bluuebunny/crossref_metadata_2025_split huggingface dataset:
Synchronized Nasal Intermittent Positive-Pressure Ventilation and Neonatal Outcomes
Authors: Bhandari Vineet , Finer Neil N. , Ehrenkranz Richard A. , Saha Shampa , Das Abhik , Walsh Michele C. , Engle William A. , VanMeurs Krisa P. ,   on behalf of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Published: July 2009

BACKGROUND: Synchronized nasal intermittent positive-pressure ventilation (SNIPPV) use reduces reintubation rates compared with nasal continuous positive airway pressure (NCPAP). Limited information is available on the outcomes of infants managed with SNIPPV.OBJECTIVES: To compare the outcomes of infants managed with SNIPPV (postextubation or for apnea) to infants not treated with SNIPPV at 2 sites.METHODS: Clinical retrospective data was used to evaluate the use of SNIPPV in infants ≤1250 g birth weight (BW); and 3 BW subgroups (500–750, 751–1000, and 1001–1250 g, decided a priori). SNIPPV was not assigned randomly. Bronchopulmonary dysplasia (BPD) was defined as treatment with supplemental oxygen at 36 weeks' postmenstrual age.RESULTS: Overall, infants who were treated with SNIPPV had significantly lower mean BW (863 vs 964 g) and gestational age (26.4 vs 27.9 weeks), more frequently received surfactant (85% vs 68%), and had a higher incidence of BPD or death (39% vs 27%) (all P &lt; .01) compared with infants treated with NCPAP. In the subgroup analysis, SNIPPV was associated with lower rates of BPD (43% vs 67%; P = .03) and BPD/death (51% vs 76%; P = .02) in the 500- to 750-g infants, with no significant differences in the other BW groups. Logistic regression analysis, adjusting for significant covariates, revealed infants with 500–700-g BW who received SNIPPV were significantly less likely to have the outcomes of BPD (OR: 0.29 [95% CI: 0.11–0.77]; P = .01), BPD/death (OR: 0.30 [95% CI: 0.11–0.79]; P = .01), neurodevelopmental impairment (NDI) (OR: 0.29 [95% CI: 0.09–0.94]; P = .04), and NDI/death (OR: 0.18 [95% CI: 0.05–0.62]; P = .006).CONCLUSION: SNIPPV use in infants at greatest risk of BPD or death (500–750 g) was associated with decreased BPD, BPD/death, NDI, and NDI/death when compared with infants managed with NCPAP.
Confirmed Moisture Damage at Home, Respiratory Symptoms and Atopy in Early Life: A Birth-Cohort Study
Authors: Karvonen Anne M. , Hyvärinen Anne , Roponen Marjut , Hoffmann Matthias , Korppi Matti , Remes Sami , von Mutius Erika , Nevalainen Aino , Pekkanen Juha 
Published: July 2009

OBJECTIVES: Most previous studies on the association between moisture or mold problems in the home and respiratory symptoms in children were cross-sectional and based on self-reported exposure. The aim of this study was to evaluate the impact of objectively observed moisture damage and visible mold in the homes on early-life respiratory morbidity and atopic sensitization in a birth cohort.
METHODS: Building inspection was performed by building engineers in the homes of 396 children, and the children were followed up with questionnaires from birth to the age of 18 months. Specific immunoglobulin E levels were measured at the age of 1 year.
RESULTS: Doctor-diagnosed wheezing was associated with the severity of moisture damage in the kitchen and with visible mold in the main living area and especially in the bedroom of the child. The risk for parent-reported wheezing apart from cold increased with the severity of moisture damage in the kitchen. Moisture damage in the bathrooms or other interior spaces had no significant association with wheezing. No significant associations were observed for other end points, such as cough, or respiratory infections. There was a suggestion for an increased risk for sensitization to cat dander linked with moisture and mold exposure.
CONCLUSIONS: This birth-cohort study supports previous observations that moisture mold problems in the kitchen and in the main living area increase the risk for wheezing in early childhood. The results underline the importance of assessing separately the health effects of moisture and mold problems in different areas of the home.
Use of Di(2-Ethylhexyl)Phthalate–Containing Infusion Systems Increases the Risk for Cholestasis
Authors: von Rettberg Heike , Hannman Torsten , Subotic Ulrike , Brade Joachim , Schaible Thomas , Waag Karl Ludwig , Loff Steffan 
Published: July 2009

