bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use and Efficacy of Endotracheal Versus Intravenous Epinephrine During Neonatal Cardiopulmonary Resuscitation in the Delivery Room
Authors: Barber Chad A. , Wyckoff Myra H. 
Published: September 2006

OBJECTIVE. Given the paucity of information regarding endotracheal epinephrine for newborn resuscitation, the objectives of this study were: (1) to determine the frequency of endotracheal epinephrine use in newborns in the delivery room, and (2) to determine whether the previously recommended dose of 0.01 to 0.03 mg/kg of endotracheal epinephrine is effective in establishing a return of spontaneous circulation.
PATIENTS AND METHODS. A retrospective review was conducted for all neonates who received ≥1 dose of epinephrine in the delivery room between January 1999 and December 2004. Infants who received ≥1 dose of endotracheal epinephrine in the delivery room during resuscitation were included in the study population whether or not they survived to be admitted to the NICU. Exclusion criteria included lethal congenital anomalies, delivery outside the hospital, and missing medical charts.
RESULTS. Of 93656 infants, 52 neonates (0.06%) received epinephrine in the delivery room, 5 of whom met exclusion criteria. Of the remaining 47 infants, 44 (94%) received the first dose via the endotracheal tube. Only 14 (32%) of 44 achieved return of spontaneous circulation after endotracheal tube administration of epinephrine. Of the 30 remaining infants, 23 (77%) had return of spontaneous circulation with intravenous epinephrine after initially failing endotracheal tube epinephrine. There were no differences in clinical characteristics between newborns who responded to endotracheal tube versus intravenous epinephrine except for a lower blood glucose on NICU admission (52 vs 113 mg%).
CONCLUSIONS. Endotracheal epinephrine is frequently used when intensive resuscitation is required in the delivery room. The previously recommended endotracheal epinephrine dose of 0.01 to 0.03 mg/kg is often ineffective. Higher endotracheal doses will likely be needed to improve efficacy. A prospective study is needed to determine the best endotracheal epinephrine dosing regimen. Until such information is available, intravenous administration should be the preferred route of delivery.
Effect of Hospital Characteristics on Outcomes From Pediatric Cardiopulmonary Resuscitation: A Report From the National Registry of Cardiopulmonary Resuscitation
Authors: Donoghue Aaron J. , Nadkarni Vinay M. , Elliott Michael , Durbin Dennis ,   for the American Heart Assocation National Registry of Cardiopulmonary Resuscitation Investigators
Published: September 2006

OBJECTIVE. Cardiac arrest is uncommon among pediatric patients. Prehospital data demonstrate differences in care processes between children and adults receiving cardiopulmonary resuscitation and advanced life support. We sought to evaluate whether children receiving in-hospital cardiopulmonary resuscitation would attain superior 24-hour survival in hospitals with a higher level of pediatric physician staffing, greater intensity of pediatric care services, and higher pediatric patient volume.
METHODS. A retrospective cohort of 778 hospital inpatients aged &lt;18 years receiving cardiopulmonary resuscitation was identified from the National Registry of Cardiopulmonary Resuscitation from January 2000 to December 2002. Data on hospital pediatric facilities were obtained via telephone survey. Univariate analyses comparing 24-hour survivors and nonsurvivors were conducted using Wilcoxon rank-sum testing for continuous variables and χ2 analysis for dichotomous variables. Multivariate regression analysis was done to examine hospital characteristics as independent predictors of 24-hour survival.
RESULTS. Complete data were available for 677 patients. Univariate analyses showed an association between several pediatric-specific facility characteristics and 24-hour survival. After accounting for indicators of pre-event clinical condition and monitoring, multivariate analysis showed improved 24-hour survival in hospitals staffed by pediatric residents and surgeons and pediatric residents, surgeons, and fellows than for hospitals with no pediatric physician staffing or pediatric surgeons alone. Measures of available facilities and patient volume were not associated with improved outcome.
CONCLUSIONS. Improved 24-hour survival for children receiving in-hospital cardiopulmonary resuscitation is associated with the presence of pediatric residents and fellows.
National Impact of Universal Childhood Immunization With Pneumococcal Conjugate Vaccine on Outpatient Medical Care Visits in the United States
Authors: Grijalva Carlos G. , Poehling Katherine A. , Nuorti J. Pekka , Zhu Yuwei , Martin Stacey W. , Edwards Kathryn M. , Griffin Marie R. 
Published: September 2006

