bluuebunny/crossref_metadata_2025_split huggingface dataset:
Onset of Mechanical Ventilation Is Associated With Rapid Activation of Circulating Phagocytes in Preterm Infants
Authors: Turunen Riikka , Nupponen Irmeli , Siitonen Sanna , Repo Heikki , Andersson Sture 
Published: February 2006

OBJECTIVE. In preterm infants with respiratory distress syndrome (RDS), circulating neutrophils are activated. Kinetics and effects of surfactant therapy on this activation are unknown. Therefore, we studied activation of circulating neutrophils and monocytes in newborn preterm infants with and without RDS.PATIENTS AND METHODS. Preterm infants with RDS who were mechanically ventilated and received surfactant (“ventilated infants”: n = 38; mean gestational age ± SD: 28.3 ± 2.2 weeks; mean birth weight ± SD: 1086 ± 353 g) and preterm infants who received nasal continuous positive airway pressure (n = 8) or no ventilatory support (n = 17) (“control infants”: mean gestational age ± SD: 32.1 ± 1.2 weeks; mean birth weight ± SD: 1787 ± 457 g) were recruited. Blood samples were taken from ventilated infants at birth, before surfactant treatment, at 1 and 2 hours after surfactant, and at 12 to 24 hours of age. Blood samples were taken from control infants at birth, at 2 to 6 hours, and at 12 to 24 hours of age. Phagocyte CD11b expression was analyzed by flow cytometry.RESULTS. In ventilated infants, phagocyte CD11b expression increased from birth to the first postnatal samples. It increased further by 12 to 24 hours of age. Control infants with or without nasal continuous positive airway pressure showed no significant increase after birth. At 12 to 24 hours of age, phagocyte CD11b expression was higher in ventilated infants than in control infants. In ventilated infants, neutrophil CD11b expression at 1 and 2 hours after surfactant correlated positively with gestational age.CONCLUSIONS. In preterm infants with RDS, significant activation of circulating phagocytes occurs within 1 to 3 hours of the onset of mechanical ventilation, independent of surfactant administration, which indicates that mechanical ventilation may be the inducer of this systemic inflammatory response.
Factors Associated With Neurodevelopmental Outcome at 2 Years After Very Preterm Birth: The Population-Based Nord-Pas-de-Calais EPIPAGE Cohort
Authors: Fily Antoine , Pierrat Véronique , Delporte Valérie , Breart Gérard , Truffert Patrick ,   on behalf of the EPIPAGE Nord-Pas-de-Calais Study Group
Published: February 2006

OBJECTIVE. We sought to (1) evaluate at 2 years the postsurfactant era developmental outcome of children who were born before 33 weeks of gestational age (GA) in the Nord-Pas-de-Calais area in France in 1997 and (2) identify risk factors of poor developmental quotient (DQ). Children were part of the EPIPAGE study, which included all of these births in 9 French regions.METHODS. A prospective observational study was conducted of all births before 33 weeks in 1997. Risk factors of poor DQ were obtained from a multiple linear regression, and results were expressed as DQ differences with 95% confidence intervals.RESULTS. A total of 546 births were included in the study. A total of 461 (84.4%) had a clinical evaluation at 2 years of age, and 380 (69.6%) had an assessment with the use of the Brunet-Lezine scale of infant development. Their mean GA was 29.9 weeks (29.7–30.1 weeks), and mean birth weight was 1378 g (1338–1418 g). A total of 9% had a recognizable pattern of cerebral palsy, 0.2% were blind, and 0.8% required hearing aids. The mean DQ was 94 ± 11 and decreased from 97 at 32 weeks to 86 at 24 to 25 weeks. After multivariate analysis, children who were born at 24 to 25 weeks had a mean DQ reduction of 11 points (−20 to −1) compared with those who were born at 32 weeks, but minor differences were found from 26 to 32 weeks. Boys had a DQ 4 points lower than girls (−7 to −1).CONCLUSIONS. In this study, the outcome of extremely preterm infants was poor. After 25 weeks, outcome was related mainly to the sociocultural level of the family and to the presence of severe cerebral ultrasound abnormalities. Consequently, in the postsurfactant era, we have to propose follow-up programs to children who are born extremely preterm and to concentrate our efforts on children with less-than-optimal social and family setting.
Quality of Life for Children and Adolescents: Impact of HIV Infection and Antiretroviral Treatment
Authors: Lee Grace M. , Gortmaker Steven L. , McIntosh Kenneth , Hughes Michael D. , Oleske James M. ,   Pediatric AIDS Clinical Trials Group Protocol 219C Team
Published: February 2006

