bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effects of Helium/Oxygen Mixture (Heliox) Before and After Extubation in Long-term Mechanically Ventilated Very Low Birth Weight Infants
Authors: Migliori Claudio , Gancia Paolo , Garzoli Elena , Spinoni Vania , Chirico Gaetano 
Published: May 2009

OBJECTIVES. Our goal was to evaluate the effects of a helium/oxygen mixture (heliox) on pulmonary mechanics and gas exchange in preterm infants during both conventional and noninvasive ventilation.
PATIENTS AND METHODS. Ten preterm infants, ventilated from birth, were enrolled. Resistive work of breathing, pulmonary compliance, static compliance, respiratory rate, minute ventilation, ventilatory support, and gas exchange were measured before and during treatment. One hour after heliox therapy, subjects who showed a decrease of peak inspiratory pressure of &gt;20% of the initial value were extubated and shifted to nasal bilevel positive airway pressure with heliox for the following 3 hours. Pulmonary mechanics and ventilatory parameters were measured during air/oxygen ventilation and again 10 minutes and 1 hour after starting heliox. Transcutaneous pressure of O2 and CO2, oxygen saturation, and respiratory rate were recorded continuously. Arterial blood gases were measured immediately before and 1 hour after initiating bilevel positive airway pressure. To maintain oxygen saturation at &gt;92% during the bilevel positive airway pressure phase, the mean fraction of inspired oxygen was increased from 0.34 to 0.36.
RESULTS. Mean peak inspiratory pressure decreased from 21.4 to 17.4 cmH2O, work of breathing decreased from 0.46 to 0.22 joule/L, and transcutaneous pressure of CO2 decreased from 52.3 to 49.1 mmHg. Mean transcutaneous pressure of O2 improved from 42.8 to 46.7 mmHg, and minute ventilation improved from 332 to 478 mL/kg per minute. No significant differences were observed in mean airway pressure, respiratory rate, oxygen saturation, pulmonary compliance, and static compliance. Eight infants were extubated. One of them needed to be reintubated after 5 hours.
CONCLUSIONS. Our data show that mechanical ventilation with heliox reduces resistive work of breathing and ventilatory support requirements and improves gas exchange in preterm infants.
Screening for Postpartum Depression at Well-Child Visits: Is Once Enough During the First 6 Months of Life?
Authors: Sheeder Jeanelle , Kabir Karolyn , Stafford Brian 
Published: May 2009

OBJECTIVE. Screening for maternal depression is gaining acceptance as a standard component of well-child care. We tested the feasibility of this policy and determined the prevalence and incidence of maternal depression at well-child visits during the first 6 months of life.
METHODS. Providers in an adolescent-oriented maternity program were cued electronically, when they opened the electronic medical records of 0- to 6-month-old infants to conduct well-child visits, to ask the mothers to complete the Edinburgh Postpartum Depression Scale. Incident cases represented mothers who crossed the referral threshold (score of ≥10) after the first screening.
RESULTS. Mothers usually brought their infants to the clinic, and none refused screening. Providers could act on 99% of the 418 screening cues; they administered the Edinburgh Postpartum Depression Scale 98% of the time and always referred mothers with scores of ≥10. Overall, 20% of the mothers scored ≥10. Scores were unstable at ≤3 postpartum weeks (κ = 0.2). Thereafter, the prevalence and incidence of scores of ≥10 decreased from 16.5% at 2 months to 10.3% and 5.7%, respectively, at 4 months. Prevalence increased to 18.5% at the 6-month visit, and incidence decreased to 1.9%. Repeat screening detected only 2 mothers (5.7%) with scores of ≥10.
CONCLUSIONS. Electronic cueing improved compliance with the detection and referral phases of screening for maternal depression at well-child visits. Screening 2 months after delivery detects most mothers who become depressed during the first 6 postpartum months, and screening at the 6-month well-child visit is preferable to screening at the 4-month visit.
Mothers' Intention for Their Daughters and Themselves to Receive the Human Papillomavirus Vaccine: A National Study of Nurses
Authors: Kahn Jessica A. , Ding Lili , Huang Bin , Zimet Gregory D. , Rosenthal Susan L. , Frazier A. Lindsay 
Published: May 2009

