bluuebunny/crossref_metadata_2025_split huggingface dataset:
State Newborn Screening in the Tandem Mass Spectrometry Era: More Tests, More False-Positive Results
Authors: Tarini Beth A. , Christakis Dimitri A. , Welch H. Gilbert 
Published: August 2006

BACKGROUND. The advent of tandem mass spectrometry has made it possible to test newborns for multiple conditions efficiently. It is not known how state newborn screening programs have changed screening practices in response to this technology and how it affects the number of false-positive test results.METHODS. We obtained data from the National Newborn Screening and Genetics Resource Center regarding the screening practices for each of the 50 states, to determine the number of mandated disorders added to state newborn screening panels between 1995 and 2005. Combining these data with reported specificities from the literature and the number of births in each state, we estimated the number of infants who would have received false-positive results through screening with tandem mass spectrometry in 2005.RESULTS. The average state mandated screening for 5 disorders in 1995 (range: 0–8 disorders). Wyoming was the only state that decreased its panel size over the next decade. Kansas and Texas were the only states that did not add disorders to their panels between 1995 and 2005; the average state added 19. Iowa, Minnesota, Mississippi, South Dakota, and Tennessee each added ≥40 disorders. Assuming that an individual test for a disorder had a specificity of 99.995%, we estimated that ∼2575 infants would have received false-positive results through screening with tandem mass spectrometry in 2005. If specificity was assumed to be 99.9%, then the number increased to &gt;51000.CONCLUSIONS. State newborn screening programs have expanded dramatically in the past decade. Because the benefit of such testing may be unclear in some cases and because the number of infants who may receive false-positive results and may be labeled falsely as having disease is potentially sizeable, a more cautious approach is needed.
Topical Ciprofloxacin/Dexamethasone Superior to Oral Amoxicillin/Clavulanic Acid in Acute Otitis Media With Otorrhea Through Tympanostomy Tubes
Authors: Dohar Joseph , Giles William , Roland Peter , Bikhazi Nadim , Carroll Sean , Moe Roderick , Reese Bradley , Dupre Sheryl , Wall Michael , Stroman David , McLean Celeste , Crenshaw Krista 
Published: August 2006

OBJECTIVE. This study was a comparison of topical ciprofloxacin/dexamethasone otic suspension to oral amoxicillin/clavulanic acid suspension in children with acute otitis media with otorrhea through tympanostomy tubes.METHODS. This was a randomized, observer-masked, parallel-group, multicenter trial of topical ciprofloxacin/dexamethasone otic suspension versus amoxicillin/clavulanic acid suspension in 80 children aged 6 months to 12 years with acute otitis media with otorrhea through tympanostomy tubes of ≤3 weeks' duration and visible otorrhea. Patients were randomly assigned to receive either 4 drops of topical ciprofloxacin 0.3%/dexamethasone 0.1% (Ciprodex Sterile Otic Suspension) into the affected ear(s) twice daily for 7 days or 600 mg of amoxicillin/42.9 mg of clavulanic acid oral suspension (Augmentin ES-600 Oral Suspension) every 12 hours for 10 days. Clinical signs and symptoms of acute otitis media with otorrhea through tympanostomy tubes were evaluated on days 1 (baseline), 3, 11 (end-of-therapy), and 18 (test-of-cure), and twice-daily assessments of otorrhea were recorded in patient diaries.RESULTS. The median time to cessation of otorrhea was significantly shorter with ciprofloxacin/dexamethasone otic suspension than with amoxicillin/clavulanic acid suspension (4.0 vs 7.0 days; n = 79). This resulted in significantly more clinical cures at the test-of-cure visit (85% vs 59%, respectively). Frequent adverse events (&gt;3%) related to ciprofloxacin/dexamethasone otic suspension included ear pain (5.1%) and related to amoxicillin/clavulanic acid suspension included diarrhea (19.5%), dermatitis (7.3%), and gastroenteritis (4.9%).CONCLUSIONS. Topical otic treatment with ciprofloxacin/dexamethasone otic suspension is superior to treatment with oral amoxicillin/clavulanic acid suspension and results in more clinical cures and earlier cessation of otorrhea with fewer adverse effects in children with acute otitis media with otorrhea through tympanostomy tubes.
Screening for Celiac Disease in Asymptomatic Children With Down Syndrome: Cost-effectiveness of Preventing Lymphoma
Authors: Swigonski Nancy L. , Kuhlenschmidt Heather L. , Bull Marilyn J. , Corkins Mark R. , Downs Stephen M. 
Published: August 2006

