bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Profile of Hospitalized Children Provided With Urgent Assistance From a Medical Emergency Team
Authors: Kinney Sharon , Tibballs James , Johnston Linda , Duke Trevor 
Published: June 2008

OBJECTIVE. The purpose of this work was to describe the frequency, characteristics, and outcomes of critical events and hospitalized children requiring medical emergency team review.PATIENTS AND METHODS. We conducted an audit of prospectively collected medical emergency team forms and a retrospective review of medical charts during an 18-month period at a tertiary pediatric hospital in Australia. Critical events were defined as cardiac arrest, endotracheal intubation on the ward, reversal of analgesia or sedation, fluid resuscitation at ≥40 mL/kg, hyponatremia (serum sodium level of ≤125 mmol/L), hypernatremia (serum sodium level of ≥155 mmol/L), hypoglycemia (glucose level of ≤2 mmol/L), or severe metabolic acidosis (pH ≤ 7.1).RESULTS. A total of 172 children had 225 medical emergency team calls (10.6 calls per 1000 hospital admissions and 2.0 calls per 1000 patient-days). Forty-two percent of calls were for infants &lt;1 year old. Preexisting chronic disease was common, with 20% having a chronic underlying neurologic disorder. Forty-four percent of the children were postoperative. The mortality rate of the 172 children was 7.6% in the hospital and 13.4% within 1 year. Thirty-three children had a critical event, with reversal of analgesia being the most common event (n = 11). Postoperative children were more frequently seen in the critical-event group (64% vs 40%). Hospital and 1-year mortality rates were higher for children who had a critical event (16.1% vs 22.6%, respectively) than those who did not (5.7% vs 11.3%).CONCLUSIONS. Chronic and complex illnesses were prevalent among children provided with urgent medical assistance from the medical emergency team in a tertiary hospital. Children in the postoperative phase were overrepresented among those with a critical event. A critical event significantly increased the risk of hospital mortality. Greater knowledge of high-risk groups is required to further improve outcomes for hospitalized children.
Differential Gender Response to Respiratory Infections and to the Protective Effect of Breast Milk in Preterm Infants
Authors: Klein M. Inés , Bergel Eduardo , Gibbons Luz , Coviello Silvina , Bauer Gabriela , Benitez Alicia , Serra M. Elina , Delgado M. Florencia , Melendi Guillermina A. , Rodríguez Susana , Kleeberger Steven R. , Polack Fernando P. 
Published: June 2008

OBJECTIVE. The protective role of breastfeeding against severe acute lung disease in infants is well established, but its mechanism is unclear. Most hypotheses assume that breastfeeding confers similar passive protection to every infant; however, a few observations have suggested that the benefits of breast milk against severe lung disease may differ according to gender. The objective of this study was to determine whether the effect of breastfeeding on susceptibility to severe acute lung disease among infants at high risk is different for girls and boys.
METHODS. A cohort was analyzed prospectively by use of 2 different strategies: (1) predictors of first episode of rehospitalization by univariate and multivariate analyses using robust Poisson regression and (2) mean number of rehospitalizations between groups using multiple regression negative binomial models.
RESULTS. A total of 119 high-risk, very low birth weight infants were enrolled. Breast milk protected girls but not boys against severe acute lung disease. The interaction between breastfeeding and gender was clinically and statistically significant, even after adjustment for variables that can affect severity of acute lung disease. Disease was most severe in formula-fed girls (versus formula-fed boys).
CONCLUSIONS. Breastfeeding decreased the risk for severe acute lung disease in girls but not in boys. These findings suggest that breast milk protection is not universally conferred by passive transfer of humoral immunity (which should be gender indifferent), show that respiratory symptoms may be amenable to nonspecific modulation, and identify nonbreastfed preterm infant girls as an at-risk group for severe acute lung disease.
Race Matters in the Prosecution of Perpetrators of Inflicted Traumatic Brain Injury
Authors: Keenan Heather T. , Nocera Maryalice , Runyan Desmond K. 
Published: June 2008