INTRODUCTION: Most polyvinylchloride infusion systems are plasticized with up to 60% of di(2-ethylhexyl)phthalate (DEHP). DEHP is easily extracted from the tubing by total parenteral nutrition (TPN) solutions and has been shown to have toxic effects on various organ systems including the liver in animals and humans. A role was postulated for DEHP in the development of hepatobiliary dysfunction in premature and newborn infants receiving parenteral nutrition, and the incidence of cholestasis was investigated after changing from polyvinylchloride infusion systems to polyvinylchloride-free infusion systems.MATERIALS AND METHODS: Two 3-year periods from 1998 to 2004 were investigated retrospectively before and after changing from polyvinylchloride to polyvinylchloride-free infusion systems in our department. This resulted in 1 group of 30 patients treated with polyvinylchloride lines and a second group of 46 patients treated with polyvinylchloride-free lines. The 2 groups were examined for the incidence of cholestasis and other possible contributing factors. Statistics were performed by using SAS software (SAS Institute, Cary, NC).RESULTS: After changing infusion systems, the incidence of cholestasis dropped from 50% to 13%. Using DEHP-plasticized polyvinylchloride infusion systems for TPN increased the risk for cholestasis by a factor of 5.6. The use of polyvinylchloride lines correlated strongly with the development of TPN-associated cholestasis (P = .0004).CONCLUSIONS: Using DEHP-containing polyvinylchloride infusions systems contributes to the development of cholestasis. Therefore, the use of DEHP-free infusion systems for TPN is recommended, especially in premature and newborn infants.
Mortality and Functional Morbidity After Use of PALS/APLS by Community Physicians
Authors: Carcillo Joseph A. , Kuch Bradley A. , Han Yong Y. , Day Susan , Greenwald Bruce M. , McCloskey Karen A. , Pearson-Shaver Anthony L. , Orr Richard A. 
Published: July 2009

OBJECTIVES: To test the hypothesis that pediatric shock is a common cause of death and functional morbidity and that pediatric advanced life support (PALS)/advanced pediatric life support (APLS) resuscitation in the community hospital setting improves child health outcomes.METHODS: This study included all children consecutively transported to 5 regional, tertiary care children's hospitals over 4 years, and is a prospective cohort study comparing outcomes in children who did or did not receive PALS/APLS resuscitation in the community hospital.RESULTS: Shock occurred in 37% of the patients transferred to the tertiary centers. Regardless of trauma status, children with shock had an increased mortality rate compared with those without shock (all patients: 11.4% vs 2.6%), trauma patients (28.3% vs 1.2%), and nontrauma patients (10.5% vs 2.8%). Early shock reversal was associated with reduced mortality (5.06% vs 16.37%) and functional morbidity (1.56% vs 4.11%) rates. Early use of PALS/APLS-recommended interventions was associated with reduced mortality (8.69% vs 15.01%) and functional morbidity (1.24% vs 4.23%) rates. After controlling for center, severity of illness, and trauma status, early reversal of shock and use of PALS/APLS-recommended interventions remained associated with reduced morbidity and mortality rates.CONCLUSIONS: Shock is common in children who are transferred for tertiary care. Pediatric shock recognition and resuscitation in the community hospital improves survival and functional outcome regardless of diagnostic category. The development of shock/trauma systems for children with and without trauma seems prudent.
Do School-Based Asthma Education Programs Improve Self-Management and Health Outcomes?
Authors: Coffman Janet M. , Cabana Michael D. , Yelin Edward H. 
Published: July 2009

