bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mortality and Morbidity by Month of Birth of Neonates Admitted to an Academic Neonatal Intensive Care Unit
Authors: Soltau Thomas D. , Carlo Waldemar A. , Gee Jonathan , Gould Jeffrey , Ambalavanan Namasivayam 
Published: October 2008

BACKGROUND. Clinical expertise and skill of pediatric housestaff improve over the academic year, and performance varies despite supervision by faculty neonatologists. It is possible that variation in clinical expertise of housestaff affects important clinical outcomes in infants in ICUs.
OBJECTIVE. Our goal was to test the hypothesis that there is a decrease in morbidity and mortality in infants admitted to an NICU over the course of the academic year.
DESIGN/METHODS. A retrospective analysis was conducted using data on infants with birthweight 401 to 1500 g and ≥24 weeks’ gestation (n = 3445) and infants with birth weights &gt;1500 g (n = 7840) admitted to a regional NICU from January 1991 to June 2004. All infants were cared for by pediatric and neonatal housestaff supervised by neonatologists. Analysis of mortality and morbidity (intraventricular hemorrhage grades 3–4/periventricular leukomalacia, necrotizing enterocolitis ≥ Bell stage 2, and bronchopulmonary dysplasia) over time were performed by repeated measures analysis of variance and the χ2 test.
RESULTS. Mortality rate in the 401 to 1500 g cohort, as well as the &gt;1500 g cohort did not decrease over time during the academic year and was similar between the first (July–December) and second (January–June) halves of the academic year. There were no differences noted over the academic year for any of the morbidities.
CONCLUSIONS. Morbidity and mortality in infants admitted to an academic NICU did not change significantly over the academic year. These observations suggest that the quality of care of critically ill neonates is not decreased early in the academic year.
Increased Mortality Rates of Young Children With Traumatic Injuries at a US Army Combat Support Hospital in Baghdad, Iraq, 2004
Authors: Matos Renée I. , Holcomb John B. , Callahan Charles , Spinella Philip C. 
Published: October 2008

OBJECTIVE. The objective of this study was to determine whether age ≤8 y is an independent predictor of mortality in noncoalition trauma patients at a US combat support hospital.
METHODS. A retrospective chart review was conducted of 1132 noncoalition trauma patients who were admitted to a combat support hospital between December 2003 and December 2004. Data on age, severity of injury indices, and in-hospital mortality rates were analyzed. All variables that were associated with death on univariate analysis were analyzed by multivariate logistic regression to determine independent associations with mortality.
RESULTS. There were 38 young pediatric patients (aged ≤8 years) and 1094 older pediatric and adult patients (aged &gt;8 years). Penetrating trauma accounted for 83% of all injuries. Young pediatric patients compared with older pediatric and adult patients had increased severity of injury indicated by decreased Glasgow Coma Scale score; increased incidence of hypotension, base deficit, and serum pH on admission; red blood cell transfusion amount; and increased injury severity scores on admission. Young pediatric patients compared with older pediatric and adult patients also had increased ICU lengths of stay (median 2 [interquartile range 0–5] vs median 0 [interquartile range 0–2] days) and in-hospital mortality rate (18% vs 4%), respectively. Multivariate logistic regression indicated that base deficit, injury severity score of ≥15, Glasgow Coma Scale score of ≤8, and age of ≤8 years were independently associated with mortality.
CONCLUSIONS. Young children who present to a combat support hospital have increased severity of injury compared with older children and adults. In a population with primarily penetrating injuries, after adjustment for severity of injury, young children may also have an independent increased risk for death compared with older children and adults. Providing forward-deployed medical staff with pediatric-specific equipment and training in the acute care of young children with severe traumatic injuries may improve outcomes in this population.
Health Risk Behaviors in Adolescents With Chronic Conditions
Authors: Surís Joan-Carles , Michaud Pierre-André , Akre Christina , Sawyer Susan M. 
Published: October 2008