OBJECTIVE. The goal was to examine the case flow of child physical abuse prosecutions through the judicial system and to examine determinants of charges and sentencing decisions.
METHODS. This prospective cohort study monitored all defendants in identified cases of inflicted traumatic brain injury in North Carolina in 2000 and 2001. Victims were identified prospectively through surveillance at all PICUs in North Carolina and the Office of the Chief Medical Examiner. Suspected perpetrators were identified through information from families, hospital records, newspaper clippings, the Department of Corrections, and Clerks of Superior Court. Judicial case flow from original charges through sentencing was mapped. The victims' injury characteristics and suspects' characteristics, including potential mitigating and aggravating factors, were examined. Suspected perpetrator and victim characteristics were entered into multivariate models for examination of associations with charges and sentencing decisions.
RESULTS. Original and final charges varied widely. The most frequent original and final charge was the lowest-class felony child abuse charge. The child's death was predictive of higher felony charges. Sentences ranged from probation to life in prison. Of the defendants who were found to be guilty, 63% were incarcerated for some period of time. Severe sentences were associated with perpetrator race.
CONCLUSIONS. Prosecutors frequently charged the lowest felony child abuse charge available unless the child died. Minority status was not important in the decision to bring charges against a suspect but was the most important measured factor in rendering a sentence. Although the most appropriate charges and sentences can be argued, there seems to be a statewide bias toward harsher sentences for minority perpetrators.
Attitudes of Neonatologists Toward Delivery Room Management of Confirmed Trisomy 18: Potential Factors Influencing a Changing Dynamic
Authors: McGraw Melanie P. , Perlman Jeffrey M. 
Published: June 2008

OBJECTIVE. The objective of this study was to determine the attitude of neonatal providers toward delivery room resuscitation of an infant with confirmed trisomy 18 with known congenital heart disease at ≥36 weeks of gestation.METHODS. A multiple-choice questionnaire listing this clinical scenario was completed by neonatologists and fellows staffing level III NICUs. Potential factors influencing the decision to initiate resuscitation included maternal preference, neonatal condition at birth, obstetric care, and legal concerns.RESULTS. Fifty-four (76%) of 71 surveys were completed. Of respondents, 44% indicated that they would be willing to initiate resuscitation. Maternal preference (70%) was the primary reason to initiate resuscitation, with the appearance of the neonate in the delivery room (46%) and legal concerns (25%) as additional factors.CONCLUSIONS. Until recently, there was universal consensus that trisomy 18 was a lethal anomaly for which resuscitation in the delivery room was not indicated. These data indicate that more providers (44%) than anticipated would consider initiation of resuscitation for an infant with trisomy 18 even with congenital heart disease. We speculate that support for the best-interest standard for neonates is diminishing in favor of ceding without question to parental autonomy. This shift may have profound implications for ethical decisions in the NICU.
Prevalence of and Risk Factors for Community-Acquired Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus Colonization in Children Seen in a Practice-Based Research Network
Authors: Fritz Stephanie A. , Garbutt Jane , Elward Alexis , Shannon William , Storch Gregory A. 
Published: June 2008

OBJECTIVE. We sought to define the prevalence of and risk factors for methicillin-resistant Staphylococcus aureus nasal colonization in the St Louis pediatric population.
METHODS. Children from birth to 18 years of age presenting for sick and well visits were recruited from pediatric practices affiliated with a practice-based research network. Nasal swabs were obtained, and a questionnaire was administered.
RESULTS. We enrolled 1300 participants from 11 practices. The prevalence of methicillin-resistant S aureus nasal colonization varied according to practice, from 0% to 9% (mean: 2.6%). The estimated population prevalence of methicillin-resistant S aureus nasal colonization for the 2 main counties of the St Louis metropolitan area was 2.4%. Of the 32 methicillin-resistant S aureus isolates, 9 (28%) were health care-associated types and 21 (66%) were community-acquired types. A significantly greater number of children with community-acquired methicillin-resistant S aureus were black and were enrolled in Medicaid, in comparison with children colonized with health care-associated methicillin-resistant S aureus. Children with both types of methicillin-resistant S aureus colonization had increased contact with health care, compared with children without colonization. Methicillin-sensitive S aureus nasal colonization ranged from 9% to 31% among practices (mean: 24%). The estimated population prevalence of methicillin-sensitive S aureus was 24.6%. Risk factors associated with methicillin-sensitive S aureus colonization included pet ownership, fingernail biting, and sports participation.
CONCLUSIONS. Methicillin-resistant S aureus colonization is widespread among children in our community and includes strains associated with health care-associated and community-acquired infections.
Gluten Intake Interferes With the Humoral Immune Response to Recombinant Hepatitis B Vaccine in Patients With Celiac Disease
Authors: Nemes Éva , Lefler Éva , Szegedi László , Kapitány Anikó , Kovács Judit B. , Balogh Márta , Szabados Katalin , Tumpek Judit , Sipka Sándor , Korponay-Szabó Ilma R. 
Published: June 2008

