bluuebunny/crossref_metadata_2025_split huggingface dataset:
Meta-analysis of Cephalosporin Versus Penicillin Treatment of Group A Streptococcal Tonsillopharyngitis in Children
Authors: Casey Janet R. , Pichichero Michael E. 
Published: August 2004

Objective. To conduct a meta-analysis of randomized, controlled trials of cephalosporin versus penicillin treatment of group A β-hemolytic streptococcal (GABHS) tonsillopharyngitis in children.
Methodology. Medline, Embase, reference lists, and abstract searches were conducted to identify randomized, controlled trials of cephalosporin versus penicillin treatment of GABHS tonsillopharyngitis in children. Trials were included if they met the following criteria: patients &lt;18 years old, bacteriologic confirmation of GABHS tonsillopharyngitis, random assignment to antibiotic therapy of an orally administered cephalosporin or penicillin for 10 days of treatment, and assessment of bacteriologic outcome using a throat culture after therapy. Primary outcomes of interest were bacteriologic and clinical cure rates. Sensitivity analyses were performed to assess the impact of careful clinical illness descriptions, compliance monitoring, GABHS serotyping, exclusion of GABHS carriers, and timing of the test-of-cure visit.
Results. Thirty-five trials involving 7125 patients were included in the meta-analysis. The overall summary odds ratio (OR) for the bacteriologic cure rate significantly favored cephalosporins compared with penicillin (OR: 3.02; 95% confidence interval [CI]: 2.49–3.67, with the individual cephalosporins [cephalexin, cefadroxil, cefuroxime, cefpodoxime, cefprozil, cefixime, ceftibuten, and cefdinir] showing superior bacteriologic cure rates). The overall summary OR for clinical cure rate was 2.33 (95% CI: 1.84–2.97), significantly favoring the same individual cephalosporins. There was a trend for diminishing bacterial cure with penicillin over time, comparing the trials published in the 1970s, 1980s, and 1990s. Sensitivity analyses for bacterial cure significantly favored cephalosporin treatment over penicillin treatment when trials were grouped as double-blind (OR: 2.31; 95% CI: 1.39–3.85), high-quality (OR: 2.50; 95% CI: 1.85–3.36) trials with well-defined clinical status (OR: 2.12; 95% CI: 1.54–2.90), with detailed compliance monitoring (OR: 2.85; 95% CI: 2.33–3.47), with GABHS serotyping (OR: 3.10; 95% CI: 2.42–3.98), with carriers eliminated (OR: 2.51; 95% CI: 1.55–4.08), and with test of cure 3 to 14 days posttreatment (OR: 3.53; 95% CI: 2.75–4.54). Analysis of comparative bacteriologic cure rates for the 3 generations of cephalosporins did not show a difference.
Conclusions. This meta-analysis indicates that the likelihood of bacteriologic and clinical failure of GABHS tonsillopharyngitis is significantly less if an oral cephalosporin is prescribed, compared with oral penicillin.
First Experiences With Early Intervention: A National Perspective
Authors: Bailey Donald B. , Hebbeler Kathleen , Scarborough Anita , Spiker Donna , Mallik Sangeeta 
Published: August 2004

Background. Families of young children with disabilities are eligible for early intervention services as mandated by Part C of the Individuals With Disabilities Education Act. Although prior research has shown that families are generally satisfied with early intervention, this research has not been based on a nationally representative sample of families, nor has it systematically examined perceptions of the initial experiences entering early intervention.
Objective. This study was designed to determine families’ initial experiences in determining their child’s eligibility, interactions with medical professionals, effort required to obtain services, participation in planning for services, satisfaction with services, and interactions with professionals.
Method. We interviewed a nationally representative sample of 3338 parents of young children with or at risk for disability. All the children had recently entered an early intervention program operated under the auspices of Part C of the Individuals With Disabilities Education Act.
Results. The average age at which families reported a concern about their child was 7.4 months. A diagnosis was made, on average, 1.4 months later, the child was referred for early intervention an average of 5.2 months after the diagnosis, and the individualized family service plan was developed 1.7 months later or at an average age of 15.7 months. Most families were very positive about their entry into early intervention programs. They reported discussing their concerns with a medical professional and finding that person helpful. Families reported relative ease in accessing services, felt that services were related to their perceived needs, rated positively the professionals working in early intervention, and felt that they had a role in making key decisions about child and family goals. A small percentage of families experienced significant delays in getting services, wanted more involvement in service planning, or felt that services were inadequate, and nearly 20% were unaware of the existence of a written plan for services. Minority families, families with limited income, and families with less-educated mothers were more likely to report negative experiences.
Conclusions. We conclude that the beginning of early intervention services generally is highly successful and responsive, a finding that should give pediatricians more confidence in referring families for early intervention services. However, research and local evaluation efforts are needed to develop strategies to assure that all families receive services in a timely and appropriate fashion.
Kangaroo Transport Instead of Incubator Transport
Authors: Sontheimer Dieter , Fischer Christine B. , Buch Kerstin E. 
Published: August 2004