BACKGROUND. HIV/AIDS mortality rates in the United States are declining; pediatric HIV has become a chronic disease, with quality of life (QoL) outcomes assuming greater importance.
OBJECTIVES. To compare QoL among HIV-infected and uninfected children and to assess the impact of different antiretroviral regimens on QoL among HIV-infected children.
METHODS. Perinatally exposed, HIV-infected (N = 1847) and uninfected (N = 712) children and adolescents were studied. Among infected children, 1283 were available for the antiretroviral regimen analysis. QoL domain scores were assessed for subjects 6 months to 4 years, 5 to 11 years, and 12 to 21 years of age, and the impact of infection status and alternative treatment regimens on QoL domains was evaluated.
RESULTS. HIV infection was associated with significantly worse mean adjusted scores for functional status among children 6 months to 4 years of age and health perceptions, physical resilience, physical functioning, and social/role functioning among those 5 to 11 years of age. However, uninfected children 5 to 11 years of age reported significantly worse psychological functioning. HIV-infected children (5–11 years of age) and adolescents (12–21 years of age) receiving no antiretroviral treatment had worse health perceptions. Adolescents receiving no antiretroviral agents also had worse symptoms. When antiretroviral regimens were compared, adolescents receiving protease inhibitor plus nonnucleoside reverse transcriptase inhibitor-containing therapy had worse symptoms, compared with those receiving protease inhibitor-containing therapy; otherwise, no significant differences were found.
CONCLUSIONS. Generally parents of HIV-infected children 6 months to 4 years and 5 to 11 years of age generally reported lower mean QoL scores than did parents of uninfected children, although worse psychological functioning was reported for uninfected children. HIV-infected adolescents not receiving antiretroviral treatment had worse health perceptions and symptoms. We found no consistent QoL differences among children receiving different antiretroviral regimens.
Persistent Bacteremia and Severe Thrombocytopenia Caused by Coagulase-NegativeStaphylococcusin a Neonatal Intensive Care Unit
Authors: Khashu Minesh , Osiovich Horacio , Henry Deborah , Khotani Aziz Al , Solimano Alfonso , Speert David P. 
Published: February 2006

OBJECTIVE. Coagulase-negative Staphylococcus (CoNS) is the most frequent cause of late-onset sepsis in NICUs, but mortality is rare and morbidity is unusual. We report a new syndrome of CoNS sepsis characterized by significant morbidity and persistent bacteremia despite aggressive antibiotic therapy and no identified focus of infection.METHODS. We conducted a retrospective review of infants in the NICU with CoNS bacteremia between 2000 and 2002. Statistical analysis included an initial exploratory analysis followed by logistic regression. Microbiological identification of all isolates and molecular typing were performed.RESULTS. Thirty-one neonates with persistent CoNS bacteremia were compared with 60 randomly selected neonates from a group of 140 with nonpersistent CoNS bacteremia. The clinical manifestations at presentation, gestational ages, and birth weights were similar in the 2 groups. Thrombocytopenia was present in 26 (84%) neonates with persistent CoNS bacteremia but only in 8 (13%) neonates in the nonpersistent group. Central venous catheterization increased the risk for persistent CoNS bacteremia, but 42% of the persistent group was never catheterized. Staphylococcus epidermidis was the most common isolate in both groups. Molecular typing failed to identify a predominant clone.CONCLUSIONS. The syndrome of persistent CoNS septicemia is remarkable for thrombocytopenia and persistence in the absence of central venous catheterization. Clinical manifestations at presentation and demographic characteristics did not discriminate between the persistent and nonpersistent groups. We did not identify the emergence of a particularly virulent clone, but it is possible that some strains of CoNS have acquired the capacity to persist under different conditions.
Improved Asthma Care After Enrollment in the State Children's Health Insurance Program in New York
Authors: Szilagyi Peter G. , Dick Andrew W. , Klein Jonathan D. , Shone Laura P. , Zwanziger Jack , Bajorska Alina , Yoos H. Lorrie 
Published: February 2006

