bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparative Analysis of Pediatric Mailing Lists on the Internet
Authors: Hernández-Borges Angel A. , Pareras Luis G. , Jiménez Alejandro 
Published: August 2004

Objective. To analyze quantitative aspects and the relative quality of various pediatric discussion groups on the Internet and to contrast them with qualitative aspects of a selected number of pediatric journals.Material and Methods. An extensive number of mailing lists on the Internet of interest to pediatricians was compiled. Twelve of them concerned with pediatric specialties were selected. Six representative journals of pediatric specialties were also analyzed and compared with the corresponding mailing lists. From the list of subscribers we studied the potential quality of each mailing list. The postings sent by each member to the on-line discussions were also analyzed. As an estimate of the standing as author of each list member as well as of each first author of the selected journals, we calculated several indexes of quality using the 1995 Medline database and the impact factors of the biomedical journals reported by the 1994 Science Citation Index.Results. The most popular lists were NICU-NET and PICU, both having more than 1100 subscribers. PEDPATH and PEDIHEART had the highest percentage of subscribers who were published authors, and their papers also yielded the highest impact factors. The most active lists were NICU-NET and PICU. The most participative ones were CHILD-NEURO and PED-LUNG. CHILD-NEURO had the highest percentage of authors among the participants. PEDPATH and CHILD-NEURO had the authors with the highest impact factors among the people who participated in the discussions. These latter two lists also showed the highest impact factor per posting. Those which had the highest yield (highest activity with highest quality per posting) were CHILD-NEURO and PEDIHEART. The average impact factor per first author of the analyzed journals was always higher than the average impact factor per participant of the lists.Conclusions. The electronic-mail discussion groups on the Internet are new nonacademic forums in which knowledge and experience in pediatrics can be shared. They cannot replace but they complement other more academic sources such as medical journals.
Recognition of the Presence and Severity of Newborn Jaundice by Parents, Nurses, Physicians, and Icterometer
Authors: Madlon-Kay Diane J. 
Published: August 2004

Objective. To determine how well parents, nurses, physicians, and an Ingram icterometer can detect the presence and the severity of jaundice in newborns.Setting. Normal newborn nursery in a 340-bed teaching hospital.Patients or Other Participants. Nurses and physicians caring for nursery infants and parents of the infants.Interventions. Physicians and nurses examining newborns documented whether they detected jaundice in the infants and, if so, the estimated bilirubin level and the extent of cephalocaudal progression of the jaundice. An assistant taught the parents how to examine the infants for jaundice and determine its cephalocaudal progression. The assistant also obtained icterometer readings. Bilirubin testing was performed according to usual clinical practice.Outcome Measures. Nurse and physician estimates of bilirubin levels; parent, nurse, and physician assessment of the presence of jaundice and its cephalocaudal progression; icterometer readings; bilirubin levels.Results. There was moderate agreement about the presence of jaundice in the infants (pairwise κ, 0.48) However, all infants with bilirubin levels &gt;12 mg/dL were correctly identified as jaundiced by all examiners. The parents' assessment of cephalocaudal progression and the icterometer readings were most highly correlated with serum bilirubin levels (adjusted Pearson correlations, 0.71 and 0.57, respectively).Conclusions. Many parents can be taught to accurately assess cephalocaudal progression of jaundice in the hospital. The icterometer is a useful tool for assessing jaundice severity. Both parent assessment and the icterometer were more highly correlated with bilirubin levels than physician and nurse estimates in this study. Additional research is needed to determine how accurate these methods of clinical assessment are at the higher bilirubin levels that typically occur after hospital discharge.
Serious and Fatal Air Gun Injuries: More Than Meets the Eye
Authors: Bratton Susan L. , Dowd M. Denise , Brogan Thomas V. , Hegenbarth Mary A. 
Published: August 2004

