bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence and Predictors of Serious Bacterial Infections Among 57- to 180-Day-Old Infants
Authors: Hsiao Allen L. , Chen Lei , Baker M. Douglas 
Published: May 2006

BACKGROUND. Numerous researchers have investigated fever in infants &lt;2 months of age. However, the etiology of fever and usefulness of screening tests in older (2–6 months) infants is not well studied.METHODS. This was a prospective study of febrile infants 57–180 days old. Evaluation included blood and urine tests and direct fluorescent antibody (DFA) of nasal swabs for respiratory viruses. Additional studies were performed at the discretion of managing clinicians.RESULTS. Serious bacterial illness (SBI) was diagnosed in 44 (10.3%) of 429 infants: 41 with bacteruria and 4 with bacteremia (1 infant had concurrent Escherichia coli bacteruria and bacteremia). Lumbar puncture, performed in 58 (13.5%) infants, revealed no cases of bacterial meningitis. DFAs were positive in 163 (38.0%) infants: the majority were respiratory syncytial virus or influenza A. SBI was noted in 4.9% of infants with positive DFA. Age and height of fever were not significant predictors of SBI. White blood cell count (17.1 K/mm3 vs 12.4 K/mm3) and CRP (2.6 mg/dL vs 0.9 mg/dL) were elevated in infants with SBI, as was the Yale Observation Score (9.4 vs 8.0).CONCLUSIONS. A substantial proportion (10.3%) of older febrile infants has SBI. In the postpneumococcal vaccine era, only 1 infant had pneumococcal disease; bacteremia was noted in 0.9%. Bacteruria is commonly associated with fever in this age range. Infants older than 8 weeks remain at risk for bacteremia and bacteruria, regardless of positive DFA or other apparent source of fever. CRP is a better indicator than white blood cell count, but no single ideal indicator of SBI was identified for this age group.
Qualitative Analysis of Mothers' Decision-Making About Vaccines for Infants: The Importance of Trust
Authors: Benin Andrea L. , Wisler-Scher Daryl J. , Colson Eve , Shapiro Eugene D. , Holmboe Eric S. 
Published: May 2006

BACKGROUND. The high visibility of controversies regarding vaccination makes it increasingly important to understand how parents decide whether to vaccinate their infants.
OBJECTIVE. The purpose of this research was to investigate decision-making about vaccinations for infants.
DESIGN. We conducted qualitative, open-ended interviews.
PARTICIPANTS. Subjects included mothers 1 to 3 days postpartum and again at 3 to 6 months.
RESULTS. We addressed 3 topics: attitudes to vaccination, knowledge about vaccination, and decision-making. Mothers who intended to have their infants vaccinated (“vaccinators,” n = 25) either agreed with or did not question vaccination or they accepted vaccination but had significant concerns. Mothers who did not intend to vaccinate (“nonvaccinators,” n = 8) either completely rejected vaccination or they purposely delayed vaccinating/chose only some vaccines. Knowledge about which vaccines are recommended for children was poor among both vaccinators and nonvaccinators. The theme of trust in the medical profession was the central concept that underpinned all of the themes about decision-making. Promoters of vaccination included trusting the pediatrician, feeling satisfied by the pediatrician’s discussion about vaccines, not wanting to diverge from the cultural norm, and wanting to adhere to the social contact. Inhibitors included feeling alienated by or unable to trust the pediatrician, having a trusting relationship with an influential homeopath/naturopath or other person who did not believe in vaccinating, worry about permanent side effects, beliefs that vaccine-preventable diseases are not serious, and feeling that since other children are vaccinated their child is not at risk.
CONCLUSION. Trust or lack of trust and a relationship with a pediatrician or another influential person were pivotal for decision-making of new mothers about vaccinating their children. Attempts to work with mothers who are concerned about vaccinating their infants should focus not only on providing facts about vaccines but also on developing trusting and positive relationships.
Adverse Neonatal Outcomes Associated With Antenatal Dexamethasone Versus Antenatal Betamethasone
Authors: Lee Ben H. , Stoll Barbara J. , McDonald Scott A. , Higgins Rosemary D. ,   for the National Institute of Child Health and Human Development Neonatal Research Network
Published: May 2006