OBJECTIVES. The aims of this study were to examine mothers' intention to vaccinate their daughters and themselves against human papillomavirus and to determine which demographic, behavioral, and attitudinal factors were associated with intention to vaccinate daughters.
METHODS. We surveyed 10 521 US mothers, all nurses, between June 2006 and February 2007. Multivariable logistic regression models were used to determine which of the following factors were associated with a mother's intention to vaccinate a 9- to 12-year-old daughter: demographic factors, gynecologic history, belief that one's daughter should have regular Papanicolaou testing, beliefs about Papanicolaou testing outcomes (3-item scale), and beliefs about human papillomavirus vaccines (7-item scale measuring beliefs about human papillomavirus vaccine efficacy, impact of vaccination on sexual and Papanicolaou screening behaviors, severity of and susceptibility to human papillomavirus, and anticipated clinician recommendations).
RESULTS. Of the 8832 mothers who completed a survey (84% response rate), 7207 had a daughter. Among mothers with a daughter, 48% intended to vaccinate a daughter if she were 9 to 12 years of age, 68% if she were 13 to 15 years of age, and 86% if she were 16 to 18 years of age. Forty-eight percent intended to receive the vaccine themselves if recommended. In multivariable regression models, variables significantly associated with intention to vaccinate a 9- to 12-year-old daughter included belief that one's daughter should have regular Papanicolaou testing and beliefs about human papillomavirus vaccines.
CONCLUSIONS. In this first national study of mothers' attitudes about human papillomavirus vaccines, mothers' intention to vaccinate a daughter &lt;13 years of age was lower than intention to vaccinate an older daughter, contrasting with national recommendations to target 11- to 12-year-old girls for vaccination. Educational interventions designed to affect mothers' willingness to vaccinate daughters should focus on human papillomavirus vaccine efficacy, behavioral impact of vaccination, perceived risk of human papillomavirus, and clinician support for vaccination.
Soluble Vascular Endothelial Growth Factor Receptor 1 in Tracheal Aspirate Fluid of Preterm Neonates at Birth May Be Predictive of Bronchopulmonary Dysplasia/Chronic Lung Disease
Authors: Hasan Jamal , Beharry Kay D. , Valencia Arwin M. , Strauss Arthur , Modanlou Houchang D. 
Published: May 2009

OBJECTIVE. We tested the hypothesis that soluble vascular endothelial growth factor receptors are involved in the development of bronchopulmonary dysplasia/chronic lung disease.
PATIENTS AND METHODS. Neonates with a birth weight of ≤1500 g and/or ≤30 weeks’ gestation, with respiratory failure, requiring O2 and mechanical ventilation within 24 hours, were eligible. Tracheal aspirate fluid samples were collected from 65 neonates before surfactant and/or assisted mechanical ventilation (baseline), at 3 and 7 days after birth, and weekly thereafter until extubation. Samples were analyzed for total vascular endothelial growth factor, soluble vascular endothelial growth factor receptor 1 and 2 levels and compared in infants with bronchopulmonary dysplasia/chronic lung disease (n = 31) versus those with no bronchopulmonary dysplasia/chronic lung disease (n = 34).
RESULTS. Mean gestational age and birth weight were lower in infants with bronchopulmonary dysplasia/chronic lung disease. At baseline, vascular endothelial growth factor levels in the tracheal aspirate fluid were significantly lower, whereas soluble vascular endothelial growth factor receptor 1 levels were higher in the bronchopulmonary dysplasia/chronic lung disease infants compared with infants with no bronchopulmonary dysplasia/chronic lung disease. Vascular endothelial growth factor levels progressively increased from baseline to 4 weeks in all of the infants developing bronchopulmonary dysplasia/chronic lung disease. Conversely, soluble vascular endothelial growth factor receptor 1 declined in both groups from baseline to 5 weeks of age. Similarly, soluble vascular endothelial growth factor receptor 2 declined from baseline to 5 weeks in the control infants, but there were significant increases at 3 and 4 weeks in infants developing bronchopulmonary dysplasia/chronic lung disease.
CONCLUSIONS. We speculate that low vascular endothelial growth factor levels in tracheal aspirate fluid, concurrent with elevated soluble vascular endothelial growth factor receptor 1 levels on the first day of life, are biological markers for the development of bronchopulmonary dysplasia/chronic lung disease in very low birth weight infants requiring O2 and assisted mechanical ventilation.
Shielding Parenteral Nutrition From Light: Does the Available Evidence Support a Randomized, Controlled Trial?
Authors: Sherlock Rebecca , Chessex Philippe 
Published: May 2009