Objective. Compared with in utero transport, incubator transport for preterm infants has several disadvantages including instability during transport with increased mortality and morbidity, lack of adequate systems for securing the infant in the event of an accident, and separation of mother and infant. As a new kind of postnatal transportation that bears some analogy to in utero transport and may be safer than incubator transport, we investigated kangaroo transport, transporting the infant on the mother’s or other caregiver’s chest. This article presents a description and preliminary data for kangaroo transport.
Design. We conducted kangaroo transports of 31 stable preterm and term infants in different settings and recorded data regarding transport conditions and cardiorespiratory stability. Eighteen transports were back transfers, and 13 were transfers in. Twenty-seven transports were conducted by the mother, 1 by the father, 2 by nurses, and 1 by a doctor. Transport distance was 2 to 400 km.
Results. Heart rate, respiratory rate, oxygen saturation, and rectal temperature remained stable during all kangaroo transports lasting 10 to 300 minutes. Weight at transport was 1220 to 3720 g. Parents felt very comfortable and safe and appreciated this method of transport.
Conclusions. Kangaroo transport promotes mother-infant closeness and might ameliorate several of the risks associated with incubator transport.
Severe Hydrogen Sulfide Exposure in a Working Adolescent
Authors: Nikkanen Heikki E. , Burns Michele M. 
Published: August 2004

We describe an occupational exposure to hydrogen sulfide gas in a 16-year-old boy. While cleaning the reoxygenation tank of a fish hatchery, he and an adult supervisor lost consciousness. The adult died, and the adolescent regained consciousness briefly when emergency medical services personnel administered oxygen. At a local emergency department, he was intubated for respiratory distress. He was transferred to a tertiary care facility for additional management and, over the next 2 weeks, had a recovery to normal function.
Hydrogen sulfide is a colorless, malodorous gas that results from the decay of organic material. It is a byproduct of industry and agriculture. The mechanism of its toxicity is related primarily to inhibition of oxidative phosphorylation, which causes a decrease in available cellular energy. Although there is some anecdotal evidence to suggest that the early use of hyperbaric oxygen is beneficial, supportive care remains the mainstay of therapy. This report highlights the sources of exposure, management, and need for more stringent application of safety regulations in industries in which adolescents are employed.
How Should Parents Protect Their Children From Environmental Tobacco-Smoke Exposure in the Home?
Authors: Johansson AnnaKarin , Hermansson Gören , Ludvigsson Johnny 
Published: August 2004

Background. Children’s exposure to tobacco smoke is known to have adverse health effects, and most parents try to protect their children.Objective. To examine the effectiveness of parents’ precautions for limiting their children’s tobacco-smoke exposure and to identify variables associated to parents’ smoking behavior.Design and participants. Children, 2.5 to 3 years old, participating in All Babies in Southeast Sweden, a prospective study on environmental factors affecting development of immune-mediated diseases. Smoking parents of 366 children answered a questionnaire on their smoking behavior. Cotinine analyses were made on urine specimen from these children and 433 age-matched controls from nonsmoking homes.Results. Smoking behavior had a significant impact on cotinine levels. Exclusively outdoor smoking with the door closed gave lower urine cotinine levels of children than when mixing smoking near the kitchen fan and near an open door or indoors but higher levels than controls.Variables of importance for smoking behavior were not living in a nuclear family (odds ratio: 2.1; 95% confidence interval: 1.1–4.1) and high cigarette consumption (odds ratio: 1.6; 95% confidence interval: 1.2-2.1).An exposure score with controls as the reference group (1.0) gave an exposure score for outdoor smoking with the door closed of 2.0, for standing near an open door + outdoors of 2.4, for standing near the kitchen fan + outdoors of 3.2, for mixing near an open door, kitchen fan, and outdoors of 10.3, and for indoor smoking of 15.2.Conclusion. Smoking outdoors with the door closed was not a total but the most effective way to protect children from environmental tobacco-smoke exposure. Other modes of action had a minor effect.
Clinical Features and Anaphylaxis in Children With Cold Urticaria
Authors: Alangari Abdullah A. , Twarog Frank J. , Shih Mei-Chiung , Schneider Lynda C. 
Published: August 2004

