bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relation of Prematurity and Brain Injury to Crying Behavior in Infancy
Authors: Maunu Jonna , Kirjavainen Jarkko , Korja Riikka , Parkkola Riitta , Rikalainen Hellevi , Lapinleimu Helena , Haataja Leena , Lehtonen Liisa ,   and the PIPARI Study Group
Published: July 2006

OBJECTIVES. The objective of this study was to assess crying behavior during infancy in very preterm infants with or without brain injury.METHODS. A total of 125 very low birth weight infants survived during January 2001 to July 2004 in Turku University Hospital, Finland. They were categorized according to the most pathologic brain finding either in ultrasound or MRI. Baby Day Diary was used to assess crying behavior at term, 6 weeks, and 5 months of corrected age. The behavior of a group of term control infants (n = 49) was assessed at 5 months.RESULTS. Severe brain injuries in very low birth weight infants did not affect the duration of fussing or crying. In very low birth weight infants, brain injuries did not affect the frequency of fussing or crying bouts or the development of circadian rhythm in crying behavior. At 5 months of corrected age, fussing bouts were more frequent in very low birth weight infants compared with term control infants (6.4 per day vs 4.5 per day), and very low birth weight infants were held more (169 minutes [97] vs 130 minutes [69], respectively).CONCLUSIONS. This prospective study using a validated cry diary showed that brain injuries that are related to prematurity do not have major effects on crying behavior or development of circadian rhythm. Prematurity does not increase the duration but increases the frequency of fussing and crying at 5 months of corrected age compared with term control infants. It also seems that prematurity and brain pathology may increase caregiving activity in the form of holding.
Prediction of Seizures in Asphyxiated Neonates: Correlation With Continuous Video-Electroencephalographic Monitoring
Authors: Murray Deidre M. , Ryan C. Anthony , Boylan Geraldine B. , Fitzgerald Anthony P. , Connolly Sean 
Published: July 2006

BACKGROUND. After perinatal asphyxia, predicting which infants will develop significant hypoxic-ischemic encephalopathy and neonatal seizures remains a difficult task. High-risk markers (Apgar score, acidosis, nucleated red blood cells, and resuscitation) have been used to predict neonatal seizures with varying success. The “3 strikes” of Apgar score of &lt;5 at 5 minutes, pH &lt;7.00, and need for intubation have been cited as having a positive predictive value of 80%. We examined whether the predictive values of these markers would be increased if early continuous electroencephalographic monitoring allowed us to accurately identify all neonatal seizures and to grade the encephalopathy.METHOD. We recruited term infants with perinatal asphyxia. Continuous video electroencephalography was commenced soon after birth and continued for 24 to 72 hours. The abilities of high-risk markers to predict electroencephalographic seizurs, background electroencephalographic activity, and Sarnat grade were examined.RESULTS. Forty-nine infants were suitable for analysis. Electrographic seizures occurred in 11 of the 49 infants. Encephalopathy was scored by using Sarnat grade (6, severe; 18, moderate; 25, mild) and electroencephalographic findings (4 inactive, 4 major abnormalities, 16 moderate abnormalities, and 25 normal/mildly abnormal). Apgar score of &lt;5 at 5 minutes, pH &lt;7.0, and the need for intubation had positive predictive values for neonatal seizures of 18%, 16%, and 21%, respectively. Combining these markers gave a positive predictive value of 25% and a negative predictive value of 77%. Substituting base deficit or lactate for pH in the 3-strikes model did not improve its predictive value. Apgar score of &lt;5 at 5 minutes, nucleated red blood cells, and a base deficit less than −15 mEq/L showed some association with Sarnat grade. Only 5-minute Apgar score was significantly associated with both Sarnat grade and electroencephalographic grade.CONCLUSION. After perinatal asphyxia, neither the condition at birth nor the degree of metabolic acidosis reliably predict neonatal seizures.
Full Breastfeeding and Hospitalization as a Result of Infections in the First Year of Life
Authors: Paricio Talayero José María , Lizán-García Máxima , Puime Ángel Otero , Muncharaz María José Benlloch , Soto Beatriz Beseler , Sánchez-Palomares Marta , Serrano Luis Santos , Rivera Leonardo Landa 
Published: July 2006

