bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disparities in Infant Health Among American Indians and Alaska Natives in US Metropolitan Areas
Authors: Grossman David C. , Baldwin Laura-Mae , Casey Susan , Nixon Brigitte , Hollow Walter , Hart L. Gary 
Published: August 2004

Objective. To determine geographic variation in urban American Indian and Alaska Native (AI/AN) rates of infant mortality, low birth weight, prenatal care use, and maternal-child health care service availability.
Methods. This was a retrospective cohort study using data from the 1989 to 1991 birth-death linked database from the National Center for Health Statistics. We examined births from metropolitan areas with a minimum of 300 AI/AN births during the study period. Key outcomes of interest included rates of low birth weight, neonatal mortality, postneonatal mortality, and women receiving inadequate prenatal care using the modified Kessner index. To determine the type of health services tailored to AI/AN mothers residing in these urban areas, we conducted a telephone survey of the 36 urban Indian health programs operating in 1997 using a semistructured survey. Items in the survey included questions about the availability of prenatal and infant health care.
Results. During the 1989 to 1991 study period, there were 72 730 singleton births to AI/AN mothers and/or fathers residing in urban areas, representing 49% of all AI/AN births in the United States. Overall 14.4% of urban AI/AN births were to women who received inadequate care during pregnancy, 5.7% of pregnancies resulted in low birth weight infants, and 11.0 infants died per 1000 live births. Death rates for the neonatal period (5.5 per 1000 births) and postneonatal period (5.4 per 1000 births) were similar. Marked disparity in these indicators exist between pregnancies to AI/AN and white women. Among the 54 metropolitan areas, 46 had a rate ratio (AI/AN: white) for inadequate care of ≥1.5 (range: 0.9–8.5). The mean rate ratios for neonatal and postneonatal mortality were 1.6 (range: 0.3–4.0) and 2.0 (range: 0.5–5.5). There was also considerable geographic variation of AI/AN mortality rates between metropolitan areas in all of the outcomes studied. All of the 20 metropolitan areas with the highest birth counts had some type of direct medical care or outreach services available from an urban clinic targeted toward AI/AN patients.
Conclusions. Considerable variation also exists among rates of AI/ANs between metropolitan areas. Disparity exists in rates of perinatal outcomes between AI/ANs and whites living in the same metropolitan areas Although AI/AN urban health programs exist in most cities with large birth counts, it seems that many have inadequate resources to meet existing needs to improve perinatal outcomes and infant health.
Prevalence, Correlates, and Trajectory of Television Viewing Among Infants and Toddlers
Authors: Certain Laura K. , Kahn Robert S. 
Published: August 2004

Objectives. Recognizing the negative effects of television on children, the American Academy of Pediatrics (AAP) recommends that children 2 years and older watch &lt;2 hours of television per day and that children younger than 2 years watch no television. However, relatively little is known about the amount of television viewed by infants and toddlers. The objective of this study was to describe the prevalence and correlates of television viewing that exceeds the AAP guidelines for 0- to 35-month-olds and to examine the trajectory of a child’s viewing over time.Methods. Data from the National Longitudinal Survey of Youth, 1990 to 1998, were used to analyze reported television viewing at 0 to 35 months of age and to follow the trajectory of a child’s viewing from infancy through age 6. Logistic regression models were used to determine risk factors associated with greater television viewing at 0 to 35 months and the association of early viewing habits with school-age viewing.Results. Seventeen percent of 0- to 11-month-olds, 48% of 12- to 23-month-olds, and 41% of 24- to 35-month-olds were reported to watch more television than the AAP recommends. Compared with college graduates, less-educated women were more likely to report that their children watched more television than recommended. Children who watched &gt;2 hours per day at age 2 were more likely to watch &gt;2 hours per day at age 6 (odds ratio: 2.7; 95% confidence interval: 1.8–3.9), controlling for maternal education, race, marital status and employment, household income, and birth order.Conclusions. A substantial number of children begin watching television at an earlier age and in greater amounts than the AAP recommends. Furthermore, these early viewing patterns persist into childhood. Preventive intervention research on television viewing should consider targeting infants and toddlers and their families.
Significant Selective Head Cooling Can be Maintained Long-Term After Global Hypoxia Ischemia in Newborn Piglets
Authors: Tooley James , Satas Saulius , Eagle Rebecca , Silver Ian A. , Thoresen Marianne 
Published: August 2004