OBJECTIVE. The objective of this study was to compare the frequency of risk behaviors and to measure the extent of co-occurrence of these behaviors in chronically ill and healthy adolescents.METHODS. Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health database, a nationally representative survey of 7548 adolescents in postmandatory school aged 16 to 20 years. There were 760 subjects who reported a chronic illness and/or a disability. The comparison group consisted of 6493 subjects who answered negatively to both questions. We defined 8 risk behaviors: daily smoking, alcohol misuse, current cannabis use, current use of any other illegal drug, early sexual debut, eating disorder, violent acts, and antisocial acts. We analyzed each behavior and the sum of behaviors, controlling for age, gender, academic track, parents' education level, depression, and health status. Results are given as adjusted odds ratios using the comparison group as the reference category.RESULTS. Youth with a chronic condition were more likely to smoke daily, to be current cannabis users, and to have performed violent or antisocial acts. Youth with a chronic condition were also more likely to report 3 or ≥4 risk behaviors.CONCLUSIONS. These results indicate that having a chronic condition carries additional risks for engaging in health risk behaviors and emphasize the importance of health risk screening and preventive counseling for young people in general and among those suffering from chronic conditions in particular.
Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents
Authors: Wagner Carol L. , Greer Frank R. ,   and the Section on Breastfeeding and Committee on Nutrition
Published: October 2008

This Clinical Report was retired October 2012.Rickets in infants attributable to inadequate vitamin D intake and decreased exposure to sunlight continues to be reported in the United States. There are also concerns for vitamin D deficiency in older children and adolescents. Because there are limited natural dietary sources of vitamin D and adequate sunshine exposure for the cutaneous synthesis of vitamin D is not easily determined for a given individual and may increase the risk of skin cancer, the recommendations to ensure adequate vitamin D status have been revised to include all infants, including those who are exclusively breastfed and older children and adolescents. It is now recommended that all infants and children, including adolescents, have a minimum daily intake of 400 IU of vitamin D beginning soon after birth. The current recommendation replaces the previous recommendation of a minimum daily intake of 200 IU/day of vitamin D supplementation beginning in the first 2 months after birth and continuing through adolescence. These revised guidelines for vitamin D intake for healthy infants, children, and adolescents are based on evidence from new clinical trials and the historical precedence of safely giving 400 IU of vitamin D per day in the pediatric and adolescent population. New evidence supports a potential role for vitamin D in maintaining innate immunity and preventing diseases such as diabetes and cancer. The new data may eventually refine what constitutes vitamin D sufficiency or deficiency.
Adverse Effects of Inhaled Corticosteroids in Funded and Nonfunded Studies
Authors: Adinoff Allen 
Published: October 2008

Nieto A, Mazon A, Pamies R, et al. Arch Intern Med. 2007;167(19):2047–2053
PURPOSE OF THE STUDY. Evidence regarding the safety profile of drugs may vary depending on study sponsorship. The authors aimed to evaluate differences between studies funded by the pharmaceutical manufacturer of the drug (PF) and those with no pharmaceutical funding (NoPF) regarding the finding and interpretation of adverse effects of inhaled corticosteroids.
METHODS. The authors assessed the safety reporting of inhaled corticosteroids in 275 PF and 229 NoPF studies identified by a Medline search using prespecified criteria.
RESULTS. Overall, the finding of statistically significant differences for adverse effects was significantly less frequent in PF (34.5%) than in NoPF (65.1%) studies (prevalence ratio [PR]: 0.53 [95% confidence interval (CI): 0.44–0.64]). This association became nonsignificant (PR: 0.94 [95% CI: 0.77–1.15]) after controlling for design features (such as dose or use of parallel groups) that tended to be associated with less-frequent findings of adverse effects and were more common in PF studies. Among studies that found a statistically significant increase in adverse effects associated with the study drug, the authors of PF articles concluded that the drug was “safe” more frequently than the authors of NoPF studies (PR: 3.68 [95% CI: 2.14–6.33]).
CONCLUSIONS. The type of funding may have determinant effects on the design of studies and on the interpretation of findings: funding by the industry is associated with design features less likely to lead to finding statistically significant adverse effects and with a more favorable clinical interpretation of such findings. Disclosure of conflicts of interest should be strengthened for a more balanced opinion on the safety of drugs
REVIEWER COMMENTS. Okay, so maybe this is not a real big shock to most of us. What was surprising to me was the extent that this bias exists with a variety of other drugs including hypertensive agents, pain medications, and cancer treatments. This seems to be related to the study design of the protocols, suggesting that the whole system is “rigged.” The investigator physicians have no clue how the studies are set up or how the data are manipulated. So where is the Food and Drug Administration in all of this?
Esophageal Subepithelial Fibrosis in Children With Eosinophilic Esophagitis
Authors: Geaney Casey 
Published: October 2008

