bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-Term Effect of Budesonide on Hypothalamic-Pituitary-Adrenal Axis Function in Children With Mild to Moderate Asthma
Authors: Bacharier Leonard B. , Raissy Hengameh H. , Wilson Laura , McWilliams Bennie , Strunk Robert C. , Kelly H. William 
Published: August 2004

Objective. To determine the safety of long-term (36 months) administration of an inhaled corticosteroid (budesonide) on hypothalamic-pituitary-adrenal (HPA) axis function in children with mild to moderate asthma.Methods. This was an ancillary study of the Childhood Asthma Management Program (CAMP). Sixty-three children who had mild to moderate asthma and were enrolled in CAMP underwent evaluation of HPA axis function before and 12 and 36 months after receiving continuous therapy with either an inhaled anti-inflammatory agent (budesonide 400 μg/day or nedocromil 16 mg/day) or placebo. HPA axis function was assessed by serum cortisol levels 30 and 60 minutes after 0.25 mg of adrenocorticotrophic hormone (ACTH) and 24-hour urinary free cortisol excretion.Results. There were no differences in serum cortisol levels after ACTH stimulation between treatment groups, regardless of time after ACTH administration or months of follow-up. Urinary cortisol excretion per body surface area was similar in both treatment groups at 36 months, after adjusting for age at randomization, race, gender, and clinic. Cumulative inhaled corticosteroid exposure did not influence serum cortisol response to ACTH or urinary free cortisol excretion at 36 months.Conclusions. We found no effects of chronic budesonide treatment at a dose of 400 μg/day on HPA axis function in children with mild to moderate asthma and demonstrated the absence of a cumulative effect on HPA axis function over a 3-year period.
Low Levels of Tissue Inhibitors of Metalloproteinases With a High Matrix Metalloproteinase-9/Tissue Inhibitor of Metalloproteinase-1 Ratio Are Present in Tracheal Aspirate Fluids of Infants Who Develop Chronic Lung Disease
Authors: Ekekezie Ikechukwu I. , Thibeault Donald W. , Simon Stephen D. , Norberg Michael , Merrill Jeffrey D. , Ballard Roberta A. , Ballard Philip L. , Truog William E. 
Published: August 2004

Objective. The pathogenesis of chronic lung disease (CLD) involves inflammation with proteolytic damage to lung extracellular matrix. Matrix metalloproteinases (MMPs) are zinc-dependent endopeptidases that, acting in concert with their tissue inhibitors, tightly orchestrate extracellular matrix morphogenesis and repair after injury. Imbalances in their levels relative to that of their inhibitors have been implicated in diseases characterized by matrix disruption and remodeling. We investigated the possibility that imbalances in MMP-9 and MMP-2 relative to their tissue inhibitor of metalloproteinase-1 (TIMP-1) and TIMP-2, respectively, in tracheal aspirates of preterm infants may be involved in the development of CLD.Methods. Serial tracheal aspirates collected from birth until extubation in 49 ventilated preterm infants (24-32 weeks’ gestations) were analyzed for MMP-2, MMP-9, TIMP-1, and TIMP-2. Data normalized by TA values of free secretory component of immunoglobulin A were compared for CLD (n = 22) versus no CLD (n = 27). Also, known clinical predictors of CLD (gestational age, birth weight, and sex) were assessed for both groups. Association of predictors with the outcome CLD was assessed by logistic regression.Results. Mean gestational age was lower in CLD infants, but birth weight and gender were comparable for both groups. CLD infants had significantly lower TIMP-1 level with higher MMP-9/TIMP-1 ratio during the first 2 weeks of life and low TIMP-2 and MMP-2 levels during the first 3 days of life compared with no-CLD infants. Logistic regression analysis indicated that the findings are predictive of CLD.Conclusions. We conclude that low tracheal aspirate levels of TIMPs, with a high MMP-9/TIMP-1 ratio early in life, are associated with subsequent development of CLD.
Early Childhood Computer Experience and Cognitive and Motor Development
Authors: Li Xiaoming , Atkins Melissa S. 
Published: August 2004

