bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Value of Autoantibodies Against C1q in Children With Glomerulonephritis
Authors: Kozyro Ina , Perahud Iryna , Sadallah Salima , Sukalo Alexander , Titov Leonid , Schifferli Jürg , Trendelenburg Marten 
Published: May 2006

OBJECTIVE. Autoantibodies against C1q (anti-C1q) have been found in a number of autoimmune and renal diseases. They are best described in adult patients with systemic lupus erythematosus, where a strong correlation between the occurrence of anti-C1q and severe lupus nephritis (LN) has been observed. However, the role of anti-C1q in children with systemic lupus erythematosus has not yet been determined. Furthermore, the clinical importance of anti-C1q in other forms of glomerulonephritis remains to be elucidated. The aim of this study was to investigate anti-C1q in children with different forms of glomerulonephritis including LN.METHODS. We prospectively investigated 112 children with different forms of newly diagnosed glomerulonephritis for the presence of anti-C1q by an enzyme-linked immunosorbent assay and compared them with healthy controls. Associations between anti-C1q and disease manifestations at the time of the measurements and during follow-up were investigated.RESULTS. Twenty-one of 112 patients were positive for anti-C1q compared with 0 of 40 healthy controls. Anti-C1q was associated with activity in LN and with disease severity in patients with acute poststreptococcal glomerulonephritis (APSGN). In LN, 7 of 12 patients were found to be anti-C1q positive. Six of these 7 had active disease at the time of the serum sampling compared with 1 of 5 of the anti-C1q-negative children. In children with APSGN, 8 of 24 were positive for anti-C1q. Anti-C1q-positive APSGN patients had significantly higher proteinuria and more often hypertension than those without anti-C1q. All 4 patients in which APSGN did not resolve spontaneously were anti-C1q positive.CONCLUSIONS. Anti-C1q is associated with active LN in children. In addition, children with anti-C1q-positive APSGN have more severe disease than those who are anti-C1q negative. These data suggest APSGN is another disease in which anti-C1q has a pathogenic role.
Cost-Effectiveness of Neonatal Extracorporeal Membrane Oxygenation Based on 7-Year Results From the United Kingdom Collaborative ECMO Trial
Authors: Petrou Stavros , Bischof Matthias , Bennett Charlotte , Elbourne Diana , Field David , McNally Helena 
Published: May 2006

OBJECTIVE. To assess the long-term cost-effectiveness of extracorporeal membrane oxygenation (ECMO) for mature newborn infants with severe respiratory failure.METHODS. A prospective economic evaluation was conducted alongside a pragmatic randomized, controlled trial in which 185 infants were randomly allocated to ECMO (n = 93) or conventional management (n = 92) and then followed up to 7 years of age. Information about their use of health services during the follow-up period was combined with unit costs (£, 2002–2003 prices) to obtain a net cost per child. The cost-effectiveness of neonatal ECMO was expressed in terms of incremental cost per additional life year gained and incremental cost per additional disability-free life year gained. The nonparametric bootstrap method was used to present cost-effectiveness acceptability curves and net benefit statistics at alternative willingness-to-pay thresholds held by decision-makers for an additional life year and for an additional disability-free life year.RESULTS. Over 7 years, neonatal ECMO was effective at reducing known death or severe disability. Mean health service costs during the first 7 years of life were £30270 in the ECMO group and £10229 in the conventional management group, generating a mean cost difference of £20041 that was statistically significant. The incremental cost per life year gained was estimated at £13385. The incremental cost per disability-free life year gained was estimated at £23566. At the notional willingness-to-pay threshold of £30000 for an additional life year, the probability that neonatal ECMO is cost-effective at 7 years was estimated at 0.98. This translated into a mean net benefit of £24362 for each adoption of neonatal ECMO rather than conventional management.CONCLUSIONS. This study provides rigorous evidence of the cost-effectiveness of neonatal ECMO during childhood.
The Changing Face of Race: Risk Factors for Neonatal Hyperbilirubinemia
Authors: Beal Anne C. , Chou Shu-Chiung , Palmer R. Heather , Testa Marcia A. , Newman Christine , Ezhuthachan Sudhakar 
Published: May 2006