OBJECTIVE. Our objective was to assess the effect of breastfeeding on the probability of hospitalization as a result of infectious processes during the first year of lifeMETHODS. We followed 1385 infants from birth to age 1 year between 1996 and 1999. Recruitment and data collection were done at the 6-month well-infant visit under the National Child Health Program. Full breastfeeding, hospital admission, and other relevant variables related to the delivery, infant, mother, health services system, and sociologic aspects were recorded. The statistical analysis included Kaplan-Meier test, Cox regression to obtain the hazard ratio, and the adjusted attributable risk.RESULTS. Full breastfeeding at discharge after delivery and at 3, 4, and 6 months of age were 85%, 52%, 41%, and 15%, respectively; 78 hospital admissions as a result of infections were recorded (38 respiratory tract, 16 gastrointestinal tract). Mean age at admission was 4.1 months. After estimating the attributable risk, it was found that 30% of hospital admissions would have been avoided for each additional month of full breastfeeding. Seemingly, 100% of full breastfeeding among 4-month-old infants would avoid 56% of hospital admissions in infants who are younger than 1 year.CONCLUSIONS. On the basis of the present data, we conclude that full breastfeeding would lower the risk for hospital admission as a result of infections among infants who are younger than 1 year within an industrialized country.
Improving Perinatal Regionalization by Predicting Neonatal Intensive Care Requirements of Preterm Infants: An EPIPAGE-Based Cohort Study
Authors: Vieux Rachel , Fresson Jeanne , Hascoet Jean-Michel , Blondel Beatrice , Truffert Patrick , Roze Jean-Christophe , Matis Jacqueline , Thiriez Gerard , Arnaud Catherine , Marpeau Loic , Kaminski Monique ,   for the EPIPAGE Study Group
Published: July 2006

OBJECTIVE. Perinatal regionalization has been organized into 3 ascending levels of care, fitting increasing degrees of pathology. Current recommendations specify that very premature infants be referred prenatally to level III facilities, yet not all very preterm neonates require level III intensive care. The objective of our study was to determine the antenatal factors that, in association with gestational age, predict the need for neonatal intensive care in preterm infants, to match the size of birth with the level of care required.METHODS. Data were analyzed from a cohort of very preterm infants born in nine French regions in 1997. We defined the need for neonatal intensive care as follows: (1) the requirement for specialized management (mechanical ventilation for &gt;48 hours, high frequency oscillation, or inhaled nitric oxide) or (2) poor outcome (transfer to a level III facility within the first 2 days of life or early neonatal death). Triplet pregnancies and pregnancies marked by fetal malformations or intensive care requirements for the mother before delivery were excluded.RESULTS. We focused our study on 1262 neonates aged 30, 31 and 32 weeks’ gestation, where the need for intensive care was 42.8%, 33.2%, and 22.8%, respectively. Multivariate analysis showed that the risk factors for intensive care requirement with low gestational age were twin pregnancies, maternal hypertension, antepartum hemorrhage, infection, and male gender. Antenatal steroid therapy and premature rupture of membranes were protective factors against intensive care requirement.CONCLUSION. Infants &lt;31 weeks' gestation should be referred to level III facilities. From 31 weeks’ gestation, some infants can be safely handled in level IIb facilities. However, the quality of perinatal regionalization may only be fully assessed by long-term follow-up.
Children at Risk for Special Health Care Needs
Authors: Newacheck Paul W. , Rising Joshua P. , Kim Sue E. 
Published: July 2006