BACKGROUND. Exposure of total parenteral nutrition to ambient light induces the generation of peroxides, creating oxidant stress, which potentially compounds complications of prematurity. Photograph protection of total parenteral nutrition reduces the peroxide load and has been shown to be associated with nutritional and biochemical benefits in animals and humans. It is unclear whether this reduction in peroxides from total parenteral nutrition leads to a reduction in the complications of prematurity, such as bronchopulmonary dysplasia. Our hypothesis was that shielding total parenteral nutrition from ambient light is linked to clinical benefits.OBJECTIVE. The purpose of this work was to determine whether photograph protection of total parenteral nutrition (light protected), as compared with no photoprotection (light exposed), reduces the occurrence of bronchopulmonary dysplasia or death in preterm infants.METHODS. The Canadian Neonatal Network provided data for infants born in 2006 at &lt;28 weeks' gestation admitted to level 3 NICUs in Canada. A retrospective analysis was performed comparing bronchopulmonary dysplasia and death in infants who received light-exposed or light-protected parenteral nutrition. Data were analyzed by using logistic regression models.RESULTS. Thirteen NICUs offered partial light-protected (total parenteral nutrition bag only, intravenous tubing exposed) and 13 offered light-exposed parenteral nutrition; not a single NICU offered complete light-protected parenteral nutrition (total parenteral nutrition bag plus intravenous tubing). The incidence of bronchopulmonary dysplasia or death was 66% with light-protected (n = 428) vs 59% with light-exposed (n = 438) parenteral nutrition.CONCLUSIONS. Partial photograph protection of total parenteral nutrition was not associated with a reduction in bronchopulmonary dysplasia or death as compared with no photograph protection; this relationship is confounded by covariates with strong associations with bronchopulmonary dysplasia. Partial photograph protection of total parenteral nutrition solutions confers no clinical benefit, while consuming valuable resources. A randomized, controlled trial is justified to determine whether there is a true “cause-and-effect” relationship between complete photoprotection of total parenteral nutrition and bronchopulmonary dysplasia or death.
Does Nebulized Lidocaine Reduce the Pain and Distress of Nasogastric Tube Insertion in Young Children? A Randomized, Double-Blind, Placebo-Controlled Trial
Authors: Babl Franz E. , Goldfinch Christopher , Mandrawa Christine , Crellin Dianne , O'Sullivan Ronan , Donath Susan 
Published: May 2009

OBJECTIVES. Nasogastric tube insertion is a common procedure in children that is very painful and distressing. Although nebulized lidocaine has been shown to be effective in reducing the pain and discomfort of nasogastric tube insertion in adults, there have been no similar studies in children. We set out to investigate the role of nebulized lidocaine in reducing pain and distress of nasogastric tube insertion in young children.
METHODS. We conducted a randomized, double-blind, placebo-controlled trial of nebulized 2% lidocaine at 4 mg/kg versus saline placebo during nasogastric tube insertion at a tertiary urban pediatric emergency department. Patients were eligible if they were aged from 1 to 5 years with no comorbid disease and a clinical indication for a nasogastric tube. Nebulization occurred for 5 minutes, 5 minutes before nasogastric tube insertion. Video recordings before, during, and after the procedure were rated using the Face, Legs, Activity, Cry, and Consolability (FLACC) pain and distress assessment tool (primary outcome measure) and pain and distress visual analog scale scores (secondary outcome measures). Difficulty of insertion and adverse events were also assessed.
RESULTS. Eighteen participants were nebulized with 2% lidocaine and 18 participants with normal saline. Nebulization was found to be highly distressing. FLACC scores during nasogastric tube insertion were very high in both groups. There was a trend in the post–nasogastric tube insertion period toward lower FLACC scores in the lidocaine group. Visual analog scale scores for this postinsertion period were significantly lower in the lidocaine arm for pain and distress. There were no significant differences between groups in terms of difficulty of insertion and the number of minor adverse events. The study was terminated early because of the distress and treatment delay associated with nebulization.
CONCLUSIONS. Nasogastric tube insertion results in very high FLACC scores irrespective of lidocaine use. Nebulized lidocaine cannot be recommended as pain relief for nasogastric tube insertion in children. The delay and distress of nebulization likely outweigh a possible benefit in the postinsertion period.
Lowering Developmental Screening Thresholds and Raising Quality Improvement for Preterm Children
Authors: Marks Kevin , Hix-Small Hollie , Clark Kathy , Newman Judy 
Published: May 2009