OBJECTIVES. Race is a predictor of health outcomes and risk for some clinical conditions, for example, mother's race predicts risk for hyperbilirubinemia in newborns, with blacks at lowest risk. Little is known about the correlation of race as recorded in medical records with self-reported race. Also, use of maternal race to predict newborn risk for hyperbilirubinemia has not been tested for multiracial mothers and newborns. We sought to examine how maternal race documented in medical records correlates with self-reported race and to examine the correlation between mothers' and newborns' race in the context of risk for neonatal hyperbilirubinemia, focusing on multiracial mothers and newborns.
DESIGN. A cohort study with 3021 newborns at ≥35 weeks gestation discharged from normal nursery between January 2001 and October 2002 with a telephone survey of their mothers within 6 months of birth.
SETTING. The study was conducted in the Neonatology Department of Henry Ford Hospital.
PATIENTS. There were 1773 mothers (58%) with incorrect telephone numbers. Of 1248 mothers contacted, 866 (69%) completed the interview.
OUTCOME MEASURES. We measured mother's race in hospital database and mother's reported race for herself, her newborn, and the father, allowing ≤5 responses for each.
RESULTS. Of mothers documented in the medical record as white, 64% self-reported as white. Among mothers recorded as black, 70% self-reported as black. Mothers identified 93 newborns as ≥2 races with primary race matching both parents for 41%, father for 25%, mother for 23%, and neither parent for 11%. Of 70 newborns whose parents were not the same race, mothers identified 45 (64%) as ≥2 races.
CONCLUSIONS. There is incomplete overlap between racial identification in medical records versus self-report. Given 1 choice, mothers of multiracial infants overselect black in their newborns' ancestry. Because black race is the lowest risk category for neonatal hyperbilirubinemia, this may lead to underestimating their risk.
Controlled Clinical Trial of Dichloroacetate for Treatment of Congenital Lactic Acidosis in Children
Authors: Stacpoole Peter W. , Kerr Douglas S. , Barnes Carie , Bunch S. Terri , Carney Paul R. , Fennell Eileen M. , Felitsyn Natalia M. , Gilmore Robin L. , Greer Melvin , Henderson George N. , Hutson Alan D. , Neiberger Richard E. , O'Brien Ralph G. , Perkins Leigh Ann , Quisling Ronald G. , Shroads Albert L. , Shuster Jonathan J. , Silverstein Janet H. , Theriaque Douglas W. , Valenstein Edward 
Published: May 2006

OBJECTIVE. Open-label studies indicate that oral dichloroacetate (DCA) may be effective in treating patients with congenital lactic acidosis. We tested this hypothesis by conducting the first double-blind, randomized, control trial of DCA in this disease.METHODS. Forty-three patients who ranged in age from 0.9 to 19 years were enrolled. All patients had persistent or intermittent hyperlactatemia, and most had severe psychomotor delay. Eleven patients had pyruvate dehydrogenase deficiency, 25 patients had 1 or more defects in enzymes of the respiratory chain, and 7 patients had a mutation in mitochondrial DNA. Patients were preconditioned on placebo for 6 months and then were randomly assigned to receive an additional 6 months of placebo or DCA, at a dose of 12.5 mg/kg every 12 hours. The primary outcome results were (1) a Global Assessment of Treatment Efficacy, which incorporated tests of neuromuscular and behavioral function and quality of life; (2) linear growth; (3) blood lactate concentration in the fasted state and after a carbohydrate meal; (4) frequency and severity of intercurrent illnesses and hospitalizations; and (5) safety, including tests of liver and peripheral nerve function.OUTCOME. There were no significant differences in Global Assessment of Treatment Efficacy scores, linear growth, or the frequency or severity of intercurrent illnesses. DCA significantly decreased the rise in blood lactate caused by carbohydrate feeding. Chronic DCA administration was associated with a fall in plasma clearance of the drug and with a rise in the urinary excretion of the tyrosine catabolite maleylacetone and the heme precursor δ-aminolevulinate.CONCLUSIONS. In this highly heterogeneous population of children with congenital lactic acidosis, oral DCA for 6 months was well tolerated and blunted the postprandial increase in circulating lactate. However, it did not improve neurologic or other measures of clinical outcome.
Variation in Standards of Research Compensation and Child Assent Practices: A Comparison of 69 Institutional Review Board–Approved Informed Permission and Assent Forms for 3 Multicenter Pediatric Clinical Trials
Authors: Kimberly Michael B. , Hoehn K. Sarah , Feudtner Chris , Nelson Robert M. , Schreiner Mark 
Published: May 2006