OBJECTIVE. Antenatal dexamethasone and betamethasone may not be equally efficacious in the prevention of adverse neonatal outcomes. We compared the risks of periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), and neonatal death among very low birth weight infants who were exposed to dexamethasone, betamethasone, or neither steroid.METHODS. Infants (401–1500 g) in the National Institute of Child Health and Human Development Neonatal Research Network were studied. Multivariate logistic regression analyses compared the 3 groups with regard to PVL, IVH, ROP, and neonatal death, adjusting for network center and selected covariates.RESULTS. A total of 3600 infants met entry criteria. Compared with no antenatal steroids, there were trends for a reduced risk for PVL associated with dexamethasone and betamethasone but no difference in risk between dexamethasone and betamethasone. Dexamethasone reduced the risk for IVH and severe IVH, compared with no antenatal steroid exposure. Betamethasone reduced the risk for IVH, severe IVH, and neonatal death, compared with no antenatal steroids. Compared with betamethasone, dexamethasone had a statistically significant increased risk for neonatal death. There were trends for greater risks associated with dexamethasone compared with betamethasone for IVH and severe ROP.CONCLUSIONS. Betamethasone was associated with a reduced risk for neonatal death, with trends of decreased risk for other adverse neonatal outcomes, compared with dexamethasone. It may be in the best interest of neonates to receive betamethasone rather than dexamethasone when available.
Prolonged Indomethacin Exposure Is Associated With Decreased White Matter Injury Detected With Magnetic Resonance Imaging in Premature Newborns at 24 to 28 Weeks' Gestation at Birth
Authors: Miller Steven P. , Mayer Eleanor E. , Clyman Ronald I. , Glidden David V. , Hamrick Shannon E.G. , Barkovich A. James 
Published: May 2006

OBJECTIVES. Newborns delivered before 28 weeks' gestation commonly have white matter lesions on MRI that are associated with adverse neurodevelopmental outcomes. Our objective was to determine the risk factors for MRI-detectable white matter injury in infants delivered before 28 weeks' gestation who were treated with prophylactic indomethacin.METHODS. This was a prospective cohort study conducted at the intensive care nursery at University of California San Francisco Children's Hospital. Patients included 57 premature newborns between 24 and 27 (+6 days) weeks' gestation at birth (October 1998 to October 2004). We identified perinatal and neonatal risk factors associated with moderate-severe “white matter injuries” (T1 signal abnormalities &gt;2 mm or &gt;3 areas of T1 abnormality) and moderate-severe “brain abnormality” (moderate-severe white matter injuries, any degree of ventriculomegaly, or severe intraventricular hemorrhage) on MRI. Infants were studied with MRI at 31.1 weeks’ postmenstrual age (median).RESULTS. Moderate-severe white matter injuries were detected in 12 (21%) of 53 preterm newborns, and 20 (35%) of 57 had moderate-severe brain abnormality. Prolonged indomethacin exposure was the only risk factor independently associated with a lower risk of white matter injury or brain abnormality, even when adjusting for the presence of a hemodynamically significant PDA, gestational age at birth, prenatal betamethasone, systemic infection, and days of mechanical ventilation.CONCLUSIONS. In this observational study, a longer duration of indomethacin exposure was associated with less white matter injury in infants delivered before 28 weeks' gestation. A randomized trial of prolonged indomethacin treatment is needed to determine whether indomethacin can decrease white matter injury and neurodevelopmental abnormalities.
Psychological Differences Between Children With and Without Soiling Problems
Authors: Joinson Carol , Heron Jon , Butler Ursula , von Gontard Alexander ,   the Avon Longitudinal Study of Parents and Children Study Team
Published: May 2006

OBJECTIVES. Previous studies, based on clinic samples, report that childhood soiling is associated with behavior problems and reduced self-esteem. This population-based study investigates the prevalence of psychological problems associated with childhood soiling.METHODS. A total of 8242 children aged 7–8 years born to mothers in the United Kingdom–based Avon Longitudinal Study of Parents and Children were studied. Parents completed postal questionnaires assessing common childhood emotional and behavioral problems, and children were asked questions at a research clinic concerning their behavior, friendships, bullying, and self-esteem. The rate of psychological problems was compared in children who soil frequently (once a week or more), those who soil occasionally (less than once a week), and those with no soiling problems (controls). Analyses were adjusted for developmental delay, gender, sociodemographic background, and stressful life events.RESULTS. Children who soil were reported by their parents to have significantly more emotional and behavioral problems compared with children who do not soil. Children who soil frequently had significantly more problems than those who soil occasionally. The rate of attention and activity problems, obsessions and compulsions, and oppositional behavior was particularly high in frequently soiling children. Children with soiling problems reported significantly higher rates of involvement in overt bullying (as both perpetrator and victim) and antisocial activities compared with controls.CONCLUSIONS. The current study finds significantly higher rates of behavior and emotional problems, bullying, and antisocial activities in children who soil compared with those who do not soil. Children who soil frequently are more likely to have these problems than those who soil occasionally.
Intrahepatic Cholestasis of Pregnancy and Neonatal Respiratory Distress Syndrome
Authors: Zecca Enrico , De Luca Daniele , Marras Marco , Caruso Alessandro , Bernardini Tommaso , Romagnoli Costantino 
Published: May 2006