Objective. Selective head cooling (SHC) combined with mild body cooling is currently being evaluated as a potentially therapeutic option in the management of neonatal hypoxic-ischemic encephalopathy. It is proposed that SHC enables local hypothermic neuroprotection while minimizing the deleterious side effects of systemic hypothermia. However, there is little evidence that it is possible to cool the brain more than the body for a prolonged period of time. The aim of this study was to examine whether the brain (Tdeep brain) could be cooled to below the rectal temperature (Trectal) in our piglet hypoxia ischemia (HI) model for a period of 24 hours, using a head-cooling cap.
Methods. Eight anesthetized piglets (median age: 15 hours) had subdural and intracerebral basal ganglia temperature probes inserted. After a 45-minute global HI insult (known to produce permanent brain damage), SHC using a cap perfused with cold water (5°C–24°C) combined with overhead body heating to maintain Trectal at 34 to 35°C was performed for 24 hours.
Results. The piglets were cooled to a median Trectal of 35.0°C (interquartile range [IQR]: 34.7–35.3) for 24 hours. During this time, the median Tdeep brain was 31.4°C (IQR: 30°C–32.2°C), with a median Trectal to Tdeep brain gradient of 3.4°C (IQR: 2.7°C–4.8°C). At the end of the cooling period, this gradient was still maintained at a median of 3.3°C (IQR: 2.9°C–3.7°C). The ability to obtain the gradient was not influenced by the size of the piglet (1300–1840 g). Cap cooling lowered scalp temperature (Tscalp) to a median of 24.9°C (IQR: 22.2°C–29.2°C) and subdural temperature to a median of 28.1°C (IQR: 25.8°C–29.5°C) but did not result in either skin injury or superficial brain hemorrhage. There was no clinically useful correlation between Tscalp and Tdeep brain or between Tscalp and Tsubdural.
Conclusions. This study using our piglet HI model shows that it is possible by means of a head-cooling cap to cool the brain more than the body for a 24-hour period while keeping the core temperature mildly hypothermic. However, we were unable to predict temperatures inside the brain using surface temperature probes on the head.
Where Do Children With Complex Chronic Conditions Die? Patterns in Washington State, 1980–1998
Authors: Feudtner Chris , Silveira Maria J. , Christakis Dimitri A. 
Published: August 2004

Objective. Little is known about factors that influence whether children with chronic conditions die at home. We sought to test whether deaths attributable to underlying complex chronic conditions (CCCs) were increasingly occurring at home and to determine what features were associated with home deaths.Design. A retrospective case series was conducted of all deaths that occurred to children age 0 to 18 years in Washington state from 1980 to 1998 using death certificate data, augmented with 1990 US Census data regarding median household income by zip code in 1989, to determine the site of death.Results. Of the 31 455 deaths identified in infants, children, and adults younger than 25 years, 52% occurred in the hospital, 17.2% occurred at home, 8.5% occurred in the emergency department or during transportation, 0.4% occurred in nursing homes, and 21.7% occurred at other sites. Among children who died as a result of some form of CCC (excluding injury, sudden infant death syndrome, and non-CCC medical conditions), the percentage of cases younger than 1 year who died at home rose slightly from 7.8% in 1980 to 11.6% in 1998, whereas the percentage of older children and young adults who had a CCC and died at home rose substantially from 21% in 1980 to 43% in 1998. Children who had lived in more affluent neighborhoods were more likely to have died at home. Using leukemia-related deaths as a benchmark, deaths as a result of congenital, genetic, neuromuscular, and metabolic conditions and other forms of cancer all were more likely to have occurred at home. Significant variation in the likelihood of home death, not explained by the individual attributes of the cases, also existed across the 39 counties in Washington state.Conclusions. Children who die with underlying CCCs increasingly do so at home. Age at death, specific condition, local area affluence, and the location of home all influence the likelihood of home death. These findings warrant additional study, as they have implications for how we envision pediatric palliative care, hospice, and other supportive services for the future.
Trends in Postneonatal Aspiration Deaths and Reclassification of Sudden Infant Death Syndrome: Impact of the “Back to Sleep” Program
Authors: Malloy Michael H. 
Published: August 2004

