bluuebunny/crossref_metadata_2025_split huggingface dataset:
School Difficulties at Adolescence in a Regional Cohort of Children Who Were Extremely Low Birth Weight
Authors: Saigal Saroj , Hoult Lorraine A. , Streiner David L. , Stoskopf Barbara L. , Rosenbaum Peter L. 
Published: August 2004

Objectives.To compare measures of psychometric assessment and school difficulties in a cohort of extremely low birth weight (ELBW) teenagers and term controls, and to determine whether there is stability in psychometric measures between age 8 and the teen years.Study Design.Longitudinal follow-up; geographically defined region. Participants: 150 of 169 (89%) ELBW survivors born between 1977 and 1982 and 124 of 145 (86%) sociodemographically matched term controls between 12 and 16 years of age. Psychometric measures: Wechsler Intelligence Scale for Children-Revised, Wide Range Achievement Test-Revised, and a validated parent questionnaire.Results.Neurosensory impairments were present in 28% of ELBW and 1% of controls. The mean Wechsler Intelligence Scale for Children-Revised scores were ELBW: 89 ± 19 and controls: 102 ± 13. ELBW children did less well on Wide Range Achievement Test-Revised Reading, Spelling, and Arithmetic measures with mean scores in the range from 75 to 85. ELBW children &lt;750 g were more disadvantaged, compared with those ≥750 g. A significantly higher proportion of ELBW children were receiving special educational assistance and/or had repeated a grade (ELBW: 58%; controls: 13%; odds ratio: 9.0). Paired analysis of within-cohort data at age 8 and teen years showed that for both cohorts Arithmetic scores declined, but there were small improvements in other measures, predominantly in the term children.Conclusions.Differences of 13 to 18 points in psychometric measures in ELBW teens compared with controls are both statistically significant and clinically relevant. Decreasing birth weight was associated with increased risk on all measures. The high utilization of special educational resources has economic implications, and the incremental cost attributable to being extremely premature needs to be determined.
Use Assessment of Self-Administered Epinephrine Among Food-Allergic Children and Pediatricians
Authors: Sicherer Scott H. , Forman Joel A. , Noone Sally A. 
Published: August 2004

Background and Objectives.Food allergy is a common cause of anaphylaxis, and early treatment with epinephrine can be life-saving. We sought to determine the ability of families with food allergic children and pediatricians to properly use self-injectable epinephrine.Methods.We enrolled families of consecutive, food-allergic pediatric patients newly referred to our allergy practice but previously prescribed epinephrine and a sampling of pediatricians. Parents or teenage patients answered a structured questionnaire concerning use of self-injectable epinephrine and demonstrated the use of devices with which they were familiar. Demonstrations were scored in a standard manner.Results.One hundred one families of food-allergic children (mean age of patients, 6.4 years) were enrolled. Self-injectable epinephrine was prescribed (mean of 2.7 years previously) primarily by pediatricians (n = 46) and allergists (n = 49). Patients were prescribed EpiPen (n = 93), EpiE-Z Pen (n = 11), and Ana-Kit (n = 3). Eighty-six percent of the families responded that they had the device with them “at all times,” but only 71% of this group had epinephrine at the visit. Among those with the epinephrine, 10% had devices beyond the labeled expiration date. Thus, only 55% of the 101 families had unexpired epinephrine on-hand at the time of the survey. Among children in school, 77% had the medication available in school, and 81% stated that the school knew the indications for administration. Only 32% of the participants correctly demonstrated the use of the device. Twenty-nine attending pediatricians were enrolled (mean 14 yrs in practice; mean 4 epinephrine prescriptions/year). Familiarity with the devices was as follows: EpiPen (86%), EpiE-Z Pen (17%) and Ana-Kit (7%). Only 24% generally gave patients written materials concerning indications. Overall, 18% were familiar with and able to demonstrate correct use of at least 1 device (21% correctly demonstrated Epi-Pen). Seventeen pediatric residents were enrolled; 65% were familiar with the EpiPen; 36% demonstrated it correctly and only 1 resident was familiar with Ana-Kit.Conclusions.Many parents of severely food-allergic children, and food-allergic teenagers cannot correctly administer their self-injectable epinephrine and may not have the medication readily available. Pediatricians are not familiar with these devices and may fail to review their use with patients. Improved patient and physician education is needed to ensure proper use of this life-saving medication.
Exogenous Apotransferrin and Exchange Transfusions in Hereditary Iron Overload Disease
Authors: Fellman Vineta , von Bonsdorff Leni , Parkkinen LicTech‡; and Jaakko 
Published: August 2004