CONTEXT: Asthma self-management education is critical for high-quality asthma care for children. A number of studies have assessed the effectiveness of providing asthma education in schools to augment education provided by primary care providers.
OBJECTIVE: To conduct a systematic review of the literature on school-based asthma education programs.
METHODS: As our data sources, we used 3 databases that index peer-reviewed literature: MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature. Inclusion criteria included publication in English and enrollment of children aged 4 to 17 years with a clinical diagnosis of asthma or symptoms consistent with asthma.
RESULTS: Twenty-five articles met the inclusion criteria. Synthesizing findings across studies was difficult because the characteristics of interventions and target populations varied widely, as did the outcomes assessed. In addition, some studies had major methodologic weaknesses. Most studies that compared asthma education to usual care found that school-based asthma education improved knowledge of asthma (7 of 10 studies), self-efficacy (6 of 8 studies), and self-management behaviors (7 of 8 studies). Fewer studies reported favorable effects on quality of life (4 of 8 studies), days of symptoms (5 of 11 studies), nights with symptoms (2 of 4 studies), and school absences (5 of 17 studies).
CONCLUSIONS: Although findings regarding effects of school-based asthma education programs on quality of life, school absences, and days and nights with symptoms were not consistent, our analyses suggest that school-based asthma education improves knowledge of asthma, self-efficacy, and self-management behaviors.
A Second Course of Ibuprofen Is Effective in the Closure of a Clinically Significant PDA in ELBW Infants
Authors: Richards Justin , Johnson Alice , Fox Grenville , Campbell Morag 
Published: July 2009

OBJECTIVES: There are few published data on the efficacy of ibuprofen in the most immature infants and no data on repeated courses. Our objectives were to describe PDA closure rates in a population of infants &lt;1000 g birth weight after repeated courses of ibuprofen, to examine the effect of gestation, and to document plasma markers of renal function and platelet counts.METHODS: This was a single center observational study. We collected data on infants weighing &lt;1000 g at birth who were treated with ibuprofen for a clinically significant PDA. A successful outcome was defined as resolution of clinical symptoms such that no additional treatment was required. Serum biochemistry and hematology data were analyzed and compared with controls.RESULTS: We identified 160 infants with a mean ± SD birth weight of 757 ± 127 g and gestation of 25.6 ± 1.4 weeks. Seventy infants closed their PDA after a single course of ibuprofen (45%) and 32/80 (40%) following a second. Infants of &lt;26 weeks' gestation (n = 83) were less likely to respond after both the first (27.7% vs 63.6%; P &lt; .001) and second (30.9% vs 60.0%; P = .026) courses. The postnatal decrease in plasma creatinine was delayed by ibuprofen treatment, while platelet counts and other plasma markers were unaffected.CONCLUSIONS: In our study population, PDA closure was gestation dependant, with a cumulative closure rate of 65%. A similar proportion of infants closed their PDA following the first and second courses regardless of gestation. These data suggest that a second course of ibuprofen may be effective in closing a PDA in even the most preterm infant.
Evaluation of School-Based Smoking-Cessation Interventions for Self-Described Adolescent Smokers
Authors: Joffe Alain , McNeely Clea , Colantuoni Elizabeth , An Ming-Wen , Wang Weiwei , Scharfstein Daniel 
Published: July 2009