Objectives. To explore the association between early computer experience (both accessibility and frequency of use) and cognitive and psychomotor development among young children.
Methods. The participants were 122 preschool children enrolled in a rural county Head Start program in the United States during 2001–2002. The following tests were administered to the children: the Bender Visual Motor Gestalt Test; the Boehm Test of Basic Concepts, Third Edition Preschool; the Test of Gross Motor Development, Second Edition; and a short form of the Wechsler Preschool and Primary Scales of Intelligence–Revised. Information pertaining to family characteristics and children’s early computer experience was collected from parents. Both bivariate and multivariate analyses were used to assess the association between early computer experience and cognitive and motor development.
Results. Of the participating children, 53% had a computer at home. Among families who had a computer, 83% had children’s software on the computer. According to parents’ reports, 29% of these children played on the home computer on a daily basis, and an additional 44% of the children played on the computer at least weekly. Of those families who did not have a home computer, 49% reported that their children had access to a computer somewhere outside home. Among these children, 10% had daily access to the computer and 33% had weekly access. The presence of a computer in the home was significantly associated with the family’s income and the educational attainment of the parents. There was no gender difference in computer accessibility and frequency use among the participating children. Children who had access to a computer performed better on measures of school readiness and cognitive development, controlling for children’s developmental stage and family socioeconomic status. The data in the current study did not suggest a relationship between computer experience and visual motor or gross motor skills among the participating children.
Conclusion. The findings in the present study suggest that early computer exposure before or during the preschool years is associated with development of preschool concepts and cognition among young children. However, frequency of use did not reveal such a relationship; neither did the ownership of other child electronic or video games in the household.
Usefulness of the American Academy of Pediatrics Recommendations for Identifying Youths With Hypercholesterolemia
Authors: O’Loughlin Jennifer , Lauzon Beatrice , Paradis Gilles , Hanley James , Lévy Emile , Delvin Edgar , Lambert Marie 
Published: August 2004

Objective. To determine the usefulness of parent history of hypercholesterolemia and cardiovascular disease as a screening criterion for hypercholesterolemia in youths.Methods. Data were available from a population-based survey of 3665 Quebec youths aged 9, 13, and 16 years (81.2% of eligible subjects). Blood specimens were collected from 2475 subjects (54.8% of those eligible), and questionnaire data were obtained from 3048 parents (67.5% of those eligible). Lipids were measured in a Centers for Disease Control and Prevention standardized laboratory. Usefulness of parent history in identifying borderline/high low-density lipoprotein cholesterol (LDL-C) (≥2.8 mmol/L [≥110 mg/dL]) and high LDL-C (≥3.4 mmol/L [≥130 mg/dL]) was assessed according to test performance statistics (sensitivity, specificity, positive predictive value, and negative predictive value).Results. The prevalence of a positive parent history was 25.6%; 18.3% of subjects had borderline/high LDL-C, and 4.8% had high LDL-C. Sensitivity, specificity, positive predictive value, and negative predictive value of parent history were 33.1%, 76.0%, 23.7%, and 83.5%, respectively, for identifying borderline/high LDL-C; they were 40.7%, 75.1%, 7.7%, and 96.1% for identifying high LDL-C. Test performance statistics were not improved in subgroups defined according to age, gender, parent education, household income, family status, and family origin (French Canadian, other); neither were they improved by adding screening criteria (parent history of diabetes or hypertension, or youth overweight).Conclusion. Parent history screening criteria offer little improvement over random population screening in identifying youths with hypercholesterolemia.
The Changing Face of Pleural Empyemas in Children: Epidemiology and Management
Authors: Schultz Karen D. , Fan Leland L. , Pinsky Jay , Ochoa Lyssa , Smith E. O’Brian , Kaplan Sheldon L. , Brandt Mary L. 
Published: August 2004

