bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prepubertal Gynecomastia: Indirect Exposure to Estrogen Cream
Authors: Felner Eric I. , White Perrin C. 
Published: August 2004

Objective.
To describe the clinical course of 3 prepubertal boys who presented with gynecomastia resulting from indirect exposure to a custom-compounded preparation of estrogen cream used by each child's mother.

Methodology.
Each child was initially referred to the Children's Medical Center of Dallas' Endocrinology Center and followed for over 1 year.

Results.
All 3 boys presented with gynecomastia and elevated estradiol levels. Two had accelerated growth and advanced bone ages. Within 4 months after each child's mother discontinued use of the topical estrogen preparation, each child's gynecomastia regressed and estradiol levels returned to normal.

Conclusion.
Indirect exposure to excessive amounts of topical estrogen may cause gynecomastia, rapid changes in growth, and advanced bone age in prepubertal children. Because custom-compounded topical estrogen preparations are not regulated by the Food and Drug Administration and may contain high concentrations of estrogen, we recommend that women requiring estrogen use an alternate form of estrogen delivery if they are in frequent close contact with children.
Alternating Antipyretics: Is This an Alternative?
Authors: Mayoral Clara E. , Marino Ronald V. , Rosenfeld Warren , Greensher Joseph 
Published: August 2004

Objectives.To identify current fever management strategies and their basis, and to assess the frequency of alternating acetaminophen and ibuprofen.Background.Practicing pediatricians confront the dilemma of elevated temperature and the anxiety this creates for parents. An informal survey of pediatricians revealed a variety of management strategies, including alternating acetaminophen and ibuprofen. There are no scientific data regarding alternating these 2 products.Design.During professional meetings, pediatricians voluntarily filled out a 15-item questionnaire.Results.One hundred sixty-one completed surveys were reviewed. Respondents were mostly general pediatricians (67.7%), with ≥20 years in practice (55.9%). Most respondents chose a temperature of 101oF to start antipyretic treatment (61.9%). A small percentage used discomfort alone as the indication (13%). The antipyretic of choice was temperature-dependent in 50% of respondents; 57% used ibuprofen for temperature ≥102°F. Fifty percent of respondents advised parents to alternate acetaminophen and ibuprofen. The method of alternation varied. The most common answers given for choosing a particular antipyretic regime were recommendations of the American Academy of Pediatrics (29%) and opinions of colleagues and mentors (25%). Physicians with &lt;5 years of practice were significantly more likely to alternate antipyretics (69.7%).Conclusion.Acetaminophen and ibuprofen are commonly being used in an alternating manner for management of fever. There is presently no scientific evidence that this combination is safe or achieves faster antipyresis than either agent alone. There is evidence that the improper use of these agents may cause harm. Despite 29% of participants citing American Academy of Pediatrics recommendations as the basis for fever management, no such policy or recommendations exist. The observation that this practice is more common in younger practitioners may reflect their continued anxiety about fever (fever phobia). Until properly controlled studies have assessed the risk of combining these 2 products, practitioners should proceed with caution.
Quality of Care and Use of the Medical Home in a State-Funded Capitated Primary Care Plan For Low-Income Children
Authors: Kempe Allison , Beaty Brenda , Englund Brian P. , Roark Robert J. , Hester Nellie , Steiner John F. 
Published: August 2004

Objective.To evaluate the quality of care and use of the medical home in a state-funded capitated insurance plan for low-income children—the Colorado Child Health Plan (CCHP).Design.A retrospective cohort study using medical record review at pediatric and family practice offices in 4 geographic areas of Colorado. At each practice, CCHP-enrolled children (6 months to 6.5 years) and 2 controls were selected, 1 with Medicaid (MK) and 1 with private insurance (PI), matched by date of birth to the CCHP-enrolled child (N = 596). CCHP-enrolled children with a diagnosis of asthma, aged 3 to 18 years, and asthmatic children with MK and PI, matched by age, were also selected from each practice (N = 139).Results.Quality of preventive services were comparable in the 3 groups. CCHP-enrolled children made more health maintenance visits than MK-enrolled children (1.3 CCHP vs .9 MK vs 1.1 PI) and were more frequently screened for lead (8.1% CCHP vs 3.4% MK vs 1.2% PI) and anemia (5.0% CCHP vs 4.4% MK vs 2.4% PI) than children in either control group. Documented immunization rates were similar in the 3 groups, but a shift in location of immunization from public health clinics to the primary care site was seen in the CCHP group. CCHP-enrolled children made more office visits for acute care than did MK-enrolled children (4.1 CCHP vs 3.1 MK vs 3.4 PI), but a higher proportion of these visits took place at the medical home rather than the emergency department for the CCHP group (.04) as compared with the MK (.07) or PI (.06) groups. Asthmatic children in the CCHP group made more preventive office visits for maintenance therapy and more frequently used the primary care site rather than the emergency department for acute exacerbations than did children with PI (mean ratio of emergency department visits to total acute visits .04 CCHP vs .06 MK vs .19 PI).Conclusions.Despite capitated reimbursement for primary care services, CCHP provided children from low-income families with preventive, acute, and chronic care services of comparable quantity and quality to those received by children with MK or PI. The program was associated with a shift of immunization location to the primary care site and increased health maintenance care for new enrollees. CCHP-enrolled children used their medical home for the majority of acute health needs and were not high utilizers of emergency department or hospital services.
Outcomes Evaluation of a Comprehensive Intervention Program for Asthmatic Children Enrolled in Medicaid
Authors: Kelly Cynthia Szelc , Morrow Ardythe L. , Shults Justine , Nakas Nermina , Strope Gerald L. , Adelman Raymond D. 
Published: August 2004