Objective.To investigate whether apotransferrin administration and exchange transfusion can improve outcome in patients with the recently described recessive congenital iron overload disease, presenting with intrauterine growth retardation, severe lactic acidosis, aminoaciduria, and hemosiderosis of the liver that so far has been treatment-resistant and lethal.Methodology.Because the patients have hypotransferrinemia, hyperferritinemia, increased transferrin saturation, and bleomycin detectable iron in plasma, we designed a treatment regime aiming at decreasing free iron and iron overload. The serum transferrrin concentration was increased to adult level (2–5 g/L) by intravenous apotransferrin administrations and thereafter exchange transfusion was performed.Results.Two patients were treated. In patient 1, the transferrin saturation decreased from a baseline value of 100% and remained normal after the third exchange transfusion, and in patient 2, a reversible beneficial effect was seen on transferrin saturation and bleomycin-detectable iron. However, both infants died later of the disease, at 10 and 8 weeks of age, respectively.Conclusions.Exogenous apotransferrin administration proved to be safe and might deserve evaluation in other neonatal diseases with presence of free iron in plasma. hemosiderosis, metabolic acidosis, newborn infant, transferrin.
Rhabdomyolysis Associated With Infection byMycoplasma pneumoniae: A Case Report
Authors: Berger Rachel Pardes , Wadowksy Robert M. 
Published: August 2004

Background.
Mycoplasma pneumoniae is responsible for approximately 20% of the cases of community-acquired pneumonia. The onset of respiratory symptoms is gradual and systemic complaints such as headache, malaise, arthalgias, and low-grade fever are frequently prominent. Extrapulmonary manifestations of M pneumoniae are common and hematologic (thrombocytopenia, splenomegaly, disseminated intravascular coagulation, hemolytic anemia), dermatologic (Stevens-Johnson syndrome), gastrointestinal (vomiting, diarrhea, pancreatitis), renal (interstitial nephritis, glomerulonephritis), cardiac (pericarditis, myocarditis, pericardial effusion) and central nervous system (meningitis, transverse myelitis, polyradiculopathy, cerebellar ataxia, sensorineural hearing loss) complications can occur.1–3

Observation.
We describe the case of an adolescent girl with massive rhabdomyolysis associated with an infection caused byM pneumoniae. We briefly review the differential diagnosis of a patient presenting with acute rhabdomyolysis and discuss the use of a new polymerase chain reaction-based assay for direct detection of M pneumoniae in throat swab specimens.

Conclusion.
Clinicians should be aware of a possible association between rhabdomyolysis and infection with M pneumoniae and should consider testing for M pneumoniae when they are presented with a patient with idiopathic rhabdomyolysis. The new polymerase chain reaction-based assay for detection of M pneumoniae is a more accurate and more efficient method than traditional culture.
Impact of Dietary Fat and Fiber Intake on Nutrient Intake of Adolescents
Authors: Nicklas Theresa A. , Myers LN*; Leann , O'Neil Carol , Gustafson Nancy 
Published: August 2004

Objective.To evaluate the impact of fat and fiber intake on energy and nutrient intake of 15-year-old adolescents.Study Design.Twenty-four-hour dietary recalls were collected on a random sample of 15-year-olds. Subjects were then categorized into groups based on fat and fiber intake, with 319 students meeting criteria for 1 of 4 dietary intake quadrants: low fat, low fiber; low fat, high fiber; high fat, low fiber; and high fat, high fiber. Students with medium fat or fiber intakes were excluded from the study. Low-fat and high-fat intake were defined as &lt;30% and &gt;40% of total energy intake, respectively. Low- and high-fiber intake were defined as &lt;15 g/day and &gt;20 g/day, respectively.Results.Low-fat and high-fiber intake had a minimal impact on energy intake and did not adversely affect nutrient intake. High-fiber intake was associated with greater likelihood of adequate intake of vitamins A, B6, B12, and C; niacin; thiamin; riboflavin; folacin; magnesium; iron; zinc; phosphorus; and calcium. High-fat intake was associated with greater likelihood of adequate vitamin B12 intake. Significant differences in fat and fiber intake distributions were found for ethnic background and gender, with more non-white than white students in the high-fat groups and more males than females in the high-fiber groups.Conclusions.A low-fat and high-fiber diet meeting current nutrition recommendations does not adversely affect energy or nutrient intake, increases nutrient density of the diet, and increases the likelihood of adequate intake for several key nutrients.
Intestinal Transplantation for Short Gut Syndrome Attributable to Necrotizing Enterocolitis
Authors: Vennarecci Giovanni , Kato Tomoaki , Misiakos Evangelos P. , Neto Alexandre Bakonyi , Verzaro Roberto , Pinna Antonio , Nery Jose , Khan Farrukh , Thompson John F. , Tzakis Andreas G. 
Published: August 2004