Objective. To characterize the features of cold urticaria in children, with particular focus on systemic reactions, because little pediatric data are available.
Methodology. Chart reviews of 30 children &lt;18 years old who were evaluated in the past 3 years at the Children’s Hospital Allergy Program (Boston, MA) and a private allergy practice. Demographic, diagnostic, and therapeutic data were collected. Telephone interviews of patients and/or their parents were performed to obtain follow-up data.
Results. Our data showed that the mean and median ages of onset were ∼7 years. No secondary causes were found. One third of patients had anaphylactic reactions. These reactions could not be predicted based on available variables. Patients with negative cold-stimulation test (ice-cube challenge) at 10 minutes had similar symptoms and response to antihistamines as those patients with positive ice-cube-challenge test. In addition, our group of patients with cold urticaria had a strikingly high rate of asthma (46.7%) and allergic rhinitis (50%). The rate of family history of atopic diseases was even higher (89.3%).
Conclusions. Cold urticaria occurs in children and may be associated with anaphylaxis. In our series, no secondary causes were found. All patients with cold urticaria and their parents should be cautioned regarding the risk of anaphylaxis and provided with an epinephrine autoinjector.
Is Chlamydia pneumoniae Infection Associated With Stroke in Children With Sickle Cell Disease?
Authors: Goyal Meenakshi , Miller Scott T. , Hammerschlag Margaret R. , Gelling Maureen , Gaydos Charlotte A. , Hardick Justin , Wood Billie Jo , Reznik Tamara , Rao S.P. 
Published: August 2004

Background. Stroke is often a devastating complication of sickle cell disease (SCD). Most children with SCD-related stroke have stenotic and occlusive disease of cerebral blood vessels due to intimal hyperplasia. This hyperplasia is hypothesized to result from an inflammatory response similar to that in atherosclerosis and has been attributed to infection by Chlamydia pneumoniae.
Objective. To determine whether C pneumoniae infection is associated with stroke and cerebrovascular disease, including transient ischemic attacks and abnormal transcranial Doppler examinations, in children with SCD.
Methods. Children with SCD on chronic transfusion due to a history of stroke, transient ischemic attack, or abnormal transcranial Doppler; children with SCD without stroke; healthy controls; and children being transfused for other reasons were enrolled. Peripheral blood and nasopharyngeal (NP) swab specimens were collected from all patients. In patients on transfusion, pretransfusion specimens and samples from the unit of packed red blood cells being transfused were obtained. Peripheral blood monocytic cells (PBMCs) and NP swab specimens were cultured for C pneumoniae in HEp-2 cells. C pneumoniae polymerase chain reaction was performed on PBMCs with a nested touch-down method with primers from the omp-1gene (in duplicate) and a second real-time polymerase chain reaction by using 16S ribosomal RNA primers.
Results. C pneumoniae DNA was detected in the PBMCs of 1 of 14 (7.1%) children with SCD on chronic transfusion, 1 of 10 (10%) sickle cell controls, 1 of 10 (10%) healthy controls, and none of the 5 children receiving chronic transfusion for other reasons. It was not detected in specimens from transfusion units. One child with SCD and stroke, 1 sickle cell control, and 1 transfusion control had positive NP cultures for C pneumoniae. C pneumoniae DNA was not detected in their PBMCs, and all 3 children were asymptomatic. C pneumoniae was not detected by culture of PBMCs from any of the patients after 7 passages.
Conclusion. Stroke in children with SCD does not seem to be associated with C pneumoniae infection in our population.
Delay in Diagnosis of Slipped Capital Femoral Epiphysis
Authors: Kocher Mininder S. , Bishop Julius A. , Weed Bryce , Hresko M. Timothy , Millis Michael B. , Kim Young Jo , Kasser James R. 
Published: August 2004