BACKGROUND. Uninsured children with asthma are known to face barriers to asthma care, but little is known about the impact of health insurance on asthma care.OBJECTIVES. We sought to assess the impact of New York's State Children's Health Insurance Program (SCHIP) on health care for children with asthma.DESIGN. Parents of a stratified random sample of new enrollees in New York's SCHIP were interviewed by telephone shortly after enrollment (baseline, n = 2644 [74% of eligible children]) and 1 year later (follow-up, n = 2310 [87%]). Asthma was defined by parent report using questions based on National Heart, Lung, and Blood Institute criteria. A comparison group (n = 401) who enrolled in SCHIP 1 year later was interviewed as a test for secular trends.MAIN OUTCOME MEASURES. Access (having a usual source of care [USC], unmet health needs, problems receiving acute asthma care), asthma-related medical visits, quality (continuity of care at the USC, problems receiving chronic asthma care, use of antiinflammatory medications), and asthma outcomes (change in asthma care or severity) were the main outcome measures used. Bivariate and multivariate analyses compared measures at baseline (year before SCHIP) versus follow-up (year during SCHIP).RESULTS. Three-hundred eighty-three children (14%) had asthma at baseline, and 364 had asthma at follow-up (16%). No secular trends were detected between the baseline study group and the comparison group. After enrollment in SCHIP, improvements were noted in access: lacking a USC (decrease from 5% to 1%), unmet health needs (48% to 21%), and problems getting to the USC for asthma (13 to 4%). Children had fewer asthma-related attacks and medical visits after SCHIP (mean number of attacks: 9.5 to 3.8: mean number of asthma visits: 3.0 to 1.5; hospitalizations: 11% to 3%). Quality of asthma care improved for general measures (most/all visits to USC: 53% to 94%; mean rating of provider: 7.9 to 8.8 of 10) and asthma-specific measures (problems getting to the USC for asthma care when child was well: 13% to 1%). More than two thirds of the parents at follow-up reported that both quality of asthma care and asthma severity were “better or much better” than at baseline, generally because of insurance coverage or lower costs of medications and medical care.CONCLUSIONS. Enrollment in New York's SCHIP was associated with improvements in access to asthma care, quality of asthma care, and asthma-specific outcomes. These findings suggest that health insurance improves the health of children with asthma.
Anticipatory Guidance and Violence Prevention: Results From Family and Pediatrician Focus Groups
Authors: Sege Robert D. , Hatmaker-Flanigan Elizabeth , De Vos Edward , Levin-Goodman Rebecca , Spivak Howard 
Published: February 2006

OBJECTIVES. Anticipatory guidance is a cornerstone of modern pediatric practice. Recent American Academy of Pediatrics policies related to violence prevention, notably those that advocate firearms safety and the use of alternatives to corporal punishment, seem to be discrepant with common parenting practices. To develop more effective anticipatory guidance, we sought the opinions of parents and pediatricians on how best to communicate these messages.DESIGN. Focus groups were conducted to elicit parent and provider opinions.SUBJECTS. Forty-nine parents participated in a total of 9 90-minute focus groups that were held in 3 cities. Twenty-six pediatricians participated in 3 focus groups that were held at a single national meeting.PROCEDURES. Participants were read summaries of current American Academy of Pediatrics policies and led through a systematic discussion of how these policies might best be communicated. The group discussions were audiotaped, transcribed, and analyzed. Common themes heard in multiple groups are reported.RESULTS. Parents provided specific feedback about corporal punishment and firearms and also raised a number of general issues. Pediatricians reported that anticipatory guidance was important to them but cited cultural and reimbursement issues as barriers to practice. They also reported the need for additional training and support to make anticipatory guidance more effective.DISCUSSION. Focus groups provide insight into doctor-patient communications and can inform efforts to improve primary prevention in the clinical setting. Anticipatory guidance that consists of authoritative useful information, offered in a supportive manner that communicates respect for parental decision-making, may be effective in improving parenting practices.
Acute and Sustained Effects of Lucinactant Versus Poractant-α on Pulmonary Gas Exchange and Mechanics in Premature Lambs With Respiratory Distress Syndrome
Authors: Gastiasoro-Cuesta Elena , Alvarez-Diaz Francisco J. , Rey-Santano Carmen , Arnaiz-Renedo Arantxa , Loureiro-Gonzalez Begoña , Valls-i-Soler Adolf 
Published: February 2006