Chehade M, Sampson H, Morotti R, Magid M. J Pediatr Gastroenterol Nutr. 2007;45:319–328
PURPOSE OF THE STUDY. To determine the prevalence and specificity of esophageal fibrosis in children with eosinophilic esophagitis (EE) and to correlate its presence with clinical presentation and additional pathologic features.
STUDY POPULATION. This was a retrospective review of 1099 upper endoscopy specimens from pediatric patients presenting over a 6-year period with upper gastrointestinal complaints suspicious for possible EE. Patients with known infectious disease, parasitic disease, celiac disease, or inflammatory bowel disease were excluded. Fifty-one patients were included: 21 with EE, 7 with eosinophilic gastroenteritis, 6 with gastroesophageal reflux disease, and 17 controls.
METHODS. A normal pattern and extent of collagen and elastin fiber composition in the esophageal lamina propria was established in the control specimens. Extent of fibrosis was determined on trichrome-stained specimens. Fibrosis was defined as abnormally increased collagen deposition. Hematoxylin and eosin staining, and immunohistochemical staining for tryptase and major basic protein and were used to determine intraepithelial and lamina propria maximum eosinophil counts and extent of eosinophilic degranulation at 400 high-power field as well as mast cell presence and extent of degranulation. Basal thickness and lymphocyte and plasma cell infiltration were also determined.
RESULTS. Subepithelial fibrosis was present in 57% of the patients with EE, 1 patient with eosinophilic gastroenteritis, 0 patients with gastroesophageal reflux disease, and 1 control patient. Dysphagia was present in 42% of the patients with fibrosis. Dysphagia was not observed in the absence of fibrosis. Fibrosis was not influenced by increasing eosinophil or mast cell counts; however, fibrosis was significantly associated with eosinophilic degranulation in the epithelium.
CONCLUSIONS. Subepithelial fibrosis is both common in EE and specific for this disease in children. There is a strong association between dysphagia and fibrosis in children with EE. The extent of eosinophilic activation seems to be influenced by the degree of fibrosis.
REVIEWER COMMENTS. This article provides additional insight into the pathology of EE, an inflammatory disorder that is often associated with food allergy. Although a strong relationship was seen between fibrosis and dysphagia in this study, its impact on motility in this specific disease would be an interesting additional determination. Nevertheless, fibrosis preceded the dysphagia in this study, and it may serve as an early marker of more-severe disease. Fibrosis was associated with eosinophilic activation, which may also serve as a maker for more-severe disease. The presence of 1 or both may indicate a need for more aggressive treatment.
Childhood Overweight Increases Hospital Admission Rates for Asthma
Authors: Randolph Christopher 
Published: October 2008