OBJECTIVE. Despite the widespread use of the Maternal and Child Health Bureau definition of children with special health care needs, no published studies have considered the “at-risk” component of the definition. The purpose of this article is to present a conceptual model of risk for special health care needs.METHODOLOGY. The conceptual model presented here was developed based on a comprehensive review of the literature on the determinants of population health and the etiologic literature for selected representative childhood chronic conditions.RESULTS. Our conceptual model is built on 5 key pillars derived from the literature. First, determinants of health have been demonstrated to include genetic endowment, the physical and social environment, health-related behaviors, and the health care system. Second, the model recognizes that the relative importance of each of these domains in contributing to the presence of a special health care need is likely to vary across the major chronic conditions experienced by children. Third, these domains can be conceptualized as acting at the child, family, community, or societal level. Fourth, the model recognizes the presence of a complex interplay of causal factors influencing the development of chronic conditions and associated special health care needs. Fifth, the model incorporates a temporal aspect to the development of special health care needs.CONCLUSIONS. The conceptual model presented here represents a starting point for thinking about the risk factors that influence the occurrence and severity of a special health care need. The model incorporates many of the important breakthroughs by social epidemiologists over the past 25 years by including a broad range of genetic, social, and environmental risk factors; multiple pathways by which they operate; a time dimension; the notion of differential susceptibility and resilience; and a multilevel approach to considering risk. Nevertheless, we recognize that the conceptual model represents an oversimplification of reality. The study of risk factors for special health care needs remains largely in its infancy and is ripe for additional development.
Neuropsychological Outcome of Children With Intrauterine Growth Restriction: A 9-Year Prospective Study
Authors: Geva Ronny , Eshel Rina , Leitner Yael , Valevski Aviva Fattal , Harel Shaul 
Published: July 2006

OBJECTIVE. The aim was to evaluate the effect of late-onset intrauterine growth restriction on the neuropsychological profile and on academic achievements at 9 years of age using a large-scale prospective paradigm.STUDY DESIGN. We followed up 123 infants diagnosed with late-onset intrauterine growth restriction yearly for 9 years. They were matched with 63 children for gestation age and multiple socioeconomic factors and evaluated by an extensive neuropsychological battery to assess intelligence quotient, academic achievements, learning and memory, visuomotor skills, visuospatial integration, attention, language, executive functions, and creativity.RESULTS. Children with intrauterine growth restriction had lower intelligence quotient and more frequent neuropsychological difficulties. Difficulties in executive functioning, inflexibility-creativity, and language, indicative of frontal lobe dysfunction, were typically affected by intrauterine growth restriction and were rarely identified in the control group. Learning difficulties accompanied by lower academic achievements were more prevalent in the intrauterine growth restriction group, particularly when anthropometric catch-up was incomplete.CONCLUSIONS. The longitudinal findings reaffirm that functional coherence depends on preestablished structural growth and reorganization of the central nervous system. The neuropsychological profile at 9 years of age indicates that late-onset intrauterine growth restriction compromises frontal network functioning.
Bronchopulmonary Dysplasia in Very Low Birth Weight Subjects and Lung Function in Late Adolescence
Authors: Doyle Lex W. , Faber Brenda , Callanan Catherine , Freezer Nicholas , Ford Geoffrey W. , Davis Noni M. 
Published: July 2006