OBJECTIVE. Patients with celiac disease, who often carry human leukocyte antigen-DR3;DQ2, are prone to inadequate response to hepatitis B immunization. We evaluated vaccine response in relation to disease activity and whether previous treatment with a gluten-free diet influences the achievement of protective antibody titers.
PATIENTS AND METHODS. We studied 128 children and adolescents with celiac disease and 113 age-matched control subjects. Twenty-two patients with celiac disease were prospectively immunized after diagnosis during dietary treatment (group 1). A total of 106 (group 2) and the control subjects received vaccination by mass immunization in schools at 14 years of age regardless of diet status and when celiac disease was still undiagnosed in 27 of these children. Diet compliance and celiac disease activity were monitored by measurement of antibodies against transglutaminase and endomysium. Vaccine response was determined by measuring antihepatitis B antibodies from serum.
RESULTS. The seroconversion after hepatitis B vaccination was 95.5% in group 1. All of these patients carried human leukocyte antigen DQ2. The response rate in group 2 was 50.9% and correlated with gluten intake (untreated patients: 25.9%, non-strict diet: 44.4%, strict diet: 61.4%). Treated and compliant patients did not significantly differ from control subjects (75.2%). Thirty-seven antihepatitis B–negative patients with celiac disease received a booster during a controlled gluten-free diet, and 36 (97.3%) seroconverted, irrespective of the presence of human leukocyte antigen DQ2.
CONCLUSIONS. Nonresponse to recombinant hepatitis B surface antigen may be a sign of undiagnosed celiac disease. However, there is a good vaccine response in adequately treated patients. Human leukocyte antigen DQ alleles do not seem to have a primary role. Revaccination is recommended during a controlled gluten-free diet.
Continuity-Structured Clinical Observations: Assessing the Multiple-Observer Evaluation in a Pediatric Resident Continuity Clinic
Authors: Zimmer Karen P. , Solomon Barry S. , Siberry George K. , Serwint Janet R. 
Published: June 2008

OBJECTIVES. The continuity-structured clinical observation tool was developed and used to conduct a multiple-observer evaluation to assess residents in the core competency areas of patient care, interpersonal and communication skills, and professionalism. The objectives were to assess pediatric resident performance in a continuity clinic by using direct observation and to compare evaluations among preceptors, residents, and parents.
METHODS. Pediatric residents in a large continuity clinic participated between August and December 2005. The continuity-structured clinical tool included items in the following domains: opening the interview, history taking, relationship skills, personal manner, negotiation or management, and physical examination. Each resident was directly observed during 1 entire patient encounter. Parents, preceptors, and residents completed evaluations by selecting 1 of 4 possible responses for performance of each item. We dichotomized responses as “yes” versus “no/partial” and analyzed aggregate scores for individual items and domains among the 3 evaluators by McNemar test, percentage agreement, and interoberserver agreement (κ).
RESULTS. Fifty-four of 57 eligible residents had all 3 evaluations completed. Parents rated residents the highest and showed least variability (only 2 items for which parents indicated the task was completed in &lt;90% of the encounters). Residents rated themselves the lowest (35 items with &lt;90%). In comparing the residents and preceptors, the domains that had the lowest percentage of agreement were history taking (range: 61%–91%) and negotiation or management (range: 51%–88%). All of the evaluators scored residents the lowest in the domain of negotiation or management, with the following lowest-score items: probe for decision-makers, assess willingness and barriers, and use of visual aids.
CONCLUSIONS. Compared with parents, residents and preceptors demonstrated greater variability in resident performance evaluations. All of the evaluators scored residents lowest in the domain of negotiation or management during continuity-clinic visits. Residency programs should strongly consider emphasizing skill development in this area.
Accurate Parental Classification of Overweight Adolescents' Weight Status: Does It Matter?
Authors: Neumark-Sztainer Dianne , Wall Melanie , Story Mary , van den Berg Patricia 
Published: June 2008