Objective. Delay in diagnosis of slipped capital femoral epiphysis (SCFE) has important implications in terms of slip severity and long-term hip outcome. The purpose of this study was to identify predictors of delay in the diagnosis of SCFE.Methods. A review of 196 patients with SCFE was performed. The primary outcome measure was delay from onset of symptoms to diagnosis. Covariates included age, gender, side, weight, pain location, insurance status, family income, slip severity, and slip stability. Delay in diagnosis was not normal in distribution; therefore, nonparametric univariate and multivariate analyses were performed.Results. The median delay in diagnosis was 8.0 weeks. There was a significant relationship between delay in diagnosis and slip severity (&lt;30°: 10.0 weeks; 30° to 50°: 14.4 weeks; &gt;50°: 20.6 weeks). There were no significant associations between delay in diagnosis and covariates of age, gender, side, and weight. There were significant associations between longer delay in diagnosis and covariates of knee/distal-thigh pain versus hip/proximal-thigh pain (6.0 vs 15.0 weeks), Medicaid coverage versus private insurance (12.0 vs 7.5 weeks), lower family income, and stable slips versus unstable slips (8.0 vs 6.5 weeks). Controlling for the other covariates, knee/distal-thigh pain, Medicaid insurance, and stable slips remained significant independent multivariate predictors of delay in diagnosis.Conclusions. Patients who present with primarily knee or distal-thigh pain, patients with Medicaid coverage, and patients with stable slips have longer delays in diagnosis of SCFE. Focused intervention programs to reduce the delay in diagnosis of SCFE should emphasize patients with knee/thigh pain and patients with Medicaid coverage.
Wilms Tumor Screening Is Unnecessary in Klippel-Trenaunay Syndrome
Authors: Greene Arin K. , Kieran Mark , Burrows Patricia E. , Mulliken John B. , Kasser James , Fishman Steven J. 
Published: August 2004

Background. Children with hemihypertrophy are screened for Wilms tumor, because this condition is a risk factor for developing the neoplasm. Patients with Klippel-Trenaunay syndrome (KTS) are often considered potential candidates for Wilms tumor, because they have unilateral overgrowth of the lower limb. In our experience, however, an association between KTS and Wilms tumor has not been observed.
Methods. To determine whether KTS and Wilms tumor are associated, we reviewed our institutional experience for patients with both diagnoses and searched the Klippel-Trenaunay literature for patients with Wilms tumor. The National Wilms Tumor Study Group database also was studied to identify patients with KTS. Two-sided exact binomial tests were used to evaluate whether patients with 1 condition had an increased risk for the other. Ninety-five percent confidence intervals for these 2 risks were compared with the general population risks of Wilms tumor (1 in 10 000) and KTS (1 in 47 313).
Results. None of the 115 patients with KTS followed at our institution developed Wilms tumor. One case of Wilms tumor has been reported in 1363 patients with KTS in the literature, giving a confidence interval of (1/57 377) and (1/267). None of the 8614 patients in the National Wilms Tumor Study Group database had KTS, giving a confidence interval of (0, 1/2336). Because the risks of KTS and Wilms tumor in the population fall within these confidence intervals, one cannot conclude that the risks of KTS among Wilms tumor patients or Wilms tumor among KTS patients are any different from the corresponding risks in the general population.
Conclusions. Patients with KTS are not at increased risk for developing Wilms tumor and thus should not undergo routine ultrasonographic screening.
All-Terrain Vehicle Legislation for Children: A Comparison of a State With and a State Without a Helmet Law
Authors: Keenan Heather T. , Bratton Susan L. 
Published: August 2004