Objective. The introduction of the “Back to Sleep” campaign for the prevention of sudden infant death syndrome (SIDS) brought with it concern that there might be an increase in the incidence of aspiration-related deaths. The objective of this analysis was to describe the trends in postneonatal mortality and proportionate mortality ratios for the United States for the years 1991 to 1996 for aspiration-related deaths and other causes to which a SIDS death could conceivably be reclassified.Methods. Linked birth and infant death vital statistic files for the United States were used for the years 1991, 1995, and 1996. US Vital Statistic Mortality files for the years 1992, 1993, and 1994 were used because of the absence of linked files for those years.Results. The overall postneonatal mortality rate between 1991 and 1996 declined 21.9%, whereas the SIDS rate declined 38.9%. The proportion of the postneonatal mortality (PNPMR) contributed by SIDS declined from 37.1% in 1991 to 28.8% in 1996. There was no significant increase in the PNPMR for aspiration, asphyxia, or respiratory failure. There was, however, a significant increase in the PNPMR for suffocation in bed or cradle from 0.9 to 1.3.Conclusions. These data show no evidence of an increased risk of death from aspiration as a result of the “Back to Sleep” program. Although there has been an increase in the proportion of postneonatal mortality attributable to suffocation, this represents a very small proportion of postneonatal mortality and thus potentially a very small number of SIDS deaths reclassified as suffocation.
Interchangeability of 2 Diphtheria-Tetanus-Acellular Pertussis Vaccines in Infancy
Authors: Greenberg David P. , Pickering Larry K. , Senders Shelly D. , Bissey Jeffrey D. , Howard Robert A. , Blatter Mark M. , Reisinger Keith , Pichichero Michael E. , Howe Barbara J. 
Published: August 2004

Objective. Currently, 4 diphtheria-tetanus-acellular pertussis (DTaP) vaccines are licensed for pediatric use in the United States, and 2 are commercially available. Although a single manufacturer’s DTaP vaccine should be used for all 3 doses of the primary immunization series, some circumstances result in infants receiving DTaP vaccines from more than 1 manufacturer. The purpose of this study was to evaluate the safety and immunogenicity of a mixed sequence of 2 different DTaP vaccines.Methods. In this multicenter, observer-blinded, controlled study, 449 infants were randomized into 1 of 3 groups (1:1:1 ratio) to receive Tripedia at 2, 4, and 6 months of age (control group); Tripedia at 2 and 4 months of age and Infanrix at 6 months of age; or Tripedia at 2 months and Infanrix at 4 and 6 months of age. Other vaccines were administered concurrently as separate injections according to the recommended childhood immunization schedule. Safety was monitored closely, and standard enzyme immunoassays were used to measure antibody concentrations to each antigen of the DTaP vaccines.Results. The rates of injection-site and systemic adverse events were similar in each study group, and there were no clinically significant differences among groups after any dose. Infants in all 3 groups responded well to each antigen contained in both vaccines, with 97% to 100% seroprotection or vaccine response rates after the 3-dose primary series. Postvaccination geometric mean antibody concentrations and seroprotection or vaccine response rates to nearly all vaccine antigens were as high or higher in the mixed-sequence groups as in the control group.Conclusion. Initiating the primary immunization series with 1 or 2 doses of Tripedia and completing the 3-dose series with Infanrix is as safe and at least as immunogenic as administering Tripedia for all 3 doses.
Detection of Pulsus Paradoxus Associated With Large Pericardial Effusions in Pediatric Patients by Analysis of the Pulse-Oximetry Waveform
Authors: Tamburro Robert F. , Ring John C. , Womback Kimberly 
Published: August 2004