OBJECTIVE. Our goal was to explore whether parents of overweight adolescents who recognize that their children are overweight engage in behaviors that are likely to help their adolescents with long-term weight management.
METHODS. The study population included overweight adolescents (BMI ≥ 85th percentile) who participated in Project EAT (Eating Among Teens) I (1999) and II (2004) and their parents who were interviewed by telephone in Project EAT I. Cross-sectional analyses were conducted with 314 adolescent-parent dyads, and longitudinal analyses were completed with 170 dyads.
RESULTS. Parents who correctly classified their children as overweight were no more likely than parents who did not correctly classify their children as overweight to engage in the following potentially helpful behaviors: having more fruits/vegetables and fewer soft drinks, salty snacks, candy, and fast food available at home; having more family meals; watching less television during dinner; and encouraging children to make healthful food choices and be more physically active. However, parents who recognized that their children were overweight were more likely to encourage them to diet. Parental encouragement to diet predicted poorer adolescent weight outcomes 5 years later, particularly for girls. Parental classification of their children's weight status did not predict child weight status 5 years later.
CONCLUSIONS. Accurate classification of child overweight status may not translate into helpful behaviors and may lead to unhealthy behaviors such as encouragement to diet. Instead of focusing on weight per se, it may be more helpful to direct efforts toward helping parents provide a home environment that supports healthful eating, physical activity, and well-being.
Head Growth in Preterm Infants: Correlation With Magnetic Resonance Imaging and Neurodevelopmental Outcome
Authors: Cheong Jeanie L. Y. , Hunt Rod W. , Anderson Peter J. , Howard Kelly , Thompson Deanne K. , Wang Hong X. , Bear Merilyn J. , Inder Terrie E. , Doyle Lex W. 
Published: June 2008

OBJECTIVE. Extremely preterm birth is associated with adverse neurodevelopmental sequelae. Head circumference has been used as a measure of brain growth. There are limited data relating head circumference to MRI. The purpose of this work was to establish the relationship between head circumference with brain MRI at term-equivalent age and to relate head circumference with neurodevelopmental outcome at 2 years.
PATIENTS AND METHODS. Two hundred and twenty-seven preterm infants (birth weight of &lt;1250 g or &lt;30 weeks’ gestation) were recruited. Head circumference was measured at birth, term, and 2 years’ corrected age, and z scores were computed. Microcephaly was defined as a head circumference z score of less than −2 SDs for age and gender. MRI scans at term (n = 214) were graded for white and gray matter abnormalities, and segmented volumes were calculated for different tissue types. Outcome at 2 years’ corrected age (n = 202) included scores on the Bayley Scales of Infant Development II.
RESULTS. Microcephaly increased from 7.5% at term to 29.7% at 2 years. There was no significant relationship between head circumference and white or gray matter abnormalities on MRI. There was a strong correlation between head circumference and brain volume at term. At term, microcephalic infants had significantly decreased volumes for total brain tissue and most segmented volumes compared with infants with normal head circumference, but only deep nuclear gray matter volume remained significantly lower when adjusted for total intracranial volume. At 2 years, microcephaly was associated with poorer cognitive and motor development and an increased rate of cerebral palsy.
CONCLUSIONS. Brain volume is a determinant of head size at term. Microcephaly is associated with a reduction of brain tissue volumes, especially deep nuclear gray matter, which suggests a selective vulnerability. Poor postnatal head growth in preterm infants becomes more evident by 2 years and is strongly associated with poor neurodevelopmental outcome and cerebral palsy.
Charges and Lengths of Stay Attributable to Adverse Patient-Care Events Using Pediatric-Specific Quality Indicators: A Multicenter Study of Freestanding Children's Hospitals
Authors: Kronman Matthew P. , Hall Matthew , Slonim Anthony D. , Shah Samir S. 
Published: June 2008