BACKGROUND. Studies demonstrate an increased prevalence of celiac disease in persons with Down syndrome, leading some organizations and authors to recommend universal screening of children with Down syndrome. However, many children with Down syndrome are asymptomatic, and the long-term implications of screening are unknown. The complication of celiac disease that leads to mortality in the general population is non-Hodgkin's lymphomas.OBJECTIVES. The purpose of this research in asymptomatic children with Down syndrome was to (1) calculate the number needed to screen to prevent a single case of lymphoma and (2) present a cost-effectiveness study of screening.METHODS. We constructed a decision tree using probabilities derived from the published literature for Down syndrome or from the general population where Down syndrome-specific data were not available. Celiac disease was determined by serologic screening and confirmation with intestinal biopsy. Sensitivity analysis was used to alter probability estimates affecting the cost of preventing lymphoma.RESULTS. Using our baseline values, the no-screen strategy is dominant; that is, screening not only costs more but also results in fewer quality-adjusted life-years. A screening strategy costs more than $500000 per life-year gained. Screening all asymptomatic children with Down syndrome for celiac disease costs almost $5 million to prevent a single case of lymphoma.CONCLUSION. These analyses do not support the cost-effectiveness of screening, and more data are needed before recommendations to screen asymptomatic children with Down syndrome for celiac disease can be made.
Childhood Bullying Involvement and Exposure to Intimate Partner Violence
Authors: Bauer Nerissa S. , Herrenkohl Todd I. , Lozano Paula , Rivara Frederick P. , Hill Karl G. , Hawkins J. David 
Published: August 2006

OBJECTIVE. Our objectives with this study were to describe the prevalence of bullying involvement (ie, bullying and victimization) among children from a multigenerational study and to examine the relationship of these childhood behaviors and exposure to intimate partner violence.
METHODS. A community-based cohort of 112 children (aged 6 to 13 years) was asked to self-report on physical, verbal, and relational types of bullying and victimization experienced in the past year. Parents reported on their child's externalizing and internalizing behaviors during the previous 6 months using items from Achenbach's Child Behavior Checklist. The frequency of parental experiences of intimate partner violence perpetration and victimization at 2 time points during the preceding 5 years was measured using Conflict Tactics Scale items. The association of intimate partner violence and parent-reported child behavioral problems was examined, followed by exposure to intimate partner violence and child-reported bullying or victimization. Parental risk factors (eg, race/ethnicity, education, problem drinking) that predispose to intimate partner violence were controlled for using propensity score statistical modeling.
RESULTS. Eighty-two (73.2%) children reported being victimized by peers, and 38 (33.9%) children reported bullying behaviors in the past year. More reports came from girls than from boys (55% for victimization and 61% for bullying). Almost all (97%) child bullies were also victims themselves. Intimate partner violence was reported by parent respondents in 53 (50.5%) households at any or both of the 2 time points. Exposure to intimate partner violence was not associated with child-reported relational bullying behaviors or victimization by peers, However, intimate partner violence–exposed children were at increased risk for problematic levels of externalizing behavior/physical aggression and internalizing behaviors.
CONCLUSIONS. In our sample, children who were 6 to 13 years of age reported a substantial amount of bullying and victimization; a large majority were bully-victims and female. Regression analyses did not show that children who were exposed to intimate partner violence were more likely to engage in relational bullying. However, children who are exposed to intimate partner violence have a higher likelihood of internalizing behaviors and physical aggression.
Metoclopramide for the Treatment of Gastroesophageal Reflux Disease in Infants: A Systematic Review
Authors: Hibbs Anna Maria , Lorch Scott A. 
Published: August 2006