Objectives.To evaluate health care and financial outcomes in a population of Medicaid-insured asthmatic children after a comprehensive asthma intervention program.Design.Controlled clinical trial.Setting.Pediatric allergy clinic in an urban, tertiary care children's hospital.Subjects.Eighty children, 2 to 16 years old, with a history of frequent use of emergent health care services for asthma.Intervention.Children in the intervention group received asthma education and medical treatment in the setting of a tertiary care pediatric allergy clinic. An asthma outreach nurse maintained monthly contact with the families enrolled in the intervention group.Outcome Measures.Emergency department (ED) visits, hospitalizations, and health care charges per patient in the year after enrollment.Results.Baseline demographics did not differ significantly between the 2 groups. In the year before the study, there were no significant differences between intervention and control children in ED visits (mean, 3.5 per patient), hospitalizations (mean, .6 per patient) or health care charges ($2969 per patient). During the study year, ED visits decreased to a mean of 1.7 per patient in the intervention group and 2.4 in controls, while hospitalizations decreased to a mean of .2 per patient in the intervention group and .5 in the controls. Average asthma health care charges decreased by $721/child/year in the intervention group and by $178/patient/year in the control group.Conclusions.A comprehensive asthma intervention program for Medicaid-insured asthmatic children can significantly improve health outcomes while reducing health care costs.asthma education, health care outcomes, Medicaid, asthma outreach, utilization.
Estimation of Neonatal Outcome and Perinatal Therapy Use
Authors: Morse Steven B. , Haywood James L. , Goldenberg Robert L. , Bronstein Janet , Nelson Kathleen G. , Carlo Waldemar A. 
Published: August 2004

Objectives.To learn whether US obstetricians and pediatricians accurately estimate rates of survival and freedom from handicap in preterm infants and to learn whether their knowledge and attitudes influence their choice of interventions that may enhance survival.Methods.A cross-sectional survey of obstetricians and pediatricians practicing in the United States was performed using a pretested questionnaire designed to identify their knowledge regarding survival and handicap-free rates of infants born at 23 to 36 weeks of gestation. At each week of gestation, they were asked whether they would provide specific therapeutic interventions to either the expectant mother or infant. Survival and handicap-free rates were compared with published national rates. Obstetricians and pediatricians were divided into an optimists group and a pessimists group, based on their estimates of survival. The rates at which each group used therapeutic interventions were compared.Results.Both obstetricians and pediatricians underestimated survival rates from 24 through 35 weeks of gestation and freedom from serious handicap from 23 through 36 weeks of gestation. On the average, optimists accurately predicted neonatal survival. Obstetricians who underestimated neonatal survival would less often administer antenatal corticosteroids, perform a cesarean section for fetal distress, and transfer a mother to a tertiary center. Pediatricians who underestimated neonatal survival would less often use mechanical ventilation, cardiopulmonary resuscitation, inotropes, intravenous fluids, thermal support, and oxygen supplementation.Conclusion.Physicians underestimate survival and freedom from handicap in preterm infants. Underestimation of outcome is associated with restriction in the use of appropriate interventions.
A Randomized Comparison of Home and Clinic Follow-Up Visits After Early Postpartum Hospital Discharge
Authors: Lieu Tracy A. , Braveman Paula A. , Escobar Gabriel J. , Fischer Allen F. , Jensvold Nancy G. , Capra Angela M. 
Published: August 2004