OBJECTIVE. The purpose of this work was to determine the excess charges, both overall and according to category, and lengths of stay attributable to adverse patient-care events during pediatric hospitalization.METHODS. Agency for Healthcare Research and Quality pediatric-specific quality indicators were used to identify adverse events in 431524 discharges from 38 freestanding, academic, not-for-profit, tertiary care pediatric hospitals in the United States participating in the Pediatric Health Information System database in 2006. All of the discharges from any of the 38 hospitals participating in the Pediatric Health Information System between January 1 and December 31, 2006, were eligible for inclusion. The primary outcomes were excess lengths of stay and charges (both overall and according to pharmacy, laboratory, imaging, clinical, supply, and other categories) were attributable to adverse patient-safety events as determined by 12 pediatric-specific quality indicators.RESULTS. Statistically significant excess lengths of stay attributable to pediatric-specific quality indicator events ranged from 2.8 days for accidental puncture and laceration to 23.5 days for postoperative sepsis, and statistically significant excess overall charges ranged from $34884 for accidental puncture and laceration to $337226 for in-hospital mortality after pediatric heart surgery. Each charge category had significant charge increases caused by pediatric-specific quality indicator events, with the largest being laboratory and other charges, ranging from $7622 to $78048 and $11094 to $97805, respectively.CONCLUSIONS. Some adverse events experienced during pediatric hospitalization have the potential to increase lengths of stay and charges considerably, and pediatric-specific quality indicators are useful in calculating these effects.
Increasing Caloric Contribution From Sugar-Sweetened Beverages and 100% Fruit Juices Among US Children and Adolescents, 1988–2004
Authors: Wang Y. Claire , Bleich Sara N. , Gortmaker Steven L. 
Published: June 2008

OBJECTIVE. We sought to document increases in caloric contributions from sugar-sweetened beverages and 100% fruit juice among US youth during 1988–2004.
PATIENTS AND METHODS. We analyzed 24-hour dietary recalls from children and adolescents (aged 2–19) in 2 nationally representative population surveys: National Health and Nutrition Examination Survey III (1988–1994, N = 9882) and National Health and Nutrition Examination Survey 1999–2004 (N = 10 962). We estimated trends in caloric contribution, type, and location of sugar-sweetened beverages and 100% fruit juice consumed.
RESULTS. Per-capita daily caloric contribution from sugar-sweetened beverages and 100% fruit juice increased from 242 kcal/day (1 kcal = 4.2 kJ) in 1988–1994 to 270 kcal/day in 1999–2004; sugar-sweetened beverage intake increased from 204 to 224 kcal/day and 100% fruit juice increased from 38 to 48 kcal/day. The largest increases occurred among children aged 6 to 11 years (∼20% increase). There was no change in per-capita consumption among white adolescents but significant increases among black and Mexican American youths. On average, respondents aged 2 to 5, 6 to 11, and 12 to 19 years who had sugar-sweetened beverages on the surveyed day in 1999–2004 consumed 176, 229, and 356 kcal/day, respectively. Soda contributed ∼67% of all sugar-sweetened beverage calories among the adolescents, whereas fruit drinks provided more than half of the sugar-sweetened beverage calories consumed by preschool-aged children. Fruit juice drinkers consumed, on average, 148 (ages 2–5), 136 (ages 6–11), and 184 (ages 12–19) kcal/day. On a typical weekday, 55% to 70% of all sugar-sweetened beverage calories were consumed in the home environment, and 7% to 15% occurred in schools.
CONCLUSIONS. Children and adolescents today derive 10% to 15% of total calories from sugar-sweetened beverages and 100% fruit juice. Our analysis indicates increasing consumption in all ages. Schools are a limited source for sugar-sweetened beverages, suggesting that initiatives to restrict sugar-sweetened beverage sales in schools may have an only marginal impact on overall consumption. Pediatricians’ awareness of these trends is critical for helping children and parents target suboptimal dietary patterns that may contribute to excess calories and obesity.