OBJECTIVES. Metoclopramide is a commonly used drug to treat gastroesophageal reflux disease in infants. Given its widespread use and growing concern about toxicity in this population, we conducted a systematic review of metoclopramide for the treatment of gastroesophageal reflux disease in infants.
METHODS. We performed a systematic search of PubMed and bibliographies of relevant review articles. We included cohort, case-control, and intervention studies of the efficacy, effectiveness, or toxicity of metoclopramide therapy for gastroesophageal reflux disease in infants. We excluded case reports, case series, review articles, and abstracts.
RESULTS. Twelve articles met our inclusion criteria. Of these, 11 were prospective trials, and 5 were randomized, blinded clinical trials. Study size ranged from 6 to 77 patients. Eight studies showed patient improvement with metoclopramide in at least 1 measured outcome; 1 study showed worsening symptoms with metoclopramide. Of the 5 randomized, blinded trials, 2 showed no effect of metoclopramide on any outcome, and 2 showed a significant placebo effect. Four studies commented on adverse effects of therapy, with irritability being the most frequently reported potential adverse effect of therapy. Other reported adverse effects included dystonic reactions, drowsiness, oculogyric crisis, emesis, and apnea. Among studies, there was marked heterogeneity in the patient populations, dosing, and outcomes studied. Therefore, a meta-analysis was not performed. We both agreed on a US Preventive Service Task Force rating of “poor” for the level of evidence, leading to an “inconclusive” recommendation for the safety and efficacy of metoclopramide in infants.
CONCLUSIONS. The current literature is insufficient to either support or oppose the use of metoclopramide for gastroesophageal reflux disease in infants. In the future, large blinded randomized clinical trials are needed to determine the efficacy and toxicity of metoclopramide in this population.
Factors Influencing the Composition of the Intestinal Microbiota in Early Infancy
Authors: Penders John , Thijs Carel , Vink Cornelis , Stelma Foekje F. , Snijders Bianca , Kummeling Ischa , van den Brandt Piet A. , Stobberingh Ellen E. 
Published: August 2006

OBJECTIVE. The aim of this study was to examine the contribution of a broad range of external influences to the gut microbiotic composition in early infancy.
METHODS. Fecal samples from 1032 infants at 1 month of age, who were recruited from the KOALA Birth Cohort Study in the Netherlands, were subjected to quantitative real-time polymerase chain reaction assays for the enumeration of bifidobacteria, Escherichia coli, Clostridium difficile, Bacteroides fragilis group, lactobacilli, and total bacterial counts. Information on potential determinants of the gut microbiotic composition was collected with repeated questionnaires. The associations between these factors and the selected gut bacteria were analyzed with univariate and multivariate analyses.
RESULTS. Infants born through cesarean section had lower numbers of bifidobacteria and Bacteroides, whereas they were more often colonized with C difficile, compared with vaginally born infants. Exclusively formula-fed infants were more often colonized with E coli, C difficile, Bacteroides, and lactobacilli, compared with breastfed infants. Hospitalization and prematurity were associated with higher prevalence and counts of C difficile. Antibiotic use by the infant was associated with decreased numbers of bifidobacteria and Bacteroides. Infants with older siblings had slightly higher numbers of bifidobacteria, compared with infants without siblings.
CONCLUSIONS. The most important determinants of the gut microbiotic composition in infants were the mode of delivery, type of infant feeding, gestational age, infant hospitalization, and antibiotic use by the infant. Term infants who were born vaginally at home and were breastfed exclusively seemed to have the most “beneficial” gut microbiota (highest numbers of bifidobacteria and lowest numbers of C difficile and E coli).
Assent for Treatment: Clinician Knowledge, Attitudes, and Practice
Authors: Lee K. Jane , Havens Peter L. , Sato Thomas T. , Hoffman George M. , Leuthner Steven R. 
Published: August 2006