OBJECTIVE: The goal was to compare the efficacy of school-based, multisession, group smoking-cessation interventions versus a single group session in increasing quit rates among adolescent smokers.
METHODS: Eight schools were assigned randomly to use 1 of 2 group smoking-cessation programs previously shown to increase quit rates among adolescents (Not on Tobacco [NOT] or Kickin' Butts). We reformatted the programs to twice-weekly 25- to 30-minute sessions delivered during lunch periods. Smoking status was assessed at end of program (EOP) and 1, 3, 6, and 12 months later. Self-reported quit status was confirmed with salivary cotinine levels.
RESULTS: A total of 407 students (56% black and 52% female; mean age: 16 years) participated. Kickin' Butts participants were no more likely to quit than control subjects. In the conservative analysis (students with missing follow-up data classified as smokers), NOT participants were 1.92 times (95% confidence interval [CI]: 1.09–3.40 times) more likely to self-report quitting at 1 month. In the Bayesian analysis (missing follow-up data imputed by using all available data), NOT participants were significantly more likely than control subjects to self-report quitting at EOP (relative risk [RR]: 1.26 [95% CI: 1.10–1.43]), 1 month (RR: 2.07 [95% CI: 1.68–2.56]), and 12 months (RR: 1.58 [95% CI: 1.22–2.04]). Cotinine-confirmed quit rates were significantly greater among NOT participants, compared with control subjects, at EOP and 1 month.
CONCLUSIONS: The reformatted NOT program had a modest effect on adolescents interested in quitting. Kickin' Butts, as reformatted for this project, did not have any effect on quit rates.
Onset of Breast and Pubic Hair Development and Menses in Urban Chinese Girls
Authors: Ma Hua-Mei , Du Min-Lian , Luo Xiao-Ping , Chen Shao-Ke , Liu Li , Chen Rui-Min , Zhu Cheng , Xiong Feng , Li Tang , Wang Wei , Liu Ge-Li ,   on behalf of the Pubertal Study Group of the Society of Pediatric Endocrinology and Genetic Disease, Chinese Medical Association
Published: July 2009

OBJECTIVES: To determine the current prevalence and mean ages of onset of pubertal characteristics in healthy urban Chinese girls.
METHODS: A cross-sectional study of sexual maturation of healthy Chinese girls was conducted in 9 representative cities of the eastern, western, southern, and northern parts and central region of China between 2003 and 2005. At examination, stages of breast and pubic hair development were rated on girls 3 through 19.83 years of age, and height and weight were also recorded. Data on menses were collected by the status quo method. Probit analysis was used to calculate the median age and 95% confidence interval (CI) for onset of breast and pubic hair development and menarche.
RESULTS: Data were analyzed for 20654 apparently healthy girls. At age 8 years, 19.57% of these girls had evidence of breast development. The median ages of onset of Tanner stages 2 and 3 for breast development were 9.20 (95% CI: 9.06–9.32) years and 10.37 (95% CI: 10.28–10.45) years, respectively. The median ages of onset of Tanner stages 2 and 3 for pubic hair development were 11.16 (95% CI: 11.03–11.29) years and 12.40 (95% CI: 12.25–12.55) years, respectively. Menses occurred at 12.27 years (95% CI: 12.16–12.39).
CONCLUSIONS: These data suggest that urban Chinese girls are actually experiencing earlier breast development than currently used norms. The up-to-date reference for normal pubertal development in urban Chinese girls needs to be established for the purpose of determining precocious puberty or pubertal delay.
Reforming Procedural Skills Training for Pediatric Residents: A Randomized, Interventional Trial
Authors: Gaies Michael G. , Morris Shaine A. , Hafler Janet P. , Graham Dionne A. , Capraro Andrew J. , Zhou Jing , Landrigan Christopher P. , Sandora Thomas J. 
Published: July 2009

BACKGROUND: Pediatric housestaff are required to learn basic procedural skills and demonstrate competence during training. To our knowledge, an evidenced-based procedural skills curriculum does not exist.OBJECTIVE: To create, implement, and evaluate a modular procedural skills curriculum for pediatric residents.METHODS: A randomized, controlled trial was performed. Thirty-eight interns in the Boston Combined Residency Program who began their training in 2005 were enrolled and randomly assigned. Modules were created to teach residents bag-mask ventilation, venipuncture, peripheral intravenous catheter (PIV) insertion, and lumbar puncture skills. The curriculum was administered to participants in the intervention group during intern orientation. Interns in the control group learned procedural skills by usual methods. Subjects were evaluated by using a structured objective assessment on simulators immediately after the intervention and 7 months later. Success in performing live-patient procedures was self-reported by subjects. The primary outcome was successful performance of the procedure on the initial assessment. Secondary outcomes included checklist and knowledge examination scores, live-patient success, and qualitative assessment of the curriculum.RESULTS: Participants in the intervention group performed PIV placement more successfully than controls (79% vs 35%) and scored significantly higher on the checklist for PIV placement (81% vs 61%) and lumbar puncture (77% vs 68%) at the initial assessment. There were no differences between groups at month 7, and both groups demonstrated declining skills. There were no statistically significant differences in success on live-patient procedures. Those in the intervention group scored significantly higher on knowledge examinations.CONCLUSIONS: Participants in the intervention group were more successful performing certain simulated procedures than controls when tested immediately after receiving the curriculum but demonstrated declining skills thereafter. Future efforts must emphasize retraining, and residents must have sufficient opportunities to practice skills learned in a formal curriculum.
Probiotic Effects on Cold and Influenza-Like Symptom Incidence and Duration in Children
Authors: Leyer Gregory J. , Li Shuguang , Mubasher Mohamed E. , Reifer Cheryl , Ouwehand Arthur C. 
Published: July 2009