OBJECTIVES. The purpose of this work was to determine the relationship between lung function in late adolescence and bronchopulmonary dysplasia, to establish whether lung function changed more from earlier in childhood in those with bronchopulmonary dysplasia, and to assess the effect of different definitions of bronchopulmonary dysplasia on respiratory outcome.METHODS. Subjects were composed of 147 survivors of birth weight &lt;1500 g from the Royal Women's Hospital (Melbourne, Australia) born during 1977–1982 and who had lung function tests at a mean age of 18.9 years. Of the 147 subjects, 33 (22%) had bronchopulmonary dysplasia in the newborn period. Lung function was measured according to American Thoracic Society guidelines.RESULTS. All of the lung function variables reflecting airflow were substantially diminished in the bronchopulmonary dysplasia group, but lung volumes were not significantly different. More subjects in the bronchopulmonary dysplasia group had reductions in airflow in the clinically significant range (eg, forced expired volume in 1 second/forced vital capacity ratio &lt;75%; bronchopulmonary dysplasia: 42.4% [14 of 33]; and no bronchopulmonary dysplasia: 16.4% [18/114]). Results were not substantially affected after adjustment for confounding variables, including intrauterine growth restriction or birth weight. Compared with earlier in childhood, the forced expired volume in 1 second/forced vital capacity ratio deteriorated more in bronchopulmonary dysplasia subjects between 8 and 18 years. Lung function results varied little with different definitions of bronchopulmonary dysplasia.CONCLUSIONS. Subjects of very low birth weight with bronchopulmonary dysplasia in the newborn period have poorer lung function in late adolescence than those without bronchopulmonary dysplasia, and their lung function may be deteriorating at a more rapid rate.
Running Out of Time: Physician Management of Behavioral Health Concerns in Rural Pediatric Primary Care
Authors: Cooper Stephanie , Valleley Rachel J. , Polaha Jodi , Begeny John , Evans Joseph H. 
Published: July 2006

OBJECTIVE. The purpose of this work was to examine pediatricians’ responses to behavioral health concerns raised in the context of rural primary care visits with particular focus on time spent.METHODS. Research assistants directly observed 302 patient visits in 2 rural pediatric primary care offices. The length of the visit, concerns raised, and physicians’ responses were recorded. Interrater reliability, scored for 25% of observed visits, was strong.RESULTS. Behavioral, emotional, or developmental concerns were raised by either the parent or physician in 23.6% of all primary care visits observed. Approximately 9% of all visits were identified as a psychological consultation before the visit and lasted ∼7 minutes longer than visits for other reasons. Behavioral concerns were raised during ∼18% of visits not originally identified as a psychological consultation. In these cases, visit length increased by &gt;5 minutes on average, a statistically significant difference. In addition, during these visits, discussion of behavioral concerns often consumed more than half of the visit. Data suggested that physicians were responsive to behavioral, developmental, or emotional concerns, engaging in further assessment, supportive statements, treatment, or referral in ∼97% of the visits when such concerns were raised.CONCLUSIONS. Findings converge with previous research, showing that approximately one quarter of all primary care visits involve a discussion of behavioral, developmental, or emotional concerns. Moreover, this study is the first to document the specific impact of such concerns on pediatricians’ time, often sited as a key reason why they struggle to effectively identify and treat behavioral concerns presenting in primary care. These data provide a starting point for controlled studies, including comparisons of rural versus urban samples and the impact of various collaborative models of care.
Angioplasty for Renovascular Hypertension in Children: 20-Year Experience
Authors: Shroff Rukshana , Roebuck Derek J. , Gordon Isky , Davies Roger , Stephens Suzanne , Marks Stephen , Chan Mark , Barkovics Maria , McLaren Clare A. , Shah Vanita , Dillon Michael J. , Tullus Kjell 
Published: July 2006

OBJECTIVE. Our aim was to evaluate the clinical outcomes, safety, and efficacy of percutaneous transluminal angioplasty for renovascular hypertension in children.METHODS. A retrospective review of data for all children with renovascular hypertension who underwent percutaneous transluminal angioplasty at a single center between 1984 and 2003 was performed. Patients with renal transplants and inflammatory multisystem diseases were excluded.RESULTS. Thirty-three children, 1.9 to 17.9 years of age (median: 10.3 years), underwent renal angioplasty and/or stenting. Underlying syndromes were present in 10. On angiograms, 16 had bilateral renal artery stenosis, 15 intrarenal disease, 8 aortic stenosis, and 7 cerebrovascular disease. Forty-eight percutaneous transluminal angioplasty procedures were performed, including 15 stenting procedures. There was a high rate of restenosis after stenting (7 of 19 cases, compared with 2 of 27 cases after balloon dilation). Outcomes were cured (ie, blood pressure normal without treatment) for 9 patients, improved blood pressure with same or reduced treatment for 7, blood pressure maintained in &gt;95th percentile because of cerebrovascular disease for 2, no change in blood pressure despite technical success for 10, and technical failure for 5. Blood pressure control improved in 11 of 13 children who had main renal artery disease alone and in 6 of 20 with associated intrarenal disease or stenoses in other vascular beds. There was 1 procedure-related death and 5 minor complications.CONCLUSIONS. Angioplasty produced clinically worthwhile improvement for ∼50% of patients. High incidence rates of extrarenal involvement and intrarenal disease and a high restenosis rate after stenting accounted for poor blood pressure control in the rest.
Breastfeeding During Infancy May Protect Against Bed-wetting During Childhood
Authors: Barone Joseph G. , Ramasamy Ranjith , Farkas Andrew , Lerner Emanuel , Creenan Eileen , Salmon Dawn , Tranchell Jessica , Schneider Dona 
Published: July 2006