OBJECTIVES. We sought to verify the association between maternal intrahepatic cholestasis of pregnancy (ICP) and neonatal respiratory distress syndrome (RDS) and to determine how bile acids levels alter the risk of developing neonatal RDS.
METHODS. We extracted data from our divisional database about all of the newborns born during the years 2000–2004. We compared 77 neonates born from pregnancies complicated by ICP with 427 neonates in the same range of gestational age born from noncomplicated pregnancies. We studied maternal bile acids levels immediately before delivery in mothers with ICP and measured bile acid levels during the first 24 hours of life in their newborns.
RESULTS. The incidence of RDS in newborns from cholestatic pregnancies was twice that the reference population (28.6% vs 14%). The multivariate analysis showed that the risk of RDS in these newborns was ∼2.5 times higher than in control infants. Within the ICP group, maternal and neonatal bile acid levels of infants affected by RDS were not significantly higher than those of healthy infants. The multivariate analysis showed that a low gestational age was the most important risk factor, but the probability of respiratory distress syndrome also increased by 2‰ for every additional micromole of the interaction term “neonatal by maternal bile acids level.”
CONCLUSIONS. Maternal ICP is significantly associated with the occurrence of RDS in the newborn. We hypothesize that bile acids can produce surfactant depletion in the alveoli reverting the reaction of phospholipase A2. This hypothesis could potentially be confirmed by bronchoalveolar lavage study.
Environmental Tobacco Smoke Exposure: Prevalence and Mechanisms of Causation of Infections in Children
Authors: Kum-Nji Philip , Meloy Linda , Herrod Henry G. 
Published: May 2006

BACKGROUND AND OBJECTIVES. Environmental tobacco smoke (ETS) exposure is probably one of the most important public health hazards in our community. Our aim with this article is to (1) review the prevalence of ETS exposure in the United States and how this prevalence is often measured in practice and (2) summarize current thinking concerning the mechanism by which this exposure may cause infections in young children.METHODS. We conducted a Medline search to obtain data published mainly in peer-reviewed journals.RESULTS. There is still a very high prevalence of ETS exposure among US children ranging from 35% to 80% depending on the method of measurement used and the population studied. The mechanism by which ETS may be related to these infections is not entirely clear but may be through suppression or modulation of the immune system, enhancement of bacterial adherence factors, or impairment of the mucociliary apparatus of the respiratory tract, or possibly through enhancement of toxicity of low levels of certain toxins that are not easily detected by conventional means.CONCLUSIONS. The prevalence of ETS exposure in the United States is still very high, and its role in causing infections in children is no longer in doubt even if still poorly understood. Research, therefore, should continue to focus on the various mechanisms of causation of these infections and how to best reduce the exposure levels.
Does Familiarity Breed Acceptance? The Influence of Policy on Physicians' Attitudes Toward Newborn Screening Programs
Authors: Koopmans Joy , Ross Lainie Friedman 
Published: May 2006