Carroll CL, Stoltz P, Raykov N, Smith SR, Zucker AR. Pediatrics. 2007;120(4):734–740
PURPOSE OF THE STUDY. To determine if childhood overweight increases the risk of hospitalization for asthma among children presenting to an emergency department with an asthma exacerbation.
STUDY POPULATION. Children who were &gt;2 years old and presented to the emergency department of a Connecticut children's hospital with an asthma exacerbation in 2005 were included in the study.
METHODS. A retrospective chart review was completed. Children were classified as overweight (&gt;95th weight-for-age percentile) or nonoverweight (≤95th weight-for-age percentile). Children with chronic medical conditions other than asthma were excluded.
RESULTS. There were 884 visits for 813 children. Overall, 238 (27%) were admitted to the hospital, and 33 (4%) were admitted to the ICU. Overweight children (202 [23%]) were significantly more likely to be older (8.5± 4.4 vs 7.3 ± 4.3 years) and to inhabit an impoverished area (37% vs 28%). Overall, hospital admission was associated with higher clinical asthma score but not with age, gender, or poverty status. Despite similar asthma scores and therapeutic management in the emergency department, hospital and ICU admission was significantly more likely for overweight than nonoverweight children (odds ratio: 1.76 [95% confidence interval: 1.23–2.51]; P = .002).
CONCLUSIONS. Overweight children with an acute episode of asthma seen in an emergency department are significantly more likely to be admitted than their nonoverweight counterparts. Overweight status clearly impacts asthma management and health in children.
REVIEWER COMMENTS. The limitations of this study include its retrospective nature and the failure to use BMI because of lack of height data. However, the weight-for-age percentiles used in this study are most commonly used in practice. When children younger than 5 years, in which asthma diagnosis is difficult, are excluded, the conclusion still holds with overweight children ≥5 years old being significantly more likely to be admitted than nonoverweight children (33% vs 24%; P = .03). Whether the results reflect comorbidity, differences in lung mechanics, differences in response to therapy, more severe asthma, or socioeconomic or behavioral factors remains to be determined.
STAT3 Mutations in the Hyper-IgE Syndrome
Authors: Bonilla Francisco A. 
Published: October 2008

Holland SM, DeLeo FR, Elloumi HZ, et al. N Engl J Med. 2007;357(16):1608–1619
PURPOSE OF THE STUDY. To identify the genetic defect underlying the hyper–immunoglobulin E (IgE) (Job) syndrome.
STUDY POPULATION. Patients with hyper-IgE syndrome were ranked by a clinical scoring system. Fifty patients over the age of 16 years who had the highest scores (most features of the disease) were selected. Forty-eight family members also underwent genetic analysis.
METHODS. The authors used a combination of microarray screening of gene expression and analysis of cytokine production in vitro from lymphocytes subjected to various stimuli.
RESULTS. Lymphocytes from patients were found to have diminished response to the cytokine interleukin 6. The authors systematically analyzed the intracellular signaling molecules involved in the response to interleukin 6 and found that patients carried a mutation in 1 of the 2 copies of the gene encoding signal transducer and activator of transcription 3 (STAT3). They confirmed the biological importance of the mutations by showing that the STAT3 protein did not function normally within the cell.
CONCLUSIONS. STAT3 mutations are the genetic basis of the hyper-IgE syndrome.
REVIEWER COMMENTS. The first clinical description of hyper-IgE syndrome as a distinct entity was published in 1966. It was given the eponym “Job syndrome” as a biblical allusion because of the many severe skin abscesses that afflict patients with the condition. This report is the culmination of &gt;40 years of investigation by many groups around the world to find the molecular basis of this disease. A similar report was published by another group around the same time (Minegishi Y, Saito M, Tsuchiya S, et al. Nature. 2007;448[7157]:1058–1062). We are reminded again of the power of modern molecular biological methods and the tremendous insights we gain when such diseases are finally understood at their “source.”
Population Prevalence of Diagnosed Primary Immunodeficiency Diseases in the United States
Authors: Bonilla Francisco A. 
Published: October 2008