Background.Necrotizing enterocolitis (NEC) is a life-threatening condition of the neonatal age, which frequently requires surgical intervention. After extensive bowel resection, a small proportion of these patients may develop chronic short gut syndrome (SGS) and require chronic total parenteral nutrition (TPN) use. Intestinal transplantation has been performed in these patients as a life-saving option.This study reviews our experience with intestinal transplantation for SGS attributable to NEC emphasizing the mode of presentation, natural history, timing, and outcome.Methods.A retrospective chart review was performed for all pediatric patients who underwent small bowel transplantation for NEC at the University of Miami between August 1994 and March 1999.Results.Eleven transplants were performed for 10 patients with NEC (8 male and 2 female; median age: 1.75 years [range: 10 months to 10.1 years]). Procedures performed were isolated intestinal transplants (n = 2), combined liver-intestinal transplants (n = 6), and multivisceral transplants (n = 3). All patients were born prematurely with median birth weight of 1.640 kg (range: 810 g to 2.730 kg). They developed NEC in the first few days of life and subsequently underwent an average of 5 surgeries per patient before transplant. Transplant was indicated for liver failure in 8 patients and recurrent central line sepsis in 2 others.At present, 6 patients are alive with an overall 1-year and 3-year actuarial survival of 60% and a median follow-up of 29 months (range: 9–46 months). Six children have been weaned off TPN after a median time of 71 days (range: 19–131) from transplantation. All survivors are at home with functional grafts.Conclusion.Intestinal transplantation provided a reasonable outcome in patients with NEC-associated SGS who had already developed life-threatening complications related to TPN. Intestinal transplantation replaced the diseased intestine and liver, enfranchised patients from TPN, and conferred improved quality of life. These patients should be actively considered for intestinal transplantation and referred to a transplant center as soon as possible.
Long-Term Developmental Outcomes in Patients With Deformational Plagiocephaly
Authors: Miller Robert I. , Clarren Sterling K. 
Published: August 2004

Objectives.
To determine whether there was an increased rate of later developmental delay in school-aged children who presented as infants with deformational plagiocephaly without obvious signs of delay at the time of initial evaluation.

Methods.
A retrospective medical record review of 254 patients evaluated at the Craniofacial Center of the Children's Hospital and Regional Medical Center in Seattle, Washington, from 1980 through 1991 was completed. Consenting patient families were interviewed via telelphone to determine what, if any, special medical or educational problems had occurred for the children who had had plagiocephaly in infancy or their siblings with normal head shapes.

Results.
A total of 181 families from the medical record review could be notified about the study and 63 families agreed to participate in a telephone interview. The sample of participants for the telephone interview was random to and representative of the group as a whole. The families reported that 25 of the 63 children (39.7%) with persistent deformational plagiocephaly had received special help in primary school including: special education assistance, physical therapy, occupational therapy, speech therapy generally through an Individual Education Plan. Only 7 of 91 siblings (7.7%), serving as controls, required similar services (χ2 = 21.24). Delays could not be specifically anticipated at the time of the diagnosis of deformational plagiocephaly from any simple set of factors including treatment with helmet therapy, although effected males with reported uterine constraint were at the highest risk for subsequent school problems.