OBJECTIVE. As newborn screening (NBS) programs expand to include conditions that challenge traditional public health criteria, little is known about what influences physicians' attitudes toward screening. We examined the effect of state policy and perceived state policy on pediatricians' attitudes toward screening.METHODS. Six hundred pediatricians from the American Academy of Pediatrics who practiced in Wisconsin, Colorado, Florida, or Illinois were queried about (1) testing high-risk infants and (2) universal NBS for cystic fibrosis (CF), glucose-6-phosphate dehydrogenase deficiency (G6PD), and type 1 diabetes.RESULTS. A total of 225 (41%) of 548 eligible pediatricians returned 223 surveys with usable data. The majority were supportive of NBS for CF (n = 188 [84%]) and G6PD (n = 130 [58%]), whereas only 25% (n = 55) supported type 1 diabetes screening. Pediatricians who lived in states that screen for a condition were more likely to support screening than those who lived in states that did not (CF: 117 of 119 [98%] vs 71 of 89 [80%]; type 1 diabetes: 32 of 88 [36%] vs 23 of 109 [21%]). Physicians also were more likely to support NBS when they believed that it was offered in their state versus when they believed that it was not (CF: 117 of 119 [98%] vs 52 of 65 [80%]; G6PD: 28 of 32 [88%] vs 75 of 108 [69%]; type 1 diabetes: 7 of 14 [50%] vs 25 of 102 [25%]).CONCLUSIONS. Most pediatricians are supportive of NBS for CF and G6PD but not type 1 diabetes. Pediatricians who live in states that screen or believe that their states screen are more likely to support screening.
Venous Thrombosis Associated With Staphylococcal Osteomyelitis in Children
Authors: Gonzalez Blanca E. , Teruya Jun , Mahoney Donald H. , Hulten Kristina G. , Edwards Rachael , Lamberth Linda B. , Hammerman Wendy A. , Mason Edward O. , Kaplan Sheldon L. 
Published: May 2006

BACKGROUND. Venous thrombosis (VT) in children with Staphylococcus aureus osteomyelitis occurs rarely. We describe clinical features of infections and molecular characterization of isolates of children at Texas Children's Hospital with S aureus osteomyelitis and VT.
METHODS. We reviewed records and imaging studies (chest radiographs, ultrasound, computed tomography, and MRI) of 9 patients at Texas Children's Hospital with acute S aureus osteomyelitis and new onset VT between August 1999 and December 2004. Isolates were fingerprinted by pulsed-field gel electrophoresis and tested for the presence of genes encoding selective virulence factors.
RESULTS. The mean age of the patients was 10.6 years. All 9 of the patients had osteomyelitis with sites of infection adjacent to the VT. The femoral and popliteal veins were most commonly affected. Two patients had VTs develop on the same side in which a central line had been in place. Four patients had chest radiographs consistent with septic emboli; inferior vena cava filters were placed in 3. Evaluation for hypercoagulable state revealed 3 patients with lupus anticoagulant, 1 with anticardiolipin IgG antibody, and 5 with no defect. Most laboratory abnormalities had resolved at follow-up. Seven patients had infections caused by methicillin-resistant S aureus belonging to the same clonal group (USA300); all were community acquired. Seven isolates carried the Panton-Valentine leukocidin (luk-S-PV and luk-F-PV) genes.
CONCLUSIONS. The predominant community-acquired, methicillin-resistant S aureus clone in Houston, Texas, (USA300) may have a unique propensity to cause VT in association with osteomyelitis. Management of the venous thrombosis in this setting may be complicated by the rapid evolution of septic emboli.
Verbal Abuse by the Teacher and Child Adjustment From Kindergarten Through Grade 6
Authors: Brendgen Mara , Wanner Brigitte , Vitaro Frank 
Published: May 2006

OBJECTIVES. Many adults mention past incidences of verbal abuse by the teacher as the most overwhelming negative experience in their lives. The present study examined (1) the course and stability of verbal abuse by the teacher from kindergarten through grade 4 and (2) the link between verbal abuse by the teacher and children's behavioral, emotional, and academic adjustment.
DESIGN. Participants were 399 children (177 girls) who were assessed yearly over a period of 7 years, starting in kindergarten. Verbal abuse by the teacher, as well as acceptance versus rejection by the peer group from kindergarten through grade 4, were assessed through peer nomination. Child adjustment from kindergarten through grade 4 (antisocial behavior, attention problems, anxiety) was evaluated by the teacher. Child adjustment in early adolescence (delinquent behavior, depressive feelings, academic performance) was assessed by teacher evaluations and self-reports.
RESULTS. The vast majority of children (∼85%) have almost 0 risk of becoming a target of verbal abuse by the teacher over the course of elementary school. However, a small minority of children (15%) seems to be at relatively high risk of verbal abuse by the teacher in kindergarten, and this risk increases even further over the course of elementary school. Boys, as well as children with high levels of early antisocial behavior and attention problems in kindergarten, are at high risk of verbal abuse by the teacher during elementary school. In turn, verbal abuse by the teacher is significantly related to subsequent delinquent behavior and academic difficulties in early adolescence, although this effect depends on child characteristics.
CONCLUSIONS. Verbal abuse by the teacher seems to be a highly stable phenomenon for at-risk children. Children who are relatively well adjusted are at low risk of becoming the target of verbal abuse by the teacher. If they do, however, these children are the most vulnerable to subsequent developmental difficulties.
Comparison of Enzyme-Linked Immunospot Assay and Tuberculin Skin Test in Healthy Children Exposed to Mycobacterium tuberculosis
Authors: Hill Philip C. , Brookes Roger H. , Adetifa Ifedayo M.O. , Fox Annette , Jackson-Sillah Dolly , Lugos Moses D. , Donkor Simon A. , Marshall Roger J. , Howie Stephen R.C. , Corrah Tumani , Jeffries David J. , Adegbola Richard A. , McAdam Keith P.W.J. 
Published: May 2006