Objective. To determine whether analysis of the pulse-oximetry waveform can be useful in detecting the pulsus paradoxus associated with large pericardial effusions in pediatric patients.
Methods. A retrospective review of charts of 8 pediatric patients (age range: 5–19 years) who had echocardiographic evidence of large pericardial effusion, subsequently underwent pericardiocentesis, and had pulse-oximetry waveform tracings obtained before and after pericardiocentesis within an 18-month period was conducted in 2 tertiary-care pediatric intensive care units. We analyzed the pulse-oximetry waveform tracings for the presence of a pulsus paradoxus. Other abstracted data included clinical evidence of tamponade, echocardiographic findings, and the volume of pericardial fluid aspirated.
Results. Before pericardiocentesis, a decrease in the highest value of the upper plethysmographic peak of the pulse-oximetry waveform was observed during inspiration in each patient. Echocardiographic evidence of large pericardial effusion with compromised cardiac filling was also present in each patient. Only 6 of these patients had clinical evidence of cardiac tamponade at that time, 4 with a documented pulsus paradoxus using standard methods of blood pressure analysis. After pericardiocentesis, the inspiratory fall in the highest value of the upper plethysmographic peak of the pulse-oximetry waveform lessened in every patient. Echocardiography documented a decrease in the size of the effusion and resolution of the compromised cardiac filling in every patient.
Conclusions. Analysis of pulse-oximetry waveforms may be a widely available, easily interpretable, and reliable method of detecting the pulsus paradoxus associated with large pericardial effusions in pediatric patients.
LactobacillusTherapy for Acute Infectious Diarrhea in Children: A Meta-analysis
Authors: Van Niel Cornelius W. , Feudtner Chris , Garrison Michelle M. , Christakis Dimitri A. 
Published: August 2004

Objective. Childhood diarrhea accounts for substantial morbidity and mortality worldwide. Multiple studies in children have shown that Lactobacillus, administered orally, may have antidiarrheal properties. We conducted a meta-analysis of randomized, controlled studies to assess whether treatment with Lactobacillus improves clinical outcomes in children with acute infectious diarrhea.Methods. Studies were sought in bibliographic databases of traditional biomedical as well as complementary and alternative medicine literature published from 1966 to 2000. Search terms were “competitive inhibition,” “diarrhea,” “gastroenteritis,” “Lactobacillus,” “probiotic,” “rotavirus,” and “yog(h)urt.” We included studies that were adequately randomized, blinded, controlled trials in which the treatment group received Lactobacillus and the control group received an adequate placebo and that reported clinical outcome measures of diarrhea intensity. These inclusion criteria were applied by blind review and consensus. The original search yielded 26 studies, 9 of which met the criteria. Multiple observers independently extracted study characteristics and clinical outcomes. Data sufficient to perform meta-analysis of the effect of Lactobacillus on diarrhea duration and diarrhea frequency on day 2 were contained in 7 and 3 of the included studies, respectively.Results. Summary point estimates indicate a reduction in diarrhea duration of 0.7 days (95% confidence interval: 0.3–1.2 days) and a reduction in diarrhea frequency of 1.6 stools on day 2 of treatment (95% confidence interval: 0.7–2.6 fewer stools) in the participants who received Lactobacillus compared with those who received placebo. Details of treatment protocols varied among the studies. A preplanned subanalysis suggests a dose-effect relationship.Conclusion. The results of this meta-analysis suggest that Lactobacillus is safe and effective as a treatment for children with acute infectious diarrhea.
Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome
Authors:   Section on Pediatric Pulmonology,   Subcommittee on Obstructive Sleep Apnea Syndrome
Published: August 2004

This clinical practice guideline, intended for use by primary care clinicians, provides recommendations for the diagnosis and management of obstructive sleep apnea syndrome (OSAS).The Section on Pediatric Pulmonology of the American Academy of Pediatrics selected a subcommittee composed of pediatricians and other experts in the fields of pulmonology and otolaryngology as well as experts from epidemiology and pediatric practice to develop an evidence base of literature on this topic. The resulting evidence report was used to formulate recommendations for the diagnosis and management of childhood OSAS.The guideline contains the following recommendations for the diagnosis of OSAS: 1) all children should be screened for snoring; 2) complex high-risk patients should be referred to a specialist; 3) patients with cardiorespiratory failure cannot await elective evaluation; 4) diagnostic evaluation is useful in discriminating between primary snoring and OSAS, the gold standard being polysomnography; 5) adenotonsillectomy is the first line of treatment for most children, and continuous positive airway pressure is an option for those who are not candidates for surgery or do not respond to surgery; 6) high-risk patients should be monitored as inpatients postoperatively; 7) patients should be reevaluated postoperatively to determine whether additional treatment is required.This clinical practice guideline is not intended as a sole source of guidance in the evaluation of children with OSAS. Rather, it is designed to assist primary care clinicians by providing a framework for diagnostic decision-making. It is not intended to replace clinical judgment or to establish a protocol for all children with this condition and may not provide the only appropriate approach to this problem.
Continuity of Care Is Associated With High-Quality Careby Parental Report
Authors: Christakis Dimitri A. , Wright Jeffrey A. , Zimmerman Frederick J. , Bassett Alta L. , Connell Frederick A. 
Published: August 2004

