studies will be needed to determine the efficacy of this novel form of therapy.