OBJECTIVES. Our goal was to determine if (1) preterm children were referred, identified, and received early-intervention/special education services at rates equivalent to term children after implementation of a universal, periodic Ages & Stages Questionnaire screening and surveillance system, (2) pediatricians sufficiently lowered their screening thresholds with preterm children, and (3) quality-improvement opportunities exist.PATIENT AND METHODS. Secondary analysis was performed on 64 lower-risk, predominantly late-preterm and 1363 term children who originally presented for their 12- or 24-month well-child visits. Higher-risk premature infants already involved with an early-intervention agency or identified with a delay were excluded. Board-certified pediatricians (n = 18) and nurse practitioners (n = 2), who were blind to the Ages & Stages Questionnaire results, were secondary participants. Differences between preterm and term early-intervention agency referrals were examined by comparing pediatric developmental impression to the Ages & Stages Questionnaire under natural clinic conditions using a combined in-office or mail-back data-collection protocol. Medical chart and county early-intervention or special education agency follow-up outcomes were conducted at 36 to 60 months.RESULTS. Preterm referral rates were 9.5% (term: 5.6%) with pediatric developmental impression and 26.2% (term: 8.1%) with the Ages & Stages Questionnaire. In follow-up, 37.5% of preterm and 20.8% of term children received referrals, of which 50.0% of preterm and 42.4% of term children were eligible for services, 54.2% of preterm children were identified with a developmental-behavioral disorder, and 29.2% of preterm and 20.8% of term children did not follow-up. For the Ages & Stages Questionnaire, only preterm referrals (55.6%) were subsequently identified with an eligible delay or disorder or both. Preterm children were ∼2 times more likely to be eligible than term children.CONCLUSIONS. Combined referral, quality-improvement, and outcome data suggest that clinicians should lower their threshold for administering a quality developmental screening instrument when providing surveillance for premature infants. Quality improvement exists with diligent developmental surveillance and a standardized, reliable, but more interpersonal referral process.
Parental Refusal of Pertussis Vaccination Is Associated With an Increased Risk of Pertussis Infection in Children
Authors: Glanz Jason M. , McClure David L. , Magid David J. , Daley Matthew F. , France Eric K. , Salmon Daniel A. , Hambidge Simon J. 
Published: May 2009

OBJECTIVE. The objective of this study was to determine if children who contracted pertussis infection were more likely to have parents who refused pertussis vaccinations than a similar group of children who did not develop pertussis infection.
METHODS. We conducted a case-control study of children enrolled in the Kaiser Permanente of Colorado health plan between 1996 and 2007. Each pertussis case was matched to 4 randomly selected controls. Pertussis case status and vaccination status were ascertained by medical chart review.
RESULTS. We identified 156 laboratory-confirmed pertussis cases and 595 matched controls. There were 18 (12%) pertussis vaccine refusers among the cases and 3 (0.5%) pertussis vaccine refusers among the controls. Children of parents who refused pertussis immunizations were at an increased risk for pertussis compared with children of parents who accepted vaccinations. In a secondary case-control analysis of children continuously enrolled in Kaiser Permanente of Colorado from 2 to 20 months of age, vaccine refusal was associated with a similarly increased risk of pertussis. In the entire Kaiser Permanente of Colorado pediatric population, 11% of all pertussis cases were attributed to parental vaccine refusal.
CONCLUSIONS. Children of parents who refuse pertussis immunizations are at high risk for pertussis infection relative to vaccinated children. Herd immunity does not seem to completely protect unvaccinated children from pertussis. These findings stress the need to further understand why parents refuse immunizations and to develop strategies for conveying the risks and benefits of immunizations to parents more effectively.
Age of Drinking Onset, Alcohol Use Disorders, Frequent Heavy Drinking, and Unintentionally Injuring Oneself and Others After Drinking
Authors: Hingson Ralph W. , Zha Wenxing 
Published: May 2009