Boyle JM, Buckley RH. J Clin Immunol. 2007;27(5):497–502
PURPOSE OF THE STUDY. To measure the prevalence of primary immunodeficiency diseases (PIDs) in the United States.
STUDY POPULATION. A random sample of 10 005 American households (26 657 people) was included in the study.
METHODS. Households were selected by random-digit dialing stratified according to time zone. Calls were placed by trained interviewers with computer assistance. Eighty percent of the households contacted completed the interview. Respondents were asked, “Has anyone in your household ever been diagnosed with a primary immunodeficiency disease such as common variable immunodeficiency, IgA [immunoglobulin A] deficiency, IgG subclass deficiency, or any other immunodeficiency? (This is not acquired immunodeficiency—AIDS).” If they replied “yes,” they were further questioned with details of the diagnosis and limited demographic information about the affected individual(s).
RESULTS. Twenty-three individuals in 18 households were identified as having a specific PID (including common variable immunodeficiency, IgA deficiency, IgG subclass deficiency, X-linked agammaglobulinemia, severe combined immunodeficiency, and chronic granulomatous disease). The calculated prevalence of diagnosed immunodeficiency was 1 in 2000 children, 1 in 1200 people of all ages, and 1 in 600 households. The 95% confidence limits for the estimate for all individuals were between 1 in 824 and 1 in 1956. Several of the identified individuals with primary immunodeficiency were not receiving therapy that is standard of care for their diagnoses (γ-globulin replacement).
CONCLUSIONS. Quoting the authors, “The current study suggests that these conditions are sufficiently common that primary care physicians are likely to see patients with underlying primary immunodeficiency disorders in their practice and should test for these disorders in patients with recurring, unusual or serious infections. In the absence of routine screening, physician awareness of the relative frequency of these disorders is critical to early diagnosis and treatment.”
REVIEWER COMMENTS. This is an extremely important message for all primary care physicians. These patients are in your practices now. The authors also pointed out that several studies have shown that many cases of PID are diagnosed late or are “mild” enough that they are never diagnosed and that patients suffer excess morbidity and mortality as a result. Some severe cases may be missed because children die before they are diagnosed. Thus, the true prevalence of PID is likely to be higher than what was found in this study. I found it discouraging that two thirds of the people who should have been receiving γ globulin were not.
Pulse Oximetry Coupled With Spirometry in the Emergency Department Helps Differentiate an Asthma Exacerbation From Possible Vocal Cord Dysfunction
Authors: Williams Larry W. 
Published: October 2008

Nolan PK, Chrysler M, Phillips G, Goodman D, Rusakow LS. Pediatr Pulmonol. 2007;42(7):605–609
PURPOSE OF THE STUDY. These investigators sought to determine if they could find evidence for vocal cord dysfunction (VCD) in asthmatic adolescents whose condition failed to respond adequately to treatment in the emergency department (ED) for a presumptive asthma exacerbation.
STUDY POPULATION. Subjects with wheezing presenting to the ED of an urban children's hospital were recruited. Inclusion criteria were age 12 to 21 years, failure to respond to treatment for wheeze sufficiently to allow discharge, and pulse oximetry reading of ≥97%. Exclusion criteria were having other cardiac or pulmonary disease, inability to perform spirometry, or need for endotracheal intubation.
METHODS. Spirometry with standard techniques was performed by using a computer-linked pneumotachygraph and appropriate software to capture both expiratory and inspiratory flow volume curves. Spirometric results were classified as small airway obstruction, variable extrathoracic airway obstruction (consistent with VCD), a combination of the 2 previous findings, or normal airflow.
RESULTS. Twenty ED encounters with 17 subjects were studied. Only 5 (25%) of the encounters included spirometric evidence of small airway obstruction, but 12 of 20 had evidence for VCD (ie, variable extrathoracic airway obstruction on the inspiratory loop). These 12 included 3 that also had evidence for small airway obstruction. There were 6 encounters with no abnormality on spirometry.
CONCLUSIONS. Spirometry may identify presumptive refractory asthma exacerbations that, instead, are episodes of VCD.
REVIEWER COMMENTS. Several years ago we treated an 8-year-old boy who had been admitted to the hospital for status asthmaticus 4 times in 1 month but never had an oxygen requirement. A videotape of the boy when he was symptomatic (provided by the parents) showed obvious stridor, not wheezing. Similarly, in this study the cardinal observation was refractory “wheeze” without arterial desaturation. Computerized spirometry is not universally available in the ED, and in addition, not all such units have software capable of displaying the inspiratory limb of the flow-volume loop. However, in busy ED environments with large asthmatic populations, availability of this measurement should greatly aid the classification of wheezing events. Pediatricians need to be more aware that VCD may present symptoms that mimic asthma.