Objective. To describe the epidemiology of air gun injuries to children that required hospitalization.Design. A consecutive series of children with air gun injuries.Setting. Urban pediatric teaching hospitals in Cincinnati, OH; Kansas City, MO; and Seattle, WA.Methods. A retrospective chart review.Results. A total of 101 children were studied: 81% were male; 80% were white, 18% were black, and 2% were other races. The median age was 10.9 years (range, 0.5 to 18.8). Victims were most commonly shot by a friend (30%) or sibling (21%). A total of 34% occurred at the victim's home, and 36% occurred at the home of a friend or relative. Although 71% of shootings were unintentional, 5% were assaults, and 1% were suicides.The median hospital stay was 3 days (range, 1 to 17 days). Fifteen children (15%) required treatment in intensive care. A total of 56% required at least one surgical procedure. Forty-nine had injuries to the head, including 38 with injuries to the eye, 10 with intracranial injuries, and 1 with a skull injury. Fourteen children were shot in the neck; 15 were shot in the chest, with 2 patients sustaining lacerations of the pericardium and 1 having a right ventricular foreign body. Another child had a laceration of the innominate artery. Nineteen had abdominal injuries, including laceration of the stomach (N = 3), small bowel (N = 4), colon (N = 2), and liver (N = 3).Three of 10 children with intracranial injuries died. Two had long-term neurologic deficits. Of children with eye injuries, 25 (66%) had permanent visual loss and 15 (39%) of these were blind.Conclusion. Air guns are associated with serious and fatal injuries. Families should be counseled that air guns may cause serious injuries and even death. Furthermore, pediatric care givers should advocate for increased regulation of air guns and expansion of safety standards.
Outcome of Extremely Low Birth Weight Infants (500 to 999 Grams) Over a 12-Year Period
Authors: Piecuch Robert E. , Leonard Carol H. , Cooper Bruce A. , Sehring Sally A. 
Published: August 2004

Objective. Advances in neonatology have contributed to improved survival for extremely low birth weight (ELBW) infants. Neurodevelopmental outcome is usually reported for a single large group of infants rather than according to smaller birth weight groups because of small numbers. Our purpose was to review the neurodevelopmental outcome of a large group of ELBW infants and examine differential outcome according to birth weight.Study Design. A total of 446 infants born between 1979 and 1991, with a birth weight of 500 to 999 g, were followed to mean age 55 months ± 33 standard deviation. Univariate analyses of medical risk factors of birth weight, gestational age, year of birth, growth retardation, gender, inborn/outborn status, days on oxygen, intracranial hemorrhage, and social risk in relation to outcome were conducted on the group as a whole. Neurologic/developmental outcome was also analyzed by 100-g weight groups.Results. A total of 61% of all infants were completely normal, with no neurologic, neurosensory, or cognitive deficits. There was no association between outcome and birth weight. There was a strong association between intracranial hemorrhage (ICH) grade III or IV and/or cystic periventricular leukomalacia (PVL) and abnormal outcome (Somers' D = .17) and ICH III/IV and/or cystic PVL and cognitive outcome (Kendall's tau = .15). Mild to moderate cognitive delays were associated with chronic lung disease (oxygen &gt;60 days) (Kruskal-Wallis χ2 = 17.53) or high social risk (Kruskal-Wallis χ2 = 22.17).Conclusion. In this study of ELBW infants, low birth weight was not associated with abnormal outcome. The risk factors of ICH III-IV/cystic PVL, chronic lung disease, and high social risk were associated with abnormal outcome.
Side Effects of Methylphenidate and Dexamphetamine in Children With Attention Deficit Hyperactivity Disorder: A Double-blind, Crossover Trial
Authors: Efron Daryl , Jarman Frederick , Barker Melinda 
Published: August 2004

Objective. To compare the side effect profiles of methylphenidate (MPH) and dexamphetamine (DEX) in children with attention deficit hyperactivity disorder (ADHD), as well as to determine which symptoms are genuine adverse effects of stimulant medication, as opposed to aspects of the child's underlying behavioral phenotype.Design. Double-blind, crossover study.Setting. Pediatric teaching hospital ambulatory behavior clinic.Subjects. A total of 125 children with ADHD with a mean age of 104.8 months.Interventions. Subjects received DEX (0.15 mg/kg/dose) and MPH (0.3 mg/kg/dose) twice a day for 2 weeks each in a randomized order.Outcome Measures. The Barkley Side Effects Rating Scale (17 symptoms; 0 = absent, severity rated from 1 to 9) was completed by parents at baseline and at the completion of each trial fortnight.Results. Subjects' parents reported a significantly greater mean number (8.19) and mean severity (4.08) of “side effects” before commencing the trial than during the MPH period (number 7.19; severity 3.24), but not the DEX period (number 7.64, severity 3.73). The mean severity (but not mean number) was greater on DEX than on MPH. DEX caused more severe insomnia and appetite suppression compared with the baseline rating. Appetite suppression was the only item rated more severe on MPH than at baseline. Six side effects were significantly more severe on DEX than MPH: insomnia, irritability, proneness to crying, anxiousness, sadness/unhappiness, and nightmares. None were more severe on MPH than DEX. Overall, both MPH and DEX were well tolerated by most subjects, with only four subjects discontinuing the trial period because of severe adverse effects (2 [1.6%] on each stimulant).Conclusions. Many symptoms commonly attributed to stimulant medication are actually preexisting characteristics of children with ADHD and improve with stimulant treatment. At the doses investigated, both DEX and MPH caused appetite suppression, and DEX caused insomnia. Negative emotional symptoms were more severe on DEX than MPH.
Kangaroo Mother Versus Traditional Care for Newborn Infants ≤2000 Grams: A Randomized, Controlled Trial
Authors: Charpak Nathalie , Ruiz-Peláez Juan G. , MD Zita Figueroa de C, , Charpak Yves 
Published: August 2004