BACKGROUND. Since introduction of the heptavalent pneumococcal conjugate vaccine in the United States in 2000, rates of invasive pneumococcal disease have declined. However, the national impact of heptavalent pneumococcal conjugate vaccine on pneumonia and otitis media remains unknown.
OBJECTIVES. We compared national rates of outpatient visits for pneumonia and otitis media in children before and after heptavalent pneumococcal conjugate vaccine introduction.
METHODS. Rates of ambulatory visits for pneumococcal and nonspecific pneumonia, otitis media, and other acute respiratory infections were compared before (1994–1999) and after (2002–2003) heptavalent pneumococcal conjugate vaccine introduction using the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. To evaluate vaccine effects while accounting for temporal variability, ratios of pneumococcal-related disease rates in children &lt;2 years old (vaccine target population) and in children 3 to 6 years old (not routinely vaccinated) were evaluated using a Poisson regression analysis. For children &lt;2 years old, the differences between observed and expected rates were the estimated vaccine effects.
RESULTS. After the introduction of heptavalent pneumococcal conjugate vaccine, otitis media visit rates declined by 20% in children aged &lt;2 years. This decline represented 246 fewer otitis media visits per 1000 children aged &lt;2 years annually. There were no significant decreases in outpatient visit rates for pneumonia or other acute respiratory infections for children aged &lt;2 years.
CONCLUSIONS. After heptavalent pneumococcal conjugate vaccine introduction, national rates of otitis media visits declined significantly in children &lt;2 years old. Persistence of this trend will produce a significant reduction of the otitis media burden and further enhance the cost-effectiveness of heptavalent pneumococcal conjugate vaccine.
Detection of Impaired Growth of the Corpus Callosum in Premature Infants
Authors: Anderson Nigel G. , Laurent Isabelle , Woodward Lianne J. , Inder Terrie E. 
Published: September 2006

OBJECTIVE. There is an urgent need for a bedside method to assess the effectiveness of neonatal therapies designed to improve cerebral development in very low birth-weight infants. The aim of this study was to assess the impact of preterm birth on the serial growth of the corpus callosum and how soon it could be detected after birth with cranial ultrasound.
METHODS. We recruited 61 very low birth-weight infants admitted to a single regional level III NICU from 1998 to 2000. Study infants had 2 cranial sonograms ≥7 days apart in the first 2 weeks of life and further sonograms at 6 weeks and at term equivalent. At each time point, the length of the corpus callosum and cerebellar vermis was measured on midline sagittal images, with growth rates calculated in millimeters per day. We compared growth of corpus callosum and cerebellar vermis in individuals, between birth age groups, and with corrected gestational age. We used antenatal growth rate of the corpus callosum of 0.2 to 0.27 mm/day as a reference. Relationships between corpus callosum growth rates and neurodevelopmental outcome at 2 years of age (corrected) were also examined.
RESULTS. Growth of the corpus callosum was normal in most infants during the first 2 weeks of life but slowed after this (0.21 mm/day from 0–2 weeks vs 0.11 mm/day for weeks 2–6). Slowing of corpus callosum growth below expected reference range was consistently detectable by age 6 weeks for 96% of infants born between 23 and 33 weeks' gestation. Although some improvement in growth rate was observed for 15% of infants after 6 weeks, this was confined to infants born after 28 weeks. Vermis length correlated strongly with corpus callosum length. By 2 years of age, serious motor delay and cerebral palsy were associated with poorer growth of the length of the corpus callosum between 2 and 6 weeks after birth.
CONCLUSIONS. The effect of preterm birth on growth of the corpus callosum is detectable by 6 weeks after delivery in preterm infants born at gestations of 23 to 33 weeks. Reduced growth of the corpus callosum in weeks 2 to 6, places these infants at elevated risks of later psychomotor delay and cerebral palsy.
Single Kidney and Sports Participation: Perception Versus Reality
Authors: Grinsell Matthew M. , Showalter Sharon , Gordon Katherine A. , Norwood Victoria F. 
Published: September 2006