Context. The benefits of continuity of pediatric care remain controversial.
Objective. To determine whether there is an association between having a continuous relationship with a primary care pediatric provider and improved quality of care by parental report.
Design. Cross-sectional study.
Setting and Population. Seven hundred fifty-nine patients presenting to a primary care clinic completed surveys, which included validated measures of provider and clinic quality of care from the Consumer Assessment of Health Plan Survey.
Main Exposure Variable. A continuity of care index that quantifies the degree to which a patient has experienced continuous care with a provider.
Main Outcome Measures. The likelihood of parents reporting quality of care as high in several provider- specific items including reporting that providers respected what they had to say, treated them with courtesy and respect, listened to them carefully, explained things in a way they could understand, and spent enough time with their children. In addition, participants were asked to rate the overall quality of the clinic and their child’s provider on a 10-point scale.
Results. In ordered logistic regression models, continuity of care was associated with statistically significantly higher Consumer Assessment of Health Plan Survey scores for 5 of the 6 items, including feeling that providers respected what parents had to say; listened carefully to them; explained things in a way that they could understand; asked about how their child was feeling, growing, and behaving; and spent enough time with their child. In addition, greater continuity of care was associated with a higher clinic rating, as well as a higher provider rating.
Conclusions. Greater continuity of primary care is associated with higher quality of care as reported by parents. Efforts to improve and maintain continuity may be warranted.
Growth and Biochemical Markers of Growth in Children With Snoring and Obstructive Sleep Apnea
Authors: Nieminen Peter , Löppönen Tuija , Tolonen Uolevi , Lanning Peter , Knip Mikael , Löppönen Heikki 
Published: August 2004

Objective. The pathophysiological mechanisms of growth impairment frequently associated with the obstructive sleep apnea syndrome (OSAS) in children are poorly defined. The main objective of this study was to evaluate whether nighttime upper airway obstruction attributable to adenotonsillar hypertrophy and subsequent surgical treatment affect the circulating concentrations of insulin-like growth factor-I (IGF-I) and IGF-binding protein 3 (IGFBP-3) along with other growth parameters in children.
Patients and Methods. We initially studied 70 children (mean age: 5.8 years; range: 2.4–10.5 years) admitted to a university hospital because of clinical symptoms of OSAS. Their sleep was monitored with a 6-channel computerized polygraph. Data on anthropometry and circulating concentrations of IGF-I and IGFBP-3 were generated and compared with corresponding characteristics in control children (N = 35). Thirty children with an obstructive apnea-hypopnea index (OAHI) of 1 or more were categorized as children with OSAS (mean OAHI: 5.4 [95% confidence interval for mean (CI): 3.8–6.9]), whereas 40 children with an OAHI of &lt;1 were considered as primary snorers (PS) (mean OAHI 0.13 [95% CI: 0.05–0.21]). Nineteen children with OAHI &gt;2 underwent adenotonsillectomy attributable to OSAS and were reassessed 6 months later together with 34 nonoperated children with OAHI &lt;2.
Results. There were no initial differences in relative height and weight for height between the 3 groups of children. No differences were observed in peripheral IGF-I concentrations, but both OSAS and PS children had reduced peripheral IGFBP-3 levels. The operated children with initial OSAS experienced a highly significant reduction in their OAHI from 7.1 (95% CI: 5.1–9.1) to 0.37 (95% CI: 0.2–0.95). Weight-for-height, body mass index, body fat mass, and fat-free mass increased during the follow-up in the operated children with OSAS, whereas only fat-free mass and relative height increased in the PS children. Both the IGF-I and the IGFBP-3 concentrations increased significantly in the operated children, whereas no significant changes were seen in the PS children.
Conclusions. These observations indicate that growth hormone secretion is impaired in children with OSAS and PS. Respiratory improvement after adenotonsillectomy in children with OSAS results in weight gain and restored growth hormone secretion.