OBJECTIVE. To compare the enzyme-linked immunospot (ELISPOT) assay with the tuberculin skin test (TST) in children for the diagnosis of Mycobacterium tuberculosis infection in the Gambia.
METHODS. We divided child contacts of sputum smear-positive tuberculosis cases into 3 age categories (&lt;5, 5–9, and 10–14 years) and assessed agreement between the 2 tests plus their relationship to prior Bacille Calmette-Guerin (BCG) vaccination. We categorized a child's level of M tuberculosis exposure according to where he/she slept relative to a case: the same room, same house, or a different house. The relationship between exposure and test result was assessed by multiple logistic regression.
RESULTS. In child contacts of 287 cases, 225 (32.5%) of 693 were positive by TST and 232 (32.3%) of 718 by ELISPOT. The overall agreement between tests was 83% and the discordance was not significant. Both tests responded to the M tuberculosis exposure gradient in each age category. The percentage of those who were TST positive/ELISPOT negative increased with increasing exposure. At the lowest exposure level, the percentage of ELISPOT-positive children who were TST negative was increased compared with the highest exposure level. Neither test had evidence of false positive results because of BCG.
CONCLUSIONS. In Gambian children, the ELISPOT is slightly less sensitive than the TST in the diagnosis of M tuberculosis infection from recent exposure, and neither test is confounded by prior BCG vaccination. Evidence of reduced TST sensitivity in subjects with the lowest known recent M tuberculosis exposure suggests that, when maximal sensitivity is important, the 2 tests may be best used together.
Impaired Flow-Mediated Vasodilation, Carotid Artery Intima-Media Thickening, and Elevated Endothelial Plasma Markers in Obese Children: The Impact of Cardiovascular Risk Factors
Authors: Meyer Andreas Alexander , Kundt Günther , Steiner Michael , Schuff-Werner Peter , Kienast Wolfgang 
Published: May 2006

OBJECTIVES. Childhood obesity contributes to the development of adult obesity and subsequent cardiovascular disease. The present study aimed to assess vascular status (flow-mediated vasodilation [FMD], intima-media thickness [IMT]) and to analyze plasma surrogate endothelial markers (von Willebrand factor [vWf], E-selectin, and thrombomodulin) in obese children as compared with controls. Associations between early morphologic and functional vascular changes, surrogate soluble markers of early atherosclerosis, and the cardiovascular risk profile were determined.METHODS. We examined 32 obese children versus 20 control subjects. All of the children underwent identical screening, comprehensive risk factor assessment, and measurements of E-selectin, vWf, thrombomodulin, FMD, and IMT.RESULTS. Compared with controls, obese children demonstrated significantly impaired FMD and increased IMT. Concentrations of soluble E-selectin and thrombomodulin were significantly elevated in obese children, whereas vWf showed no significant differences between obese children and controls. FMD, IMT, E-selectin, and thrombomodulin were significantly associated with various risk factors, including the extent of obesity, arterial hypertension, fibrinogen, C-reactive protein, and low physical fitness.CONCLUSIONS. The present study documented increased IMT, impaired endothelial function, and elevated plasma markers of endothelial activation and injury in obese children. Morbid obesity, arterial hypertension, subclinical inflammation, and low physical fitness formed a risk profile associated with the risk of early atherosclerosis in these children. Sonographic assessment of vascular status and the estimation of soluble endothelial plasma markers, combined with comprehensive risk factor screening, may form a rationale to identify high-risk children susceptible to early atherosclerotic disease and to monitor vascular changes during follow-up studies and therapeutic measures.