Conclusions.
Infants with deformational plagiocephaly comprise a high-risk group for developmental difficulties presenting as subtle problems of cerebral dysfunction during the school-age years. There is a need for additional research on the long-term developmental problems in infants with deformational plagiocephaly. plagiocephaly, facial asymmetry, torticollis, developmental delay.
Asthma in Life Context: Video Intervention/Prevention Assessment (VIA)
Authors: Rich Michael , Lamola Steven , Amory Colum , Schneider Lynda 
Published: August 2004

Objective.Video Intervention/Prevention Assessment (VIA) was developed to determine whether medical information gathering might be augmented by video diaries created by patients to show clinicians the realities of managing chronic disease in the contexts of their lives.Design.Children and adolescents who met National Heart, Lung, and Blood Institute criteria for moderate or severe asthma were enrolled from an urban pediatric hospital and an inner-city health center. Comprehensive, asthma-specific medical histories were obtained from study participants in standard clinical interviews. Participants were trained to use video camcorders and recorded visual narratives of how they lived with and managed their asthma over a 4- to 8-week period. These visual narratives were screened by a trained observer, who completed the initial comprehensive medical history based solely on viewing the video. Information from participants' medical history interviews was compared with observations of their visual narratives.Results.Twenty young people 8 to 25 years old completed the VIA Asthma study. Important variations were found between participants' medical history interviews and their visual narratives. All 20 participants reported specific environmental triggers for their asthma; 19 had 1 or more of these triggers documented on video in their daily living environments (video illustrations online, available at:www.pediatrics.org). Exposures to known triggers ranged from 25% (noxious fumes) to 91% (mold). Exposure to tobacco smoke that was denied in the interview was revealed on video in 63%. The 18 participants who revealed medication use in their visual narratives were assessed for adherence: 33% exceeded prescribed doses, 28% discontinued medications without consulting a clinician, and 72% used ineffective inhaler technique.Conclusions.VIA visual narratives extended a comprehensive, standard of care medical history, yielding a more complete and accurate understanding of exacerbating environmental exposures and inappropriate medication usage of children and adolescents with asthma. VIA is an effective tool for revealing the physical and psychosocial environments in which young people live with disease. Patient-created video can enrich our understanding of the illness experiences of children and adolescents. VIA has the potential to enhance clinical data gathering, guide the development of more effective and sensitive management strategies, and educate clinicians about the realities of the young person living with illness.
Outcome of Children in the Indomethacin Intraventricular Hemorrhage Prevention Trial
Authors: Ment Laura R. , Vohr Betty , Allan Walter , Westerveld Michael , Sparrow Sara S. , Schneider Karen C. , Katz Karol H. , Duncan Charles C. , Makuch Robert W. 
Published: August 2004

Background.For preterm infants, intraventricular hemorrhage (IVH) may be associated with adverse neurodevelopmental outcome. We have demonstrated that early low-dose indomethacin treatment is associated with a decrease in both the incidence and severity of IVH in very low birth weight preterm infants. In addition, we hypothesized that the early administration of low-dose indomethacin would not be associated with an increase in the incidence of neurodevelopmental handicap at 4.5 years of age in our study children.Methods.To test this hypothesis, we provided neurodevelopmental follow-up for the 384 very low birth weight survivors of the Multicenter Randomized Indomethacin IVH Prevention Trial. Three hundred thirty-seven children (88%) were evaluated at 54 months' corrected age, and underwent neurodevelopmental examinations, including the Wechsler Preschool and Primary Scale of Intelligence–Revised (WPPSI-R), the Peabody Picture Vocabulary Test–Revised (PPVT-R), and standard neurologic examinations.Results.Of the 337 study children, 170 had been randomized to early low-dose indomethacin therapy and 167 children had received placebo. Twelve (7%) of the 165 indomethacin children and 11 (7%) of the 158 placebo children who underwent neurologic examinations were found to have cerebral palsy. For the 233 English-monolingual children for whom cognitive outcome data follow, the mean gestational age was significantly younger for the children who received indomethacin than for those who received placebo. In addition, although there were no differences in the WPPSI-R or the PPVT-R scores between the 2 groups, analysis of the WPPSI-R full-scale IQ by function range demonstrated significantly less mental retardation among those children randomized to early low-dose indomethacin (for the indomethacin study children, 9% had an IQ &lt;70, 12% had an IQ of 70–80, and 79% had an IQ &gt;80, compared with the placebo group, for whom 17% had an IQ &lt;70, 18% had an IQ of 70–80, and 65% had an IQ &gt;80). Indomethacin children also experienced significantly less difficulty with vocabulary skills as assessed by the PPVT-R when compared with placebo children.Conclusions.These data suggest that, for preterm neonates, the early administration of low-dose indomethacin therapy is not associated with adverse neurodevelopmental function at 54 months' corrected age.
Predicting First-Year Relapses in Children With Nephrotic Syndrome
Authors: Constantinescu Alexandru R. , Shah Hetal B. , Foote Edward F. , Weiss Lynne S. 
Published: August 2004