Objective. Empyema remains a significant cause of morbidity in children. This study evaluates the changes that have affected the outcome in children with pleural empyema, including the emergence of resistant organisms, the introduction of the pneumococcal conjugate vaccine, and earlier treatment with video-assisted thoracoscopy (VATS).
Methods. A retrospective chart review was performed on all patients who were discharged with a diagnosis of empyema and community-acquired pneumonia over a 10-year period (1993–2002) at Texas Children’s Hospital in Houston, Texas. Data collected included demographic information, clinical presentation, radiographic studies, laboratory data including culture results, and hospital course.
Results. A total of 230 charts were available for review. The mean age of the patients was 4.0 ± 3.6 years. Of the pleural fluid cultures performed, 32% (69 of 219) were positive. An additional 27 patients had a cause identified by blood culture. The first penicillin-nonsusceptible Streptococcus pneumoniae was identified in 1995, and the first methicillin-resistant Staphylococcus aureus was identified in 1998. After the universal use of the pneumococcal conjugate vaccine, 3 major changes have occurred (1999–2000 vs 2001–2002): 1) the number of patients admitted with empyema (per 10 000 admissions) has decreased from 23 to 12.6; 2) the prevalence of S pneumoniae has decreased from 66% (29 of 44) to 27% (4 of 15); and 3) S aureus has become the most common pathogen isolated (18% vs 60%), with 78% of those being methicillin resistant. The use of early VATS (&lt;48 hours after admission) versus late VATS (&gt;48 hours after admission) significantly decreased the length of hospitalization (11.49 ± 6.56 days vs 15.18 ± 8.62 days).
Conclusions. The microbiologic cause of empyema has changed with an increasing incidence of S aureus, particularly methicillin-resistant S aureus. The use of VATS for initial therapy of empyema results in decreased duration of fever and length of hospitalization.
Pediatric Patient Safety in Hospitals: A National Picture in 2000
Authors: Miller Marlene R. , Zhan Chunliu 
Published: August 2004

Objective. To describe potential patient safety events for hospitalized children, examine associated factors, and explore impacts of safety events.
Methods. The newly released Patient Safety Indicators (PSIs), developed by researchers at the Agency for Healthcare Research and Quality to identify potential in-hospital patient safety problems using administrative data, were applied to hospital discharge data. All 5.7 million discharge records for children younger than 19 years from 27 states in the 2000 Healthcare Cost and Utilization Project were analyzed for PSI events. Prevalence of PSI events and associations with patient-level and hospital-level characteristics were examined. Multivariate regression adjusting for patient severity of illness was used to estimate impacts of safety events in terms of excess length of stay, charges, and in-hospital mortality.
Results. The prevalence of pediatric patient safety events is significant. PSI events occurred more frequently in the very young and those on Medicaid insurance, some of the most vulnerable hospitalized children. Regression analysis found that almost all PSIs are associated with significant and substantial increases in length of stay, charges, and in-hospital death. Using the estimates derived here and the actual number of cases identified in the 2000 data, we estimate that patient safety events incurred &gt;$1 billion in excess charges for children alone in 2000.
Conclusions. Patient safety problems for hospitalized children occur frequently and with substantial impacts to our health care industry. Unmeasurable by this study are the additional “costs” and “burdens” of safety events that our patients are forced to handle. Additional work to describe and quantify better these outcomes in addition to ones measured here can help solidify the “business case” for patient safety efforts.
Institutional Review Board Practices Regarding Assent in Pediatric Research
Authors: Whittle Amy , Shah Seema , Wilfond Benjamin , Gensler Gary , Wendler David 
Published: August 2004

Objective. To assess how Institutional Review Boards (IRBs) implement the assent requirement for research with children.
Methods. Telephone interviews were conducted with 188 chairpersons of IRBs from a range of institutions nationwide. Respondents were queried on 4 topics: 1) which children are considered capable of assent, 2) which information investigators must provide pediatric research subjects, 3) whether IRBs favor the enrollment of children who are capable of assent, and 4) how chairpersons view payment for children’s research participation.
Results. Half of IRBs have a method that they require investigators to follow when determining which children are capable of assent, most commonly an age cutoff. Half of IRBs do not have a method, and the majority rely on investigators’ clinical judgment. IRBs largely follow the adult research regulations when determining which information should be provided to an assenting child. A total of 58% of IRBs would enroll a child who is incapable of assent in a nonbeneficial study, even if children who are capable of assent could be enrolled instead. Almost half (46%) of chairpersons believe that it sometimes or always acceptable to offer incentive payments to children, and more than one third (35%) thought it acceptable to offer payment to the parents.
Conclusion. When possible, IRBs follow the federal regulations for research with adults when implementing the assent requirement. For considerations that do not have analogs in the adult regulations, IRB practices vary widely. These data suggest that IRBs need guidance on how to implement the assent requirement in a way that provides appropriate protections for pediatric research subjects.
Factors Associated With Difficult Toilet Training
Authors: Schonwald Alison , Sherritt Lon , Stadtler Ann , Bridgemohan Carolyn 
Published: August 2004