OBJECTIVE. To systematically compare standards for compensation and child participant assent in informed permission, assent, and consent forms (IP-A-CFs) approved by 55 local institutional review boards (IRBs) reviewing 3 standardized multicenter research protocols.METHOD. Sixty-nine principal investigators participating in any of 3 national, multicenter clinical trials submitted standardized research protocols for their trials to their local IRBs for approval. Copies of the subsequently IRB-approved IP-A-CFs were then forwarded to an academic clinical research organization. This collection of IRB-approved forms allowed for a quasiexperimental retrospective evaluation of the variation in informed permission, assent, and consent standards operationalized by the local IRBs.RESULTS. Standards for compensation and child participant assent varied substantially across 69 IRB-approved IP-A-CFs. Among the 48 IP-A-CFs offering compensation, monetary compensation was offered by 33 as reimbursement for travel, parking, or food expenses, whereas monetary or material compensation was offered by 22 for subject inconvenience and by 13 for subject time. Compensation ranged widely within and across studies (study 1, $180–1425; study 2, $0–500; and study 3, $0–100). Regarding child participant assent, among the 57 IP-A-CFs that included a form of assent documentation, 33 included a line for assent on the informed permission or consent form, whereas 35 included a separate form written in simplified language. Of the IP-A-CFs that stipulated the documentation of assent, 31 specified ≥1 age ranges for obtaining assent. Informed permission or consent forms were addressed either to parents or child participants.CONCLUSION. In response to identical clinical trial protocols, local IRBs generate IP-A-CFs that vary considerably regarding compensation and child participant assent.
The Role of Early Maternal Responsiveness in Supporting School-Aged Cognitive Development for Children Who Vary in Birth Status
Authors: Smith Karen E. , Landry Susan H. , Swank Paul R. 
Published: May 2006

OBJECTIVES. To examine the relation between the pattern of maternal responsiveness that children experienced in the infancy, preschool, and school-age periods and growth in cognitive skills across 3–10 years of age and determine whether the relation differs by birth status.METHODS. In 1990–1992, 360 children varying in birth status (very low birthweight [VLBW]; demographically matched controls) were recruited to examine parenting and birth status influences on development. This report includes children with observations of parenting at 6, 12, and 24 months and 3, 4, 6, 8, and 10 years and cognitive skills evaluated at 3, 4, 6, 8, and 10 years of age (71% of original cohort).RESULTS. Four groups of mothers varying in the pattern of responsiveness displayed across the infancy and the preschool period were found. When controlling for school-age parenting and economic status, children parented with higher levels of responsiveness across both developmental periods, irrespective of birth status, showed higher levels in development than those who experienced responsiveness in only 1 development period or minimal responsiveness. Greater benefit was found for consistency in responsiveness for children born VLBW with less, versus more, severe neonatal complications. Inspection of the means showed that higher risk birth status combined with minimal responsiveness resulted in cognitive scores, on average, 14 points lower than when parented with consistently higher responsiveness.CONCLUSIONS. Cognitive development for children born at VLBW, particularly those with less severe complications, are supported by consistently responsive parenting across early childhood in similar ways to those born at term. This effect persisted through 10 years of age even after school-age parenting and economic level. These findings have important implications for the timing (across early childhood) and content (responsive interactive behaviors) of early intervention to enhance the outcomes for children born at VLBW.
Factors That Are Associated With Parental Acceptance of Human Papillomavirus Vaccines: A Randomized Intervention Study of Written Information About HPV
Authors: Dempsey Amanda F. , Zimet Gregory D. , Davis Robert L. , Koutsky Laura 
Published: May 2006