BACKGROUND. Animal-derived, protein-containing surfactants seem to be superior to protein-free surfactants. Lucinactant, a synthetic surfactant containing a surfactant protein-B peptide analog, has been shown to be effective in animal models and phase II clinical trials. To date, lucinactant has not been compared with an animal-derived surfactant in a premature animal model.OBJECTIVE. The objective was to compare the acute and sustained effects of lucinactant among premature lambs with respiratory distress syndrome (RDS) with the effects of a natural porcine surfactant (poractant-α).METHODS. After 5 minutes of mechanical ventilation twin premature lambs were assigned randomly to the lucinactant group (30 mg/mL, 5.8 mL/kg) or the poractant-α group (80 mg/mL, 2.2 mL/kg). Heart rate, systemic arterial pressure, arterial pH, blood gas values, and lung mechanics were recorded for 12 hours.RESULTS. Baseline fetal pH values were similar for the 2 groups (pH 7.27). After 5 minutes of mechanical ventilation, severe RDS developed (pH: &lt;7.08; Paco2: &gt;80 mm Hg; Pao2: &lt;40 mm Hg; dynamic compliance: &lt;0.08 mL/cm H2O per kg). After surfactant instillation, similar improvements in gas exchange and lung mechanics were observed for the lucinactant and poractant-α groups at 1 hour (pH: 7.3 ± 0.1 vs 7.4 ± 0.1; Paco2: 8 ± 18 mm Hg vs 40 ± 8 mm Hg; Pao2: 167 ± 52 mm Hg vs 259 ± 51 mm Hg; dynamic compliance: 0.3 ± 0.1 mL/cm H2O per kg vs 0.3 ± 0.1 mL/cm H2O per kg). The improvements in lung function were sustained, with no differences between groups. Cardiovascular profiles remained stable in both groups.CONCLUSIONS. Among preterm lambs with severe RDS, lucinactant produced improvements in gas exchange and lung mechanics similar to those observed with a porcine-derived surfactant.
Toward Understanding Kernicterus: A Challenge to Improve the Management of Jaundiced Newborns
Authors: Wennberg Richard P. , Ahlfors Charles E. , Bhutani Vinod K. , Johnson Lois H. , Shapiro Steven M. 
Published: February 2006

PURPOSE. We sought to evaluate the sensitivity and specificity of total serum bilirubin concentration (TSB) and free (unbound) bilirubin concentration (Bf) as predictors of risk for bilirubin toxicity and kernicterus and to examine consistency between these findings and proposed mechanisms of bilirubin transport and brain uptake.METHODS. A review of literature was undertaken to define basic principles of bilirubin transport and brain uptake leading to neurotoxicity. We then reviewed experimental and clinical evidence that relate TSB or Bf to risk for bilirubin toxicity and kernicterus.RESULTS. There are insufficient published data to precisely define sensitivity and specificity of either TSB or Bf in determining risk for acute bilirubin neurotoxicity or chronic sequelae (kernicterus). However, available laboratory and clinical evidence indicate that Bf is better than TSB in discriminating risk for bilirubin toxicity in patients with severe hyperbilirubinemia. These findings are consistent with basic pharmacokinetic principles involved in bilirubin transport and tissue uptake.CONCLUSIONS. Experimental and clinical data strongly suggest that measurement of Bf in newborns with hyperbilirubinemia will improve risk assessment for neurotoxicity, which emphasizes the need for additional clinical evaluation relating Bf and TSB to acute bilirubin toxicity and long-term outcome. We speculate that establishing risk thresholds for neurotoxicity by using newer methods for measuring Bf in minimally diluted serum samples will improve the sensitivity and specificity of serum indicators for treating hyperbilirubinemia, thus reducing unnecessary aggressive intervention and associated cost and morbidity.
Parental Expectations, Physical Punishment, and Violence Among Adolescents Who Score Positive on a Psychosocial Screening Test in Primary Care
Authors: Ohene Sally-Ann , Ireland Marjorie , McNeely Clea , Borowsky Iris Wagman 
Published: February 2006