Background. In 1978, kangaroo mother care (KMC) was proposed as a caring alternative for low birth weight (LBW) infants. We are reporting here early outcomes of a randomized, controlled trial comparing KMC to traditional care.Method. An open randomized, controlled trial was conducted in a large tertiary care hospital. All newborn infants ≤2000 g, surviving the neonatal period and being eligible for a minimal care unit, were included. A total of 1084 newborns ≤2000 g were followed, and 746 were randomized—382 to KMC and 364 to traditional care. KMC infants were discharged after randomization, regardless of weight or gestational age. Infants spent 24 hours per day in an upright position, in skin-to-skin contact, and attached to the mother's chest. After randomization, control infants remained at the minimal care unit until meeting usual discharge criteria. Both groups are being followed up to 12 months of corrected age; 679 (90%) were available for evaluation when they reached term (40 to 41 weeks of postconceptional age). The present paper reports early outcomes (when reaching term) including mortality, infectious episodes, hospital stay after eligibility, and growth and feeding patterns.Results. Both study groups were similar regarding all baseline variables but weight at eligibility. The risk of dying was similar in both groups (relative risk = 0.59, 95% confidence interval 0.22–1.6). There were no differences in growth indices. Nosocomial infections were more frequent in control infants. Hospital stay after eligibility was shorter in KMC, primarily for infants ≤1800 g.Conclusions. These results show that KMC is a safe approach to the care of clinically stable LBW infants. Our findings provide the necessary scientific support to a method that is already incorporated in the care of LBW infants at many hospitals around the world and at different levels of care.
Hydroxyl Radical Generation in Oxygen-treated Infants
Authors: Lubec Gert , Widness John A. , Hayde Michael , Menzel Daniel , Pollak Arnold 
Published: August 2004

Objective. Because the hydroxyl radical is capable of oxidizing phenylalanine too-tyrosine, we sought to determine whether increased levels of o-tyrosine are found in urine of infants treated with supplemental oxygen.
Methods. A total of 39 consecutively admitted neonates to an intensive care unit were included. Twenty-seven received supplemental oxygen therapy for respiratory disease, and 12 did not. Urinary o-tyrosine levels were determined on two or more occasions using high-performance liquid chromatography with results expressed as a percentage of the urinary phenylalanine concentration. Using simple and stepwise multiple linear regression analyses, urinaryo-tyrosine was examined for associations with relevant clinical conditions and laboratory measurements.
Results. Infants supplemented with oxygen showed significantly higher mean ± SEM urinary o-tyrosine levels (0.40% ± 0.028) compared with those remaining in room air (0.18% ± 0.012). Mean daily Fio2 was the clinical and laboratory variable most highly correlated with urinaryo-tyrosine (r = 0.66). In the stepwise regression, significant associations were also found for renal fractional sodium excretion and Apgar score at 5 minutes.
Conclusions. Hydroxylation at the oposition of phenylalanine, a specific direct marker for the hydroxyl radical attack, was strongly associated with oxygen treatment in neonates. This finding increases our understanding of the pathogenesis of oxygen injury and suggests a basis for developing therapeutic approaches.
Pediatric Nonpowder Firearm Injuries: Outcomes in an Urban Pediatric Setting
Authors: Scribano Philip V. , Nance Michael , Reilly Patrick , Sing Ronald F. , Selbst Steven M. 
Published: August 2004