OBJECTIVES. Prophylactic vaccines against human papillomavirus (HPV) are expected to be available for public use by 2007 and likely will be targeted to preadolescent children. Parental acceptance of these vaccines will be critical for their success. The objectives of this study were (1) to determine the overall acceptance of HPV vaccines for preadolescent children by parents, (2) to evaluate the influence of written educational information about HPV on parental acceptability of HPV vaccines, and (3) to identify independent predictors associated with HPV vaccine acceptability by parents.
METHODS. A randomized intervention study within a cross-sectional survey was conducted. Parental HPV vaccine acceptability was measured under 3 different hypothetical scenarios. A self-administered survey on the knowledge, attitudes, and beliefs about HPV and HPV vaccines was sent to 1600 parents of 8- to 12-year-old children. In addition to a baseline paragraph about HPV that was received by all study participants, a random half of the study participants received a detailed “HPV Information Sheet” outlining the epidemiology and potential clinical sequelae of HPV infection. Independent predictors of parental HPV vaccine acceptability were determined using multivariate linear regression models.
RESULTS. Parents who received the HPV information sheet had higher mean scores on the HPV knowledge assessment tool than the control group. However, despite this apparent improvement in knowledge, there was not a statistically significant difference in HPV vaccine acceptability between the 2 groups.
CONCLUSIONS. Providing parents with an HPV information sheet did seem to improve knowledge about HPV, but this increased knowledge had little effect on the acceptability of these vaccines by parents for their children. Instead, attitudes and life experiences seemed to be more important factors influencing HPV vaccine acceptability among parents.
Mortality and Morbidities Among Very Premature Infants Admitted After Hours in an Australian Neonatal Intensive Care Unit Network
Authors: Abdel-Latif Mohamed E. , Bajuk Barbara , Oei Julee , Lui Kei ,   for the New South Wales and the Australian Capital Territory Neonatal Intensive Care Audit Group
Published: May 2006

OBJECTIVES. To assess risk-adjusted early (within 7 days) mortality and major morbidities of newborn infants at &lt;32 weeks' gestation who are admitted after office hours to a regional Australian network of NICUs where statewide caseload is coordinated and staffed by on-floor registrars working in shift rosters. We hypothesize that adverse sequelae are increased in these infants.
DESIGNS. We conducted a database review of the records of infants (n = 8654) at &lt;32 weeks' gestation admitted to a network of 10 tertiary NICUs in New South Wales and the Australian Capital Territory from 1992 to 2002. Multivariate logistic regression analysis was performed to adjust for case-mix and significant baseline characteristics.
OUTCOMES. Sixty-five percent of infants were admitted to the NICUs after hours. These infants did not have an increase in early neonatal mortality or major neonatal sequelae compared with their office-hours counterparts. Admissions during late night hours after midnight or fatigue risk periods before the end of a medical 12-hour shift were not associated with higher early mortality. Risk factors significantly predictive of early neonatal death were lack of antenatal steroid treatment, Apgar score &lt;7 at 5 minutes, male gender, gestation age, and being small for gestation.
CONCLUSIONS. Current staffing levels, specialization, and networking are associated with lower circadian variation in adverse outcomes and after-hours admission to this NICU network and have no significant impact on early neonatal mortality and morbidity.
A Multicenter Case-Control Study on Predictive Factors Distinguishing Childhood Leukemia From Juvenile Rheumatoid Arthritis
Authors: Jones Olcay Y. , Spencer Charles H. , Bowyer Suzanne L. , Dent Peter B. , Gottlieb Beth S. , Rabinovich C. Egla 
Published: May 2006

OBJECTIVE. Acute lymphocytic leukemia (ALL) often presents with musculoskeletal concerns such as pain or swelling, even before appearance of blasts in the peripheral blood. Such presentation may lead to misdiagnosis of a child with juvenile rheumatoid arthritis (JRA). This study was designed to identify the predictive factors for leukemia using basic clinical and laboratory information.
METHODS. A retrospective chart review was performed using a simple questionnaire to compare the clinical and laboratory findings present during the initial visit to a pediatric rheumatology clinic for 277 children who were ultimately diagnosed with either JRA (n = 206) or ALL (n = 71). Sensitivity and specificity analysis of a variety of parameters, both singly and in combination, was performed to identify predictive value for ALL.
RESULTS. The majority (75%) of children with ALL did not have blasts in the peripheral blood at the time of evaluation by pediatric rheumatologists. In children presenting with unexplained musculoskeletal complaints, the 3 most important factors that predicted a diagnosis of ALL were low white blood cell count (&lt;4 × 109/L), low-normal platelet count (150–250 × 109/L), and history of nighttime pain. In the presence of all 3, the sensitivity and specificity for a diagnosis of ALL were 100% and 85%, respectively. Other findings, including antinuclear antibody, rash, and objective signs of arthritis, were not helpful in differentiating between these diagnoses because they occurred at similar rates in both groups.
CONCLUSIONS. When a child develops new-onset bone-joint complaints, the presence of subtle complete blood count changes combined with nighttime pain should lead to consideration of leukemia as the underlying cause.
Intussusception After Administration of the Rhesus Tetravalent Rotavirus Vaccine (Rotashield): The Search for a Pathogenic Mechanism
Authors: Lynch Maureen , Shieh Wun-Ju , Bresee Joseph S. , Tatti Kathleen M. , Gentsch Jon R. , Jones Tara , Jiang Baoming , Hummelman Erik , Zimmerman Christopher M. , Zaki Sherif R. , Glass Roger I. 
Published: May 2006