OBJECTIVE. Our goal was to test the hypothesis that children who exhibit bed-wetting during childhood were less likely to be breastfed during infancy compared with normal controls.METHODS. A case-control study was conducted in a pediatric continence center and a general pediatric practice. Cases (n = 55) were recruited from the continence center and defined as children 5 to 13 years of age who experienced lifetime involuntary voiding of urine during nighttime sleep at least 2 times a week in the absence of defects of the central nervous system or urinary tract. Age- and gender-matched controls (n = 117) who did not exhibit bed-wetting were enrolled from a general pediatric practice. Infant feeding practices were measured as breastfeeding (yes/no) and, for those who were breastfeed, by the duration of breastfeeding and the time of formula supplementation.RESULTS. Among the case subjects, 45.5% were breastfed, whereas among the controls 81.2% were breastfed. The controls reported higher household incomes than the case subjects, and their mean family size (number of children) was slightly lower. After adjusting for race, income, and family size, the odds ratio was 0.283, indicating that case subjects were significantly less likely than controls to be breastfeed. Among all the study subjects who were breastfed, controls were breastfed for a significantly longer period than case subjects (an average of 3 months longer). Although breastfed controls were less likely to be supplemented with formula than breastfed case subjects, this difference was not statistically significant.CONCLUSIONS. Breastfeeding longer than 3 months may protect against bed-wetting during childhood. Breast milk supplemented with formula did not make a difference in the rate of enuresis.
Asthma Symptoms Among Adolescents Who Attend Public Schools That Are Located Near Confined Swine Feeding Operations
Authors: Mirabelli Maria C. , Wing Steve , Marshall Stephen W. , Wilcosky Timothy C. 
Published: July 2006

OBJECTIVES. Little is known about the health effects of living in close proximity to industrial swine operations. We assessed the relationship between estimated exposure to airborne effluent from confined swine feeding operations and asthma symptoms among adolescents who were aged 12 to 14 years.METHODS. During the 1999–2000 school year, 58169 adolescents in North Carolina answered questions about their respiratory symptoms, allergies, medications, socioeconomic status, and household environments. To estimate the extent to which these students may have been exposed during the school day to air pollution from confined swine feeding operations, we used publicly available data about schools (n = 265) and swine operations (n = 2343) to generate estimates of exposure for each public school. Prevalence ratios and 95% confidence intervals for wheezing within the past year were estimated using random-intercepts binary regression models, adjusting for potential confounders, including age, race, socioeconomic status, smoking, school exposures, and household exposures.RESULTS. The prevalence of wheezing during the past year was slightly higher at schools that were estimated to be exposed to airborne effluent from confined swine feeding operations. For students who reported allergies, the prevalence of wheezing within the past year was 5% higher at schools that were located within 3 miles of an operation relative to those beyond 3 miles and 24% higher at schools in which livestock odor was noticeable indoors twice per month or more relative to those with no odor.CONCLUSIONS. Estimated exposure to airborne pollution from confined swine feeding operations is associated with adolescents’ wheezing symptoms.