OBJECTIVE. To explore whether early age of drinking onset is prospectively associated with respondents unintentionally injuring themselves and others when respondents were under the influence of alcohol, controlling for current alcohol dependence/abuse, frequency of consuming 5 drinks per occasion, and other demographic characteristics.
METHODS. From 2001 to 2002, in-person interviews were conducted with a national multistage probability sample of 43 093 adults aged 18 years older. From 2004 to 2005, of 39 959 eligible respondents, 34 653 were reinterviewed. The cumulative 2-survey response rate was 70.2%. Respondents were asked the age at which they first started drinking (not counting tastes or sips), diagnostic questions for alcohol dependence and abuse, questions about behaviors that increase risk of injury, and whether respondents, when under the influence of alcohol, injured themselves or someone else as a driver in a motor vehicle crash or in some other way.
RESULTS. Logistic regression analyses revealed that the younger respondents were when they started drinking, the greater the likelihood that, between the 2 surveys, they experienced alcohol dependence/abuse, drank 5 drinks per occasion at least weekly drove under the influence of alcohol, and placed themselves in situation after drinking where they could be hurt. After controlling for those injury risk and sociodemographic characteristics, respondents who began drinking at earlier ages remained more likely between the 2 surveys to have, under the influence of alcohol, unintentionally injured themselves and someone else. More than one third of those injuries occurred when respondents 25 years of age were under the influence, although only 7% of respondents were 25 years of age. Persons other than respondents experienced 20% of those unintentional injuries, more than one third of them in traffic.
CONCLUSION. Delaying drinking onset may help reduce unintentional alcohol-related injuries that drinkers may inflict on themselves and others.
Incidence of Early Neonatal Mortality and Morbidity After Late-Preterm and Term Cesarean Delivery
Authors: De Luca Roberta , Boulvain Michel , Irion Olivier , Berner Michel , Pfister Riccardo Erennio 
Published: May 2009

OBJECTIVE. To determine the age-stratified risk of intrapartum and neonatal mortality as well as morbidities of clinical relevance after elective cesarean delivery (ECD).METHODS. This work was a cohort study including 56 549 prospectively recorded late-preterm and term deliveries. We analyzed the effect of cesarean delivery (CD) before the onset of labor on the following multiple neonatal outcomes before hospital discharge, compared with planned vaginal delivery (PVD) and emergency CD: mortality, birth depression, special care admission, and respiratory morbidity. We adjusted for confounders by multivariate analysis and stratified the risk according to gestational age (GA).RESULTS. Mortality and morbidities had a strong GA-related trend with the lowest incidences consistently found between 38 and 40 weeks of gestation independent of delivery mode. Compared with infants delivered via PVD, infants delivered via ECD had significantly higher rates of mortality (adjusted risk ratio [aRR]: 2.1), risk of special care admission (aRR: 1.4), and respiratory morbidity (aRR: 1.8) but not of depression at birth (aRR: 1.1). Compared with emergency CD, newborns delivered via ECD had less depression at birth (aRR: 0.6) and admission to special care (aRR: 0.8), but mortality (aRR: 0.8) and respiratory morbidity (aRR: 1.0) rates were similar.CONCLUSIONS. Gestational age–specific risk estimates are lowest between 38 and 40 weeks and should be included in the informed-consent process. The information should also be used to allow for appropriate preparation with respect to adequate staff and equipment. ECD is consistently associated with increased intrapartum and neonatal mortality, risk of admission, and respiratory morbidity compared with PVD and has no advantage over emergency CD in terms of mortality. Neonatal morbidities are lower after ECD than emergency CD only with term births. Our data provide evidence that ECD should not be performed before term.