OBJECTIVES. Our purpose for this work was to explore clinician knowledge, attitudes, and practice regarding assent for medical treatment and to compare current practice with existing American Academy of Pediatrics guidelines.METHODS. One of the investigators administered a questionnaire to clinicians who perform procedures on children at an academic tertiary care pediatric hospital to assess knowledge of assent for medical treatment and familiarity with the American Academy of Pediatrics policy statement on assent and to measure clinician attitudes and approaches to consent/assent in pediatrics.RESULTS. Of 35 clinicians enrolled, 23 (66%) had heard of the term “assent,” and 9 (26%) of 35 were aware of the American Academy of Pediatrics policy statement on assent. Twenty five (74%) of 34 thought 1 of the main goals of assent was to educate the child. Only 12 (35%) of 34 included the element of seeking the child's agreement as a goal of assent. In practice, the element of explaining the proposed treatment was “always” included by 26 (74%) of 35. The element of seeking the child's agreement was “always” included by 9 (26%) of 35.CONCLUSIONS. The clinicians in this study had limited explicit knowledge of the concept of assent for medical treatment and were largely unaware of the recommendations from the American Academy of Pediatrics. Their attitudes and practice reflected implicit acceptance of the importance of including children in discussions about their medical care and reluctance to give children decision-making authority. A model of medical decision-making for children that includes education but does not allow children to share decision-making authority may be more applicable to clinical practice than the current American Academy of Pediatrics–supported model of assent.
The Influence of Variation in Type and Pattern of Symptoms on Assessment in Pediatric Asthma
Authors: Fuhlbrigge Anne L. , Guilbert Theresa , Spahn Joseph , Peden David , Davis Kourtney 
Published: August 2006

OBJECTIVE. We conducted a national, population-based survey to examine the asthma-related health burden of US children.METHODS. A telephone-based survey was conducted in 2004 of children 4 to 18 years of age with current asthma in the United States. In 41433 households screened, 1089 children reported current asthma; 801 interviews were completed by parents of children aged 4 to 15 years and by children themselves aged 16 to 18 years. The survey included questions about symptoms, perceived level of control, activity limitations, health care use, medicines, disease management, and knowledge. Global asthma symptom burden, derived from the National Asthma Education and Prevention Program guidelines, was composed of 3 components: short-term symptom burden (4-week recall), long-term symptom burden (past year), and functional impact (activity limitation).RESULTS. The majority of children were classified with mild intermittent disease on the basis of recent daytime symptoms alone (80%); yet, when report of nighttime symptoms was included, the proportion of children classified as having mild intermittent symptoms decreased (74%). When asthma burden was assessed on the basis of the global symptom burden construct, only a minority (13%) of individuals was classified as having an asthma symptom burden consistent with mild intermittent disease; the majority (62%) was classified as having moderate/severe disease. In addition, the impact of asthma on the daily activities is substantial; avoiding exertion (47%) and staying inside (34%) are common approaches to improve control of asthma symptoms.CONCLUSIONS. The goals of therapy for asthma, based on the National Asthma Education and Prevention Program guidelines, have not been achieved for the majority of children. In addition, parents and children overestimate the child's asthma control and commonly restrict activities to control asthma symptoms. Deficiencies in the control of asthma may be related to the underestimation of the burden of disease.
What Pediatricians Should Know About Child-Related Malpractice Payments in the United States
Authors: Kain Zeev N. , Caldwell-Andrews Alison A. 
Published: August 2006

OBJECTIVE. The purpose of this study was to examine child-related National Practitioner Data Bank data.
METHODS. Data were obtained from the National Practitioner Data Bank.
RESULTS. the period from February 1, 2004, through December 31, 2005, a total of 30195 malpractice payments were made on behalf of practitioners in the United States; 14% of those payments (4107 of 30195 payments) were child related. During the period analyzed, $1.73 billion were paid for malpractice cases involving children. More than 95% of all payments were the result of settlements and only ∼5% the result of judgments. The average child-related malpractice payment was significantly greater than an adult-related malpractice payment ($422000 vs $247000); however, child-related malpractice payments were only one half as likely to occur, compared with adult-related malpractice payments. Significant geographic variability was found in the numbers and sizes of child-related malpractice payments. Failure to diagnose was the leading reason for child-related payments (18%), followed by improper performance (9%), delay in diagnosis (9%), and improper management (6%). Finally, we found that ∼40% of all malpractice awards were the result of surgical or obstetrical issues.
CONCLUSIONS. Practicing pediatricians should be aware of the existence of a mandatory electronic depository that documents all malpractice settlements and judgments involving practitioners.
Longitudinal Associations Between Blood Lead Concentrations Lower Than 10 μg/dL and Neurobehavioral Development in Environmentally Exposed Children in Mexico City
Authors: Téllez-Rojo Martha M. , Bellinger David C. , Arroyo-Quiroz Carmen , Lamadrid-Figueroa Héctor , Mercado-García Adriana , Schnaas-Arrieta Lourdes , Wright Robert O. , Hernández-Avila Mauricio , Hu Howard 
Published: August 2006