Background. All-terrain vehicles (ATVs) continue to be a source of morbidity and mortality in the pediatric population despite recommendations from the American Academy of Pediatrics that children &lt;16 years old not ride in or drive ATVs. ATV injuries have increased significantly in both children and adults most years since 1997.
Objective. To assess the effectiveness of ATV regulations for children on serious injuries by comparing ATV-related admissions to level I and II trauma hospitals in a state with and a state without ATV regulations.
Design. Ecologic study.
Patients. Children &lt;16 years old who died and/or were treated in the trauma system of Pennsylvania or North Carolina after ATV crashes.
Outcome Measures. Injury types and cause of death were examined for all children. Comparisons were made by state (Pennsylvania [regulated] and North Carolina [unregulated]) for patterns of injury, place of injury, helmet use, and death.
Results. There were 1080 children identified in the trauma registries between January 1997 and July 2000. Forty-four percent required intensive care. Head injuries were the primary cause of death (45.7%). Fewer North Carolina children than Pennsylvania children (16.7% vs 35.8%) wore helmets, and they were more likely to be &lt;11 years old (35.1% vs 27.8%). Living in North Carolina was an independent predictor for not wearing a helmet.
Conclusions. Living in Pennsylvania was associated with decreased risk factors for ATV injury such as young age and riding unhelmeted. However, despite regulations, many children suffered serious morbidity and mortality. These data support the recommendation that children &lt;16 years old should be prohibited from riding or driving ATVs.
Effect of Prenatal Diagnosis on Outcomes in D-Transposition of the Great Arteries
Authors: Bartlett Jodi M. , Wypij David , Bellinger David C. , Rappaport Leonard A. , Heffner Linda J. , Jonas Richard A. , Newburger Jane W. 
Published: August 2004

Background. By decreasing preoperative morbidity, prenatal diagnosis could improve neurodevelopmental outcomes in infants with critical congenital heart disease. We explored the impact of prenatal diagnosis on perinatal and perioperative variables and on outcomes at 1 year of age.
Methods. We analyzed a database of children enrolled in prospective studies on surgical support techniques from 1988 to 2000. Selection criteria included a diagnosis of D-transposition of the great arteries with intact ventricular septum or ventricular septal defect, no extracardiac congenital anomalies, birth weight &gt;2.3 kg, and repair by arterial switch procedure.
Results. Of 346 patients at enrollment, 25 had a prenatal diagnosis, and 321 did not. Children with prenatal diagnosis, compared with those without, had a lower likelihood of birth by spontaneous labor, lower birth weights, lower Apgar 5 scores, a higher rate of preoperative endotracheal intubation, and surgery at a younger age. They tended to have a lower incidence of fetal distress during labor. At 1 year of age, 272 patients were tested with the Psychomotor Development Index and Mental Development Index of the Bayley Scales. Mean z scores were similar in those with and without prenatal diagnosis for both Psychomotor Development Index (−0.92 ± 0.93 vs −0.88 ± 1.05) and Mental Development Index (−0.29 ± 1.13 vs −0.41 ± 0.93).
Conclusions. Infants with D-transposition of the great arteries with and without prenatal diagnosis differed with respect to perinatal and perioperative variables, but their development at 1 year of age was similar. Future studies should include a greater number of children with prenatal diagnosis and a variety of congenital heart lesions.
Physical Activity in Urban School-Aged Children With Asthma
Authors: Lang David M. , Butz Arlene M. , Duggan Anne K. , Serwint Janet R. 
Published: August 2004

Objectives. To compare the physical activity levels of children with and without asthma and evaluate predictors of activity level in children with asthma.Methods. Parents of 137 children with asthma and 106 controls 6 to 12 years old who attended an urban primary care pediatric clinic were interviewed by telephone. A structured survey evaluated 1 day’s total activity and the number of days active in a typical week; asthma characteristics and treatment; physician advice; opportunities for physical activity; and caregiver beliefs about physical activity. The activity levels of children with and without asthma were compared. Predictors of activity level of children with asthma were evaluated.Results. Children with asthma were less active than their peers. The mean amount of daily activity differed by group: 116 (asthma) vs 146 (nonasthma) minutes; 21% (asthma) vs 9% (nonasthma) were active &lt;30 minutes/day; and 23% (asthma) vs 11% (nonasthma) were active &lt;3 days/week. Among children with asthma, disease severity and parental beliefs regarding exercise and asthma predicted activity level. Children with moderate or severe persistent asthma were more likely to be active &lt;30 minutes/day (odds ratio: 3.0; confidence interval: 1.2–7.5), and children whose parents believed exercise could improve asthma were more likely to be highly active ≥120 minutes/day (odds ratio: 2.5; confidence interval: 1.2–5.4).Conclusions. Disease severity and parental health beliefs contribute to the lower activity level of children with asthma. Pediatricians should evaluate exercise level as an indicator of disease control and address exercise and its benefits with patients and caregivers to help achieve the goal of normal physical activity in children with asthma.