OBJECTIVE: Probiotic consumption effects on cold and influenza-like symptom incidence and duration were evaluated in healthy children during the winter season.METHODS: In this double-blind, placebo-controlled study, 326 eligible children (3–5 years of age) were assigned randomly to receive placebo (N = 104), Lactobacillus acidophilus NCFM (N = 110), or L acidophilus NCFM in combination with Bifidobacterium animalis subsp lactis Bi-07 (N = 112). Children were treated twice daily for 6 months.RESULTS: Relative to the placebo group, single and combination probiotics reduced fever incidence by 53.0% (P = .0085) and 72.7% (P = .0009), coughing incidence by 41.4% (P = .027) and 62.1% (P = .005), and rhinorrhea incidence by 28.2% (P = .68) and 58.8% (P = .03), respectively. Fever, coughing, and rhinorrhea duration was decreased significantly, relative to placebo, by 32% (single strain; P = .0023) and 48% (strain combination; P &lt; .001). Antibiotic use incidence was reduced, relative to placebo, by 68.4% (single strain; P = .0002) and 84.2% (strain combination; P &lt; .0001). Subjects receiving probiotic products had significant reductions in days absent from group child care, by 31.8% (single strain; P = .002) and 27.7% (strain combination; P &lt; .001), compared with subjects receiving placebo treatment.CONCLUSION: Daily dietary probiotic supplementation for 6 months was a safe effective way to reduce fever, rhinorrhea, and cough incidence and duration and antibiotic prescription incidence, as well as the number of missed school days attributable to illness, for children 3 to 5 years of age.
Acquired Microcephaly: Causes, Patterns, Motor and IQ Effects, and Associated Growth Changes
Authors: Baxter Peter Stuart , Rigby Alan Steven , Rotsaert Marianne Hélène Elise Pascale Dominique , Wright Ingram 
Published: July 2009

OBJECTIVES: The goals were to identify and to classify causes and growth patterns of acquired (or progressive) microcephaly and to look for hypothesized correlations between causes, growth patterns, and developmental quotient/IQ.
METHODS: Fifty-one children (24 boys), 0.7 to 11.3 years of age, with early occipitofrontal circumference measurements above and later ones below the second percentile (SD: −2.03) were studied through retrospective note and growth chart review, with formal assessments of developmental quotient or IQ (n = 34).
RESULTS: Causes were classifiable into 5 groups as follows: idiopathic, familial, syndromic, symptomatic, and mixed. Four patterns of head growth were identified, as follows: type A, initial decrease from the normal range to below the second percentile, followed by growth below and parallel to the second percentile; type B, continued decrease away from the second percentile; type C, decrease below the normal range, with partial later recovery; type D, insufficient data. For 12 children, there were accompanying decreases in weight percentiles and for 5 of these in height percentiles as well. Infants with lower head circumference z scores at the end of the study also had lower z scores for final weight and final length. There was no correlation between causal group and growth pattern. Developmental quotient/IQ values were mostly &lt;100 and did not correlate with head circumference z score, cause, or pattern.
CONCLUSIONS: The classification of causal groups and growth patterns should aid clinical management. Neither cause nor pattern predicted outcomes. The associations with poor weight gain and body growth deserve further study.