OBJECTIVES. Physician opinions and practice patterns regarding the participation of children and adolescents with single, normal kidneys in contact/collision sports are widely varied. We hypothesize that limitation of participation from play based only on the presence of a single kidney is not supported by available data. We sought to determine recommendations of pediatric nephrologists regarding the participation of patients with single, normal kidneys in contact/collision sports and review the literature to determine the rate of sports-related kidney injury compared with other organs.METHODS. Members of the American Society of Pediatric Nephrology were surveyed regarding their recommendations for participation of patients with single, normal kidneys in contact/collision sports. Medical and sports literature databases were searched to determine sports-related kidney, brain, spinal cord, and cardiac injury rates and the sports associated with kidney injury.RESULTS. Sixty-two percent of respondents would not allow contact/collision sports participation. Eighty-six percent of respondents barred participation in American football, whereas only 5% barred cycling. Most cited traumatic loss of function as the reason for discouraging participation. The literature search found an incidence of catastrophic sports-related kidney injury of 0.4 per 1 million children per year from all sports. Cycling was the most common cause of sports-related kidney injury causing &gt;3 times the kidney injuries as football. American football alone accounted for 0.9 to 5.3 fatal brain injuries and 4.9 to 7.3 irreversible spinal cord injuries per 1 million players per year. Commotio cordis causes 2.1 to 9.2 deaths per year.CONCLUSIONS. Most pediatric nephrologists prohibit contact/collision sports participation by athletes with a single kidney, particularly football. The available evidence suggests that cycling is far more likely to cause kidney injury. In addition, kidney injury from sports is much less common than catastrophic brain, spinal cord, or cardiac injury. Restricting participation of patients with a single, normal kidney from contact/collision sports is unwarranted.
Neonatal Screening for Very Long-Chain Acyl-CoA Dehydrogenase Deficiency: Enzymatic and Molecular Evaluation of Neonates With Elevated C14:1-Carnitine Levels
Authors: Liebig Michaela , Schymik Ina , Mueller Martina , Wendel Udo , Mayatepek Ertan , Ruiter Jos , Strauss Arnold W. , Wanders Ronald J.A. , Spiekerkoetter Ute 
Published: September 2006

OBJECTIVE. Neonatal screening programs for very long-chain acyl-coenzyme A dehydrogenase deficiency have been implemented recently in various countries. Mildly elevated C14:1-carnitine on day 3 of life strongly suggests very long-chain acyl-coenzyme A dehydrogenase deficiency.
DESIGN. We characterized 11 neonates with elevated C14:1-carnitine by enzyme and molecular analyses. Palmitoyl-coenzyme A oxidation was measured in lymphocytes. Sequencing of all 20 exons of the VLCAD gene was performed from genomic DNA.
RESULTS. Palmitoyl-coenzyme A oxidation revealed significantly decreased residual activities consistent with very long-chain acyl-coenzyme A dehydrogenase deficiency in 7 neonates. In 2 individuals, residual activities of 48% and 44%, respectively, suggested heterozygosity. Two disease-causing mutations were detected in 6 of 7 neonates with very long-chain acyl-coenzyme A dehydrogenase deficiency; in the remaining 1 patient, only 1 mutation was identified. Of 2 individuals with residual activities consistent with heterozygosity, 1 was heterozygous for a VLCAD mutation. The other child and both individuals with normal palmitoyl-coenzyme A oxidation had normal genotypes.
CONCLUSIONS. In 4 of 11 neonates identified with elevated C14:1-carnitine, very long-chain acyl-coenzyme A dehydrogenase deficiency was excluded. A C14:1-carnitine level &gt;1 μmol/L strongly suggests very long-chain acyl-coenzyme A dehydrogenase deficiency, whereas concentrations ≤1 μmol/L do not allow a clear discrimination among affected patients, carriers, and healthy individuals. Further diagnostic evaluation, including enzyme and molecular analyses, is essential to identify very long-chain acyl-coenzyme A dehydrogenase deficiency correctly.
Pretransport and Posttransport Characteristics and Outcomes of Neonates Who Were Admitted to a Cardiac Intensive Care Unit
Authors: Yeager Scott B. , Horbar Jeffrey D. , Greco Karla M. , Duff Julianna , Thiagarajan Ravi R. , Laussen Peter C. 
Published: September 2006