Background. Approximately 32 000 nonpowder firearm injuries are reported annually with more than 60% occurring in the pediatric population. Case reports of serious and fatal injuries have been described; however, no large inclusive series have been published. We reviewed an 11-year experience of an urban pediatric emergency department to evaluate the circumstances, spectrum of injuries, and outcomes attributable to nonpowder firearms.Methods. A retrospective, descriptive case series of all children 18 years of age or younger evaluated at an urban children's hospital from January 1983 through December 1994 were eligible for study. Patients were identified using a computerized database, the National Electronic Injury Surveillance System, and the trauma registry in the department of surgery. Medical records were reviewed to collect demographic information, circumstances of injury, anatomic site and type of injury, treatment, and outcomes for nonpowder firearm injuries.Results. One hundred eighty patients were identified, and a complete data set was available for 166 (92%). The mean age was 12 ± 3.7 years, 24% of children were &lt;10 years old, and 71% of the children were male. Three patients returned with a second nonpowder firearm injury during the study period. Forty-nine percent of injuries were intentional and 44% of all injuries occurred during the summer and early fall months. The most common sites of injury were the extremity/buttocks (39%), head and neck (33%), thorax (13%), and eye (8%). Serious injuries included intracranial hemorrhage, cardiac right ventricle laceration, hyphema, and abdominal visceral injury (liver laceration, pancreatic laceration, intestinal perforation). The majority of wounds required local wound care, and the children (74%) were discharged from the emergency department. Of the patients admitted to the hospital (27%), 45% required operative intervention. There were no deaths. Seven percent (12/166) of patients sustained some functional deficit with 42% (5/12) the result of an ocular injury.Conclusion. The majority of nonpowder firearm injuries are minor; however, the potential for serious injury should not be underestimated. Minor injuries can be treated with local wound care and tetanus prophylaxis, and patients can be discharged from the emergency department. Education of parents and children to the potential risks associated with these weapons is essential. Stricter regulations regarding ownership of nonpowder firearms and mandatory safety instruction should be considered.
Exclusive Breastfeeding Protects Against Bacterial Colonization and Day Care Exposure to Otitis Media
Authors: Duffy Linda C. , Faden Howard , Wasielewski Raymond , Wolf Judy , Krystofik Debra ,   Tonawanda/Williamsville Pediatrics
Published: August 2004

Objective. We followed a cohort (N = 306) of infants at well-baby visits in two suburban pediatric practices to assess the relation of exclusive breastfeeding, and other environmental exposures, to episodes of acute otitis media (AOM) and otitis media with effusion (OME).Methods. Detailed prospective information about the exclusiveness of breastfeeding, parental smoking, day care attendance, and family history was obtained at scheduled clinic visits. Tympanometric and otoscopic examinations were used in the diagnosis of otitis media (OM). Nasopharyngeal cultures were performed at 1–6 months, and at 8, 10, 12, 15, 18, and 24 months of age to detect colonization with middle-ear pathogens.Results. Between 6 and 12 months of age, cumulative incidence of first OM episodes increased from 25% to 51% in infants exclusively breastfed and from 54% to 76% in infants formula-fed from birth. Peak incidence of AOM and OME episodes was inversely related to rates of breastfeeding beyond 3 months of age. A twofold elevated risk of first episodes of AOM or OME was observed in exclusively formula-fed infants compared with infants exclusively breast-fed for 6 months. In the logistic regression analysis, formula-feeding was the most significant predictor of AOM and OME episodes, although age at colonization with middle-ear pathogens and day care (outside the home) were significant competing risk factors. A hazard health model suggested additionally that breastfeeding, even for short durations (3 months), reduced onset of OM episodes in infancy.Conclusions. Modifiable factors in the onset of AOM and OME episodes during the first 2 years of life include early age at colonization (≤3 months of age), day care outside the home, and not being breastfed.
An Unusual Cause of Neonatal Seizures in a Newborn Infant
Authors: de Klerk O. L. , de Vries T. W. , Sinnige L. G. F. 
Published: August 2004