Objective. To identify temperament and behavioral patterns in children with difficult toilet training and to compare those children with same-aged toilet-trained children.
Methods. We compared 46 referred clinic patients who were difficult toilet trainers (DTT) with 62 comparison children (CC) using the Carey-McDevitt Behavioral Style Questionnaire, the Parenting Scale, and a questionnaire of toilet-training history.
Results. CC were more likely to have easy temperaments (odds ratio [OR]: 33.51). DTT were more likely to be less adaptable (OR: 3.12), more negative in mood (OR: 2.79), less persistent (OR: 2.97), and lower in approach (OR: 1.85). DTT were more likely than CC to be constipated (OR: 3.52), although 55% of CC were constipated. DTT were likely to hide to stool (74%) and to ask for pull-ups in which to leave stool (37%). Parenting styles did not differ between the groups.
Conclusions. Although the referral population may be inherently biased, these data suggest that difficult toilet training is associated with difficult temperamental traits and constipation in affected children.
Population-Based Surveillance for Hospitalizations Associated With Respiratory Syncytial Virus, Influenza Virus, and Parainfluenza Viruses Among Young Children
Authors: Iwane Marika K. , Edwards Kathryn M. , Szilagyi Peter G. , Walker Frances J. , Griffin Marie R. , Weinberg Geoffrey A. , Coulen Charmaine , Poehling Katherine A. , Shone Laura P. , Balter Sharon , Hall Caroline B. , Erdman Dean D. , Wooten Karen , Schwartz Benjamin ,   for the New Vaccine Surveillance Network
Published: August 2004

Objective. Respiratory syncytial virus (RSV), influenza virus, and parainfluenza viruses (PIV) cause significant morbidity in young children. Although only influenza virus infection and illness is currently vaccine-preventable, vaccines are under development for RSV and PIV. We established a prospective, active population-based surveillance network to provide precise estimates of hospitalization rates for viral acute respiratory illness (ARI) in young children and to measure the potential impact of enhanced vaccine usage on these rates.
Methods. Prospective, active population-based surveillance was conducted in young children who were hospitalized for ARI from October 1, 2000, to September 30, 2001, in Monroe County, New York (Rochester area) and Davidson County, Tennessee (Nashville area). Eligible children younger than 5 years were those who resided in surveillance counties and were hospitalized for febrile or acute respiratory illness. Viral culture and polymerase chain reaction identified viruses from nasal and throat samples obtained from all surveillance children. We measured population-based rates of hospitalization for RSV, influenza virus, and PIV as well as demographic, clinical, and risk factor assessment for each virus.
Results. Of 812 eligible hospital admissions, 592 (73%) children were enrolled. Of the enrolled children, RSV was identified in 20%, influenza in 3%, PIV in 7%, other respiratory viruses in 36%, and no detectable virus in 39%. Population-based rates of ARI hospitalizations in children younger than 5 years were 18 per 1000. Virus-positive hospitalization rates per 1000 children were 3.5 for RSV, 1.2 for PIV, and 0.6 for influenza virus. Younger age (particularly &lt;1 year), black and Hispanic race/ethnicity, male gender, and presence of chronic underlying illness were associated with higher hospitalization rates.
Conclusions. This study confirms that children younger than 5 years and particularly children younger than 1 year have a high burden of hospitalization from RSV, influenza, and PIV. The enhanced use of influenza vaccine and the development of RSV and PIV vaccines have the potential to reduce markedly the pediatric morbidity from ARIs.
Cushing’s Syndrome After Intra-articular and Intradermal Administration of Triamcinolone Acetonide in Three Pediatric Patients
Authors: Kumar Seema , Singh Ravinder J. , Reed Ann M. , Lteif Aida N. 
Published: August 2004