OBJECTIVE. The objective for this study was to characterize the impact and the safety of transporting neonates with known or suspected cardiac abnormalities.METHODS. We reviewed retrospectively the charts and computerized records of 192 admissions to a cardiac ICU in 2002. Patients were included when they were &lt;28 days of age at admission and were transported from adjacent obstetric facilities (local N = 70) or other inpatient medical facilities (transport N = 122). Demographic, clinical, pharmacologic, laboratory, and diagnostic information was obtained before transport (when available) and within 3 hours of arrival. Arrival status was considered optimal when measured metabolic and clinical parameters all were within range. Outcome variables included days on ventilator, days in ICU, days in hospital, and death.RESULTS. Of local admissions, 31 (44%) patients had 61 suboptimal arrival values, including pH &lt;7.25 (n = 11), saturation &lt;70% (n = 12), and temperature &lt;36°C (n = 9). There were 69 undocumented values in 39 patients. Of transported patients, 55 (45%) had 86 suboptimal arrival values, including pH &lt;7.25 (n = 8), saturation &lt;70% (n = 14), and temperature &lt;36°C (n = 13). There were 98 undocumented values in 53 patients. No in-transport deaths or catastrophic events occurred. Local admissions were more likely to have a prenatal diagnosis of heart disease and had more complex disease and higher mortality. Other outcome parameters were not significantly different between the 2 groups. Low admission arterial saturation, pH, and core temperature were not correlated with adverse outcome measures.CONCLUSIONS. Although we did not encounter major transport complications, opportunities exist to optimize arrival status and improve surveillance and documentation.
Little Evidence for Early Programming of Weight and Insulin Resistance for Contemporary Children: EarlyBird Diabetes Study Report 19
Authors: Jeffery Alison N. , Metcalf Brad S. , Hosking Joanne , Murphy Michael J. , Voss Linda D. , Wilkin Terence J. 
Published: September 2006

OBJECTIVE. The aim of this study was to evaluate whether adaptive responses made to the uterine or very early infant environment are affecting the current metabolic health of young children in the United Kingdom.METHODS. Participants were 300 healthy children and their parents from the EarlyBird Diabetes Study cohort. Children were recruited from randomly selected schools at 5 years of age. Retrospective measures were maternal prepregnancy weight (n = 230), maternal fasting glucose levels at 28 weeks of pregnancy (n = 27), birth weight, and infant weight at ages 3 and 6 weeks. Prospective measures were insulin resistance, height, weight, and percentage of body fat (sum of 5 skinfold measurements) at ages 5, 6, 7, and 8 years.RESULTS. Maternal third-trimester fasting glucose levels were associated positively with birth weight but were not associated with either weight or insulin resistance for the same children at 8 years. Birth weight was unrelated to insulin resistance at 8 years. There were no relationships between weight change in the first weeks of life and weight, percentage of fat, or insulin resistance at 8 years. Longer breastfeeding correlated inversely, although weakly, with percentage of body fat for boys only. Current weight was correlated with insulin resistance at 8 years.CONCLUSIONS. For these contemporary children, neither the gestational environment nor early postnatal growth predicted insulin resistance, which was best predicted by current weight. There was no evidence that predictive adaptive responses made by the fetus or infant affected the child's weight or insulin resistance later in childhood.
Influenza Vaccination Coverage of Children Aged 6 to 23 Months: The 2002–2003 and 2003–2004 Influenza Seasons
Authors: Santibanez Tammy A. , Santoli Jeanne M. , Bridges Carolyn B. , Euler Gary L. 
Published: September 2006

BACKGROUND. Beginning in 2002 the Advisory Committee on Immunization Practices encouraged, when feasible, annual influenza vaccination of all children aged 6 to 23 months and household contacts and out-of-home caregivers of children &lt;2 years of age.
OBJECTIVE. We sought to report influenza vaccination coverage for the 2002–2003 and 2003–2004 influenza seasons among children aged 6 to 23 months according to demographic and immunization-provider characteristics.
METHODS. Data from the 2003 and 2004 National Immunization Survey were analyzed. Two measures of childhood influenza vaccination are reported: receipt of ≥1 influenza vaccination and full vaccination (ie, receipt of the appropriate number of doses on the basis of previous vaccination history). χ2 tests and logistic-regression analyses to test for associations between influenza vaccination status and demographic characteristics were performed.
RESULTS. In the 2002–2003 and 2003–2004 influenza seasons only 7.4% and 17.5%, respectively, of children aged 6 to 23 months received ≥1 influenza vaccination, whereas only 4.4% and 8.4%, respectively, were fully vaccinated. In both seasons, adjusted influenza vaccination coverage was significantly lower among children living below the poverty level; non-Hispanic black children; older children; children with less-educated mothers; children vaccinated only at public clinics; and children not residing in a metropolitan statistical area.
CONCLUSIONS. During the first 2 years of the Advisory Committee on Immunization Practices' encouragement for children aged 6 to 23 months to receive influenza vaccination, coverage was low, with significant demographic differences in receipt of vaccination. Beginning with the 2004–2005 influenza season, they replaced the encouragement with a recommendation that children aged 6 to 23 months receive annual influenza vaccination. Substantial work remains to fully and equitably implement this new recommendation and ensure vaccination with 2 doses for previously unvaccinated children.
Stimulants and Sudden Death: What Is a Physician to Do?
Authors: Wilens Timothy E. , Prince Jefferson B. , Spencer Thomas J. , Biederman Joseph 
Published: September 2006