OBJECTIVE. We sought to examine the relationship between perceived and stated parental expectations regarding adolescents' use of violence, parental use of physical punishment as discipline, and young adolescents' violence-related attitudes and involvement.METHODS. Surveys were completed by 134 youth and their parents attending 8 pediatric practices. All youth were 10 to 15 years of age and had scored positive on a psychosocial screening test.RESULTS. Multivariate analyses revealed that perceived parental disapproval of the use of violence was associated with a more prosocial attitude toward interpersonal peer violence and a decreased likelihood of physical fighting by the youth. Parental report of whether they would advise their child to use violence in a conflict situation (stated parental expectations) was not associated with the adolescents' attitudes toward interpersonal peer violence, intentions to fight, physical fighting, bullying, or violence victimization. Parental use of corporal punishment as a disciplining method was inversely associated with a prosocial attitude toward interpersonal peer violence among the youth and positively correlated with youths' intentions to fight and fighting, bullying, and violence victimization.CONCLUSIONS. Perceived parental disapproval of the use of violence may be an important protective factor against youth involvement in violence, and parental use of physical punishment is associated with both violence perpetration and victimization among youth. Parents should be encouraged to clearly communicate to their children how to resolve conflicts without resorting to violence and to model these skills themselves by avoiding the use of physical punishment.
Personality in Young Adults Who Are Born Preterm
Authors: Allin Matthew , Rooney Maeve , Cuddy Marion , Wyatt John , Walshe Muriel , Rifkin Larry , Murray Robin 
Published: February 2006

INTRODUCTION. Very preterm birth (VPT; &lt;33 weeks' gestation) is associated with later neuromotor and cognitive impairment, reduced school performance, and psychiatric morbidity. Several follow-up studies have demonstrated increased anxiety and social rejection and reduced self-esteem in preterm children and adolescents, but few studies have examined the effects of preterm birth on adult personality.
METHODS. We assessed 108 VPT individuals and 67 term-born controls at ages 18 to 19 years with the Eysenck Personality Questionnaire-Revised, short form (EPQ-RS). This questionnaire rates 3 dimensions of personality: extraversion (sociability, liveliness, sensation seeking); neuroticism (anxiety, low mood, low self-esteem); and psychoticism (coldness, aggression, predisposition to antisocial behavior). A fourth scale, “lie,” which measures dissimulation, is also derived.
RESULTS. VPT individuals had significantly lower extraversion scores, higher neuroticism scores, and higher lie scores than term-born controls, after controlling for age at assessment and socioeconomic status. P scores were not significantly different between the 2 groups. There was a gender difference in that the increased neuroticism and decreased extraversion scores were accounted for mainly by VPT females. Associations between EPQ-RS scores and neonatal status, adolescent behavioral ratings, and body size at 18 to 19 years were assessed by using Kendall partial correlations, correcting for age at assessment and socioeconomic status. Gestational age, indices of neonatal hypoxia, and neonatal ultrasound ratings were not correlated with EPQ-RS scores. Birth weight was weakly associated with increased lie scores. Rutter Parents' Scale score, a measure of adolescent psychopathology, was associated with an increased neuroticism score. Poor social adjustment in adolescence was associated with an increased lie score. Height and weight at 18 to 19 years were not associated with EPQ-RS, but reduced occipitofrontal circumference was associated with both decreased extraversion and increased lie scores.
CONCLUSIONS. Young adults who are born VPT have different personality styles from their term-born peers. This may be associated with an increased risk of psychiatric difficulties.