OBJECTIVES. The rhesus tetravalent rotavirus vaccine (RRV) was withdrawn from the routine program for childhood immunization in the United States because of the rare and unexpected occurrence of intussusception in the 2-week period after administration of the first dose.
METHODS. To search for the pathogenesis of this association, we compared the pathology of surgical specimens from infants who had surgical reduction of their intussusceptions within 2 weeks of receiving the vaccine (case patients; n = 8) with the pathology of specimens from children who had surgery &gt;2 weeks after immunization (n = 6) or who had never been immunized (n = 26). Tissue was examined for evidence of the vaccine strain of rotavirus by reverse transcriptase-polymerase chain reaction (RT-PCR), in situ hybridization, and immunohistochemical staining.
RESULTS. RRV was identified by RT-PCR in tissue samples from 7 of the 8 case patients and in 2 of the 6 children who received the vaccine at a more distant time (29 and 58 days before surgery), but it was not identified in samples from any of the nonvaccinated children. No evidence of rotavirus tissue involvement was detected in any of the children by in situ hybridization or immunohistochemical staining. Pathologic evidence (for example, inclusion bodies, smudge cells) of adenovirus infection was present in 35% of the 37 specimens examined by routine staining and immunohistochemistry.
CONCLUSIONS. The fact that RRV was detected by RT-PCR but not by either of the other assays could be explained by RRV being present in the lumen of the gut but not in the tissues of appendix, ileum, or Peyer's patches. The Peyer's patches were not hyperplastic, and we could not establish the pathogenic mechanism for this association.
Differences in Infant and Parent Behaviors During Routine Bed Sharing Compared With Cot Sleeping in the Home Setting
Authors: Baddock Sally A. , Galland Barbara C. , Bolton David P.G. , Williams Sheila M. , Taylor Barry J. 
Published: May 2006

OBJECTIVES. To observe the behavior of infants sleeping in the natural physical environment of home, comparing the 2 different sleep practices of bed sharing and cot sleeping quantifying to factors that have been identified as potential risks or benefits.
METHODS. Forty routine bed-sharing infants, aged 5–27 weeks were matched for age and season of study with 40 routine cot-sleeping infants. Overnight video and physiologic data of bed-share infants and cot-sleep infants were recorded in the infants' own homes. Sleep time, sleep position, movements, feeding, blanket height, parental checks, and time out of the bed or cot were logged.
RESULTS. The total sleep time was similar in both groups (bed-sharing median: 8.6 hours; cot-sleeping median: 8.2 hours). Bed-sharing infants spent most time in the side position (median: 5.7 hours, 66% of sleep time) and most commonly woke at the end of sleep in this position, whereas cot-sleeping infants most commonly slept supine (median: 7.5 hours, 100%) and woke at the end of sleep in the supine position. Prone sleep was uncommon in both groups. Head covering above the eyes occurred in 22 bed-sharing infants and 1 cot-sleeping infant. Five of these bed-sharing infants were head covered at final waking time, but the cot-sleeping infant was not. Bed-sharing parents looked at or touched their infant more often (median: 11 vs 4 times per night) but did not always fully wake to do so. Movement episodes were shorter in the bed-sharing group as was total movement time (37 vs 50 minutes respectively), whereas feeding was 3.7 times more frequent in the bed-sharing group than the cot-sleeping group.
CONCLUSIONS. Bed-share infants without known risk factors for sudden infant death syndrome (SIDS) experience increased maternal touching and looking, increased breastfeeding, and faster and more frequent maternal responses. This high level of interaction is unlikely to occur if maternal arousal is impaired, for example, by alcohol or overtiredness. Increased head covering and side sleep position occur during bed-sharing, but whether these factors increase the risk of SIDS, as they do in cot sleeping, requires further investigation.