OBJECTIVE. Increasing evidence suggests that 10 μg/dL, the current Centers for Disease Control and Prevention screening guideline for children's blood lead level, should not be interpreted as a level at which adverse effects do not occur. Using data from a prospective study conducted in Mexico City, Mexico, we evaluated the dose-effect relationship between blood lead levels and neurodevelopment at 12 and 24 months of age.METHODS. The study population consisted of 294 children whose blood lead levels at both 12 and 24 months of age were &lt;10 μg/dL; blood lead levels were measured by graphite furnace atomic absorption spectroscopy; Bayley Scales of Infant Development II were administered at these ages. The outcomes of interest were the Mental Development Index and the Psychomotor Development Index.RESULTS. Adjusting for covariates, children's blood lead levels at 24 months were significantly associated, in an inverse direction, with both Mental Development Index and Psychomotor Development Index scores at 24 months. Blood lead level at 12 months of age was not associated with concurrent Mental Development Index or Psychomotor Development Index scores or with Mental Development Index at 24 months of age but was significantly associated with Psychomotor Development Index score at 24 months. The relationships were not altered by adjustment for cord blood lead level or, in the analyses of 24-month Mental Development Index and Psychomotor Development Index scores, for the 12-month Mental Development Index and Psychomotor Development Index scores. For both Mental Development Index and Psychomotor Development Index at 24 months of age, the coefficients that were associated with concurrent blood lead level were significantly larger among children with blood lead levels &lt;10 μg/dL than it was among children with levels &gt;10 μg/dL.CONCLUSIONS. These analyses indicate that children's neurodevelopment is inversely related to their blood lead levels even in the range of &lt;10 μg/dL. Our findings were consistent with a supralinear relationship between blood lead levels and neurobehavioral outcomes.
Air Pollution and Infant Death in Southern California, 1989–2000
Authors: Ritz Beate , Wilhelm Michelle , Zhao Yingxu 
Published: August 2006

OBJECTIVE. We evaluated the influence of outdoor air pollution on infant death in the South Coast Air Basin of California, an area characterized by some of the worst air quality in the United States.METHODS. Linking birth and death certificates for infants who died between 1989 and 2000, we identified all infant deaths, matched 10 living control subjects to each case subject, and assigned the nearest air monitoring station to each birth address. For all subjects, we calculated average carbon monoxide, nitrogen dioxide, ozone, and particulate matter &lt;10 μm in aerodynamic diameter exposures experienced during the 2-week, 1-month, 2-month, and 6-month periods before a case subject's death.RESULTS. The risk of respiratory death increased from 20% to 36% per 1-ppm increase in average carbon monoxide levels 2 weeks before death in early infancy (age: 28 days to 3 months). We also estimated 7% to 12% risk increases for respiratory deaths per 10-μg/m3 increase in particulate matter &lt;10 μm in aerodynamic diameter exposure experienced 2 weeks before death for infants 4 to 12 months of age. Risk of respiratory death more than doubled for infants 7 to 12 months of age who were exposed to high average levels of particulates in the previous 6 months. Furthermore, the risk of dying as a result of sudden infant death syndrome increased 15% to 19% per 1-part per hundred million increase in average nitrogen dioxide levels 2 months before death. Low birth weight and preterm infants seemed to be more susceptible to air pollution-related death resulting from these causes; however, we lacked statistical power to confirm this heterogeneity with formal testing.CONCLUSIONS. Our results add to the growing body of literature implicating air pollution in infant death from respiratory causes and sudden infant death syndrome and provide additional information for future risk assessment.