Objective.More than half of the children diagnosed with nephrotic syndrome will have relapses. These can be infrequent relapses (IRs: &lt;2 in 6 months or &lt;3 in a year) or frequent relaspses (FRs: &gt;2 in 6 months or &gt;3 in a year). Patients who relapse while on alternate day steroids or within 1 month of discontinuation of steroid therapy are considered steroid-dependent (SD; J Pediatr. 1982; 101:514–518). Patients with an IR course have a better long-term prognosis, and many of them have minimal-change disease without mesangial hypercellularity or sclerosis. The purpose of our study was to identify factors at initial presentation that could predict the relapse pattern in the first year after diagnosis, without taking into consideration the histopathology found on renal biopsy.Design.We analyzed the medical records of children who were seen by us before March 1997 and followed for at least 1 year. Variables selected in the study were age, sex, race, presence or absence of hematuria, and days to remission (defined as protein-free) at the initial presentation, because they could relate to the pattern of relapses (ie, IR, FR, and SD).Results.Of 70 patients, 14 were excluded because of insufficient data. There were 38 males (67.9%) and 18 females (32.1%), giving a male:female ratio of 1.8:1. Median age at presentation was 3.25 years (range: 1.5–13), and 76.9% were white, 8.9% black, 7.1% Hispanic, and 7.1% other. Of all the patients, 23 were IR (41.1%), 9 were FR (16.1%), and 24 were SD (42.9%). Median days to remission were 10 (range: 2–60), on Prednisone 60 mg/M2 daily. Hematuria was present initially in 26 patients (46.4%), and absent in 30 (53.6%). Age, sex, race, and hematuria, as independent variables, were not predictors of relapses in the first year. However, using a stratified analysis based on the presence or absence of hematuria, we found that if the remission occurred within the first week of therapy, the patients without hematuria were more likely to be IR. The sensitivity and specificity of this finding were 67% and 89%, respectively, with a positive predictive value of 94%.Conclusion.We conclude that of all the presenting features, the rapidity of initial response to steroid therapy combined with the presence of hematuria, could predict future relapses and should be well documented.
An Analysis of Clinical Outcomes Using Color Doppler Testicular Ultrasound for Testicular Torsion
Authors: Baker Linda A. , Sigman David , Mathews Ranjiv I. , Benson Jane , Docimo Steven G. 
Published: August 2004

Objectives.
To delineate the clinical outcomes of color Doppler ultrasound (US) in the equivocal torsion patient.

Methods.
From 1992 to 1997, 130 patients (&lt;23 years old) from 2 institutions underwent US imaging using a 7.5-mHz linear transducer to evaluate an acute scrotum equivocal, or of low suspicion, for torsion. The US reports and hospital charts of these patients were retrospectively reviewed.

Results.
After clinical and radiologic evaluation, torsion was excluded in 110 patients without surgical exploration. In 3 patients, intermittent testicular torsion was diagnosed and in 17 patients, emergent exploration was performed for US diagnosis of testicular torsion. Twenty-five patients (22.7%) were subsequently lost to follow-up. Follow-up of 85 patients with US negative for torsion (mean length of follow-up = 466.9 days) revealed no testicular atrophy in 83. Two patients underwent delayed orchiectomy/contralateral orchiopexy for missed testicular torsion. Of 17 patients with US positive for torsion, 9 underwent orchiectomy for a necrotic torsed testis, 7 viable torsed testes were found, and 1 torsed appendix testis was found. Therefore, color Doppler US for the equivocal acute scrotum yielded a 1% false-positive rate, sensitivity of 88.9%, and specificity of 98.8%.

Conclusion.
When faced with ruling out testicular torsion, it is necessary to integrate the multiple pieces of patient data, knowing that each piece of data may have inaccuracies. With this in mind, this analysis of outcomes verifies that color Doppler US is an excellent adjunctive study in the clinically real situation in which the clinical evaluation is equivocal or low suspicion.