Neonatal seizures in the neonatal period are symptoms of numerous underlying disorders of the neonate. We present a case in which neonatal seizures due to cerebral infarction led to a diagnosis in the mother.
Neonatal convulsions caused by cerebral artery thrombosis is relatively rare in the neonatal period and is often secondary to indwelling intravascular catheters that cause thromboembolism, but may be associated with many conditions.1
Cerebral artery thrombosis in newborns, in which antiphospholipid antibodies (APA) were found in the mother, has been described in three case reports.23 Two of these premature infants were born with other risk factors for thrombosis. APA could not be identified in any of these three infants. In the two cases reported by Silver et al3 the diagnosis was made several months after birth.
This case is unique in the fact that no other risk factors for thrombosis could be identified to explain the infarction, and that APA were found in the offspring of an apparently healthy mother. Whether the prior fetal death was caused by APA remains unclear. The finding of lupus anticoagulant in her child led to the diagnosis of antiphospholipid antibody syndrome in her. We believe that in case of cerebral artery thrombosis in a neonate, with no trivial cause such as an indwelling catheter or sepsis, both mother and infant should be tested for presence of APA, even when the mother seems healthy.
Interleukin-6 in the Cerebrospinal Fluid After Perinatal Asphyxia Is Related to Early and Late Neurological Manifestations
Authors: Martı́n-Ancel Ana , Garcı́a-Alix Alfredo , Pascual-Salcedo Dora , Cabañas Fernando , Valcarce Manuel , Quero José 
Published: August 2004

Objectives. To investigate if the concentration of interleukin-6 (IL-6) in the cerebrospinal fluid (CSF) is affected by perinatal asphyxia, and to examine the relation of IL-6 levels in the CSF to the severity of hypoxic-ischemic encephalopathy (HIE), to brain damage, and to the neurological outcome.Methods. Asphyxiated term neonates were included. Cerebrospinal fluid IL-6 was measured by a sensitive enzyme-linked immunosorbent assay.Results. Twenty neonates were studied: 3 had no HIE, 5 had stage 1, 6 had stage 2, and 6 had stage 3. CSF IL-6 levels (8 to 90 hours of life) were higher in neonates with HIE stage 3 (range, 65 to 2250 pg/mL) when compared with neonates with HIE stage 0 to 2 (&lt;2 pg/mL in 12 neonates, 10 pg/mL in 1). According to neuroimaging techniques and/or pathological examination, 14 neonates were normal, and 5 showed signs of brain damage; 1 was not classified. CSF IL-6 levels were significantly higher in neonates with signs of brain damage. Finally, 5 neonates had adverse outcomes (4 died, 1 had cerebral palsy), 2 had mild motor impairment, and 13 had normal outcomes. CSF IL-6 levels were higher in neonates with adverse outcomes (range, 65 to 2250 pg/mL) compared with neonates with favorable outcomes.Conclusion. The magnitude of IL-6 response in the CSF after perinatal asphyxia is related to the severity of neonatal HIE, to brain damage, and to the neurological outcome. Our results suggest that IL-6 might play a role in neonatal hypoxic-ischemic brain damage.
Hypospadias Trends in Two US Surveillance Systems
Authors: Paulozzi Leonard J. , Erickson J. David , Jackson Richard J. 
Published: August 2004

Objective. Hypospadias is a common congenital anomaly, the cause of which is unknown. Unexplained increases in the rates of hypospadias occurred in five European countries in the 1970s and 1980s. We examined data from two birth defects surveillance systems in the United States for evidence of similar trends.
Methodology. The Metropolitan Atlanta Congenital Defects Program (MACDP) provided birth prevalence rates from 1968 to 1993. The nationwide Birth Defects Monitoring Program (BDMP) provided rates from 1970 to 1993. MACDP data are population-based and could be categorized by the severity of the hypospadias. BDMP data allowed analysis of rate trends for the four census regions of the United States.
Results. Data from both surveillance systems showed an approximate doubling of hypospadias rates in the 1970s and 1980s. MACDP data showed that the rate of severe cases increased while the ratio of mild to severe cases decreased. BDMP data showed that hypospadias rates increased markedly in all four regions of the United States.
Conclusions. The observed increases are unlikely to be attributable to increased sensitivity of the surveillance systems or the identification of more mild cases by physicians over time, because either trend would have increased rather than decreased the ratio of mild to severe cases. If real, these trends represent the largest number of cases and the first report of an increase in hypospadias rates outside of Europe. Additional investigation of a possible increase in hypospadias rates is warranted.