Background. Intra-articular and intradermal steroids are often used for their antiinflammatory effect. There is limited experience with intra-articular and intralesional administration of corticosteroids in the pediatric age group.
Design/Methods. We performed a retrospective chart review of 3 pediatric patients who developed Cushing’s syndrome after local administration of triamcinolone acetonide (TCA).
Results. Two females 9 and 17 years old, received intra-articular injections of TCA. One patient received multiple injections of TCA into the interphalangeal joints (cumulative dose: 120 mg), whereas the other received a single injection of 40 mg, a dose that is considered to be in the therapeutic range, into the hip joint. The third patient, a 7-year-old female, received multiple intralesional injections of TCA. These patients developed signs and symptoms of hypercortisolism that appeared 4 to 6 weeks after local administration of TCA and lasted for 4 to 6 months after the last dose of TCA. TCA was detectable in the plasma and urine by the liquid chromatography/tandem mass spectrometry method 4 to 5 months after the last dose of the steroid.
Conclusions. We noted evidence for Cushing’s syndrome in 3 pediatric patients after intra-articular or intradermal administration of TCA. One of them had received a therapeutic dose of TCA. The possibility of hypothalamic-pituitary-adrenal axis suppression should be considered in patients who have received intra-articular or intradermal steroid injections, particularly in those who have had multiple or relatively high doses.
Sexual Orientation and Adolescents
Authors: Frankowski Barbara L. ,   and Committee on Adolescence
Published: August 2004

The American Academy of Pediatrics issued its first statement on homosexuality and adolescents in 1983, with a revision in 1993. This report reflects the growing understanding of youth of differing sexual orientations. Young people are recognizing their sexual orientation earlier than in the past, making this a topic of importance to pediatricians. Pediatricians should be aware that some youths in their care may have concerns about their sexual orientation or that of siblings, friends, parents, relatives, or others. Health care professionals should provide factual, current, nonjudgmental information in a confidential manner. All youths, including those who know or wonder whether they are not heterosexual, may seek information from physicians about sexual orientation, sexually transmitted diseases, substance abuse, or various psychosocial difficulties. The pediatrician should be attentive to various potential psychosocial difficulties, offer counseling or refer for counseling when necessary and ensure that every sexually active youth receives a thorough medical history, physical examination, immunizations, appropriate laboratory tests, and counseling about sexually transmitted diseases (including human immunodeficiency virus infection) and appropriate treatment if necessary.Not all pediatricians may feel able to provide the type of care described in this report. Any pediatrician who is unable to care for and counsel nonheterosexual youth should refer these patients to an appropriate colleague.
Guidelines for Pediatric Cancer Centers
Authors:   Section on Hematology/Oncology
Published: August 2004

This Policy Statement was revised. See https://doi.org/10.1542/peds.2014-1526.
Since the American Academy of Pediatrics published guidelines for pediatric cancer centers in 1986 and 1997, significant changes in the delivery of health care have prompted a review of the role of tertiary medical centers in the care of pediatric patients. The potential effect of these changes on the treatment and survival rates of children with cancer led to this revision. The intent of this statement is to delineate personnel and facilities that are essential to provide state-of-the-art care for children and adolescents with cancer. This statement emphasizes the importance of board-certified pediatric hematologists/oncologists, pediatric subspecialty consultants, and appropriately qualified pediatric medical subspecialists and pediatric surgical specialists overseeing the care of all pediatric and adolescent cancer patients and the need for facilities available only at a tertiary center as essential for the initial management and much of the follow-up for pediatric and adolescent cancer patients.
School-Based Mental Health Services
Authors:   Committee on School Health
Published: August 2004

This Policy Statement was retired July 2017.
More than 20% of children and adolescents have mental health problems. Health care professionals for children and adolescents must educate key stakeholders about the extent of these problems and work together with them to increase access to mental health resources. School-based programs offer the promise of improving access to diagnosis of and treatment for the mental health problems of children and adolescents. Pediatric health care professionals, educators, and mental health specialists should work in collaboration to develop and implement effective school-based mental health services.