OBJECTIVE. Recently, a US Food and Drug Administration advisory committee raised concerns about cardiovascular risks and sudden death in children and adolescents with attention-deficit/hyperactivity disorder who are receiving stimulants.
METHODS. We comment on the risk of sudden death in children/adolescents taking stimulants compared with population rates, biological plausibility, and known cardiovascular effects of stimulants to determine specific risk.
RESULTS. There does not seem to be higher risk of sudden death in stimulant-treated individuals compared with the general population. Although there is evidence of biological plausibility, the known effects of the stimulants on cardiovascular electrophysiology and vital signs seem to be benign.
CONCLUSIONS. There does not seem to be compelling findings of a medication-specific risk necessitating changes in our stimulant treatment of children and adolescents with attention-deficit/hyperactivity disorder. The use of existing guidelines on the use of stimulants (and psychotropic agents) may identify children, adolescents, and adults who are vulnerable to sudden death.
Lactose Intolerance in Infants, Children, and Adolescents
Authors: Heyman Melvin B. ,   for the Committee on Nutrition
Published: September 2006

This Clinical Report was reaffirmed November 2024.
The American Academy of Pediatrics Committee on Nutrition presents an updated review of lactose intolerance in infants, children, and adolescents. Differences between primary, secondary, congenital, and developmental lactase deficiency that may result in lactose intolerance are discussed. Children with suspected lactose intolerance can be assessed clinically by dietary lactose elimination or by tests including noninvasive hydrogen breath testing or invasive intestinal biopsy determination of lactase (and other disaccharidase) concentrations. Treatment consists of use of lactase-treated dairy products or oral lactase supplementation, limitation of lactose-containing foods, or dairy elimination. The American Academy of Pediatrics supports use of dairy foods as an important source of calcium for bone mineral health and of other nutrients that facilitate growth in children and adolescents. If dairy products are eliminated, other dietary sources of calcium or calcium supplements need to be provided.
Occurrence of Photoprotective Compounds in Yeasts from Freshwater Ecosystems of Northwestern Patagonia (Argentina)
Authors: Libkind Diego , Diéguez María C. , Moliné Martín , Pérez Patricia , Zagarese Horacio E. , van Broock María 
Published: September 2006

ABSTRACTIn this paper we present the results of research on the occurrence, induction and role of photoprotective compounds (PPCs) present in native aquatic yeasts from freshwater Patagonian ecosystems. We focus on the effect of UV radiation (UVR) as a factor that controls the level of photoprotection of yeasts, and explore its potential significance in shaping yeast distributional patterns. The research presented here combines field surveys and laboratory work, including the isolation and culture of native yeasts strains, and laboratory assays under different radiation conditions. The results obtained suggest that yeasts are common dwellers of oligotrophic Patagonian water bodies, and provide the first evidence of the distribution of PPC (carotenoid and mycosporine)‐producing yeasts in temperate freshwaters. A greater proportion of carotenogenic yeasts were observed in high‐elevation lakes. The yeast strains isolated from these environments were found to produce higher amounts of mycosporines (MYCs), and to present higher tolerance to UVB exposure than those from piedmont lakes. Patagonian yeasts have only one type of MYC, mycosporine‐glutaminol‐glucoside (myc‐glu‐glu), which seems common to all other yeasts. By analyzing the production of myc‐glu‐glu in a large number of yeasts belonging to different taxonomic groups, we propose that this compound may have potential use as a chemotaxonomic marker in yeast systematics. Collectively, our work reveals that in Patagonian freshwater yeasts there is an apparent relationship between the ability to produce PPCs, their tolerance to UV exposure and their success in colonizing habitats highly exposed to UVR.