Background.Recently enacted federal legislation mandates insurance coverage of at least 48 hours of postpartum hospitalization, but most mothers and newborns in the United States will continue to go home before the third postpartum day. National guidelines recommend a follow-up visit on the third or fourth postpartum day, but scant evidence exists about whether home or clinic visits are more effective.Methods.We enrolled 1163 medically and socially low-risk mother-newborn pairs with uncomplicated delivery and randomly assigned them to receive home visits by nurses or pediatric clinic visits by nurse practitioners or physicians on the third or fourth postpartum day. In contrast with the 20-minute pediatric clinic visits, the home visits were longer (median: 70 minutes), included preventive counseling about the home environment, and included a physical examination of the mother.Clinical utilization and costs were studied using computerized databases. Breastfeeding continuation, maternal depressive symptoms, and maternal satisfaction were assessed by means of telephone interviews at 2 weeks' postpartum.Results.Comparing the 580 pairs in the home visit group and the 583 pairs in the pediatric clinic visit group, no significant differences occurred in clinical outcomes as measured by maternal or newborn rehospitalization within 10 days postpartum, maternal or newborn urgent clinic visits within 10 days postpartum, or breastfeeding discontinuation or maternal depressive symptoms at the 2-week interview. The same was true for a combined clinical outcome measure indicating whether a mother-newborn pair had any of the above outcomes. In contrast, higher proportions of mothers in the home visit group rated as excellent or very good the preventive advice delivered (80% vs 44%), the provider's skills and abilities (87% vs 63%), the newborn's posthospital care (87% vs 59%), and their own posthospital care (75% vs 47%). On average, a home visit cost $255 and a pediatric clinic visit cost $120.Conclusions.For low-risk mothers and newborns in this integrated health maintenance organization, home visits compared with pediatric clinic visits on the third or fourth postpartum hospital day were more costly, but were associated with equivalent clinical outcomes and markedly higher maternal satisfaction. This study had limited power to identify group differences in rehospitalization, and may not be generalizable to higher-risk populations without comparable access to integrated hospital and outpatient care.
Effect of Early Versus Late Administration of Human Recombinant Erythropoietin on Transfusion Requirements in Premature Infants: Results of a Randomized, Placebo-Controlled, Multicenter Trial
Authors: Donato Hugo , Vain Nestor , Rendo Pablo , Vivas Norma , Prudent Luis , Larguı́a Miguel , Digregorio Jorge , Vecchiarelli Carmen , Valverde Regina , Garcı́a Cecilia , Subotovsky Patricia , Solana Claudio , Gorenstein Adriana ,   for the Private Hospitals Neonatal Network
Published: August 2004

Objective.The administration of recombinant human erythropoietin (rHuEPO), started after the first 2 weeks of life, reduces the transfusion requirement in premature infants. However, its use throughout the first 2 weeks of life, when anemia results predominantly from phlebotomy losses, remains controversial. We investigated whether early use of rHuEPO would reduce the total transfusion requirement and/or the number of transfusions throughout the first 2 weeks of life.Methods.We randomized 114 infants with birth weight (BW) &lt;1250 g to receive rHuEPO (1250 units/kg/week; IV; early group:n = 57) or placebo (late group:n = 57) from day 2 to day 14 of life; subsequently, all the patients received rHuEPO (750 units/kg/week, subcutaneously) for 6 additional weeks. All infants were given oral iron (6 mg/kg/day) and folic acid (2 mg/day).Results.The early group showed higher hematocrit and reticulocyte counts than the late group in the first 3 weeks of life, but there was no difference in the total number of transfusions (early: 1.8 ± 2.3 vs late: 1.8 ± 2.5 transfusion/patient) or the transfusion requirement throughout the first 2 weeks of life (early: .8 ± 1.1 vs late: .9 ± 1.3) could be demonstrated. In infants with BW &lt;800 g and total phlebotomy losses &gt;30 mL/kg (n = 29), a lower number of transfusions was received by infants in the early group, compared with late group, from the second week to the end of the treatment (early: 3.4 ± 1.1 vs late: 5.4 ± 3.7 transfusion/patient). No clinical adverse effects were observed. Thrombocytosis was detected during the treatment with rHuEPO in 31% of the infants.Conclusions.In the whole population, the early administration of rHuEPO induced a rise of reticulocyte counts, but not enough to reduce the transfusion requirement. The most severely ill infants (BW &lt;800 g and phlebotomy losses &gt;30 mL/kg) seemed to benefit from early use of rHuEPO, and this deserves additional study.
Neurodevelopmental Outcome and Lifestyle Assessment in School-Aged and Adolescent Children With Hypoplastic Left Heart Syndrome
Authors: Mahle William T. , Clancy Robert R. , Moss Edward M. , Gerdes Marsha , Jobes David R. , Wernovsky Gil 
Published: August 2004

Objectives.The purposes of this study are to describe the quality of life and cognitive function in school-aged children who have undergone staged palliation for hypoplastic left heart syndrome (HLHS), and to identify factors that are predictive of neurodevelopmental outcome in this population.Methods.School-aged survivors with HLHS who had undergone palliative surgery at our institution were identified and mailed a questionnaire to assess subjectively quality of life, school performance, and incidence of medical complications. A subgroup of local patients underwent standardized testing of cognitive function and neurologic examination. These patients were compared with the larger (remote) group of questionnaire respondents to determine whether results may be generalizable to the entire HLHS population. Potential predictors of neurologic and cognitive outcome were tested for their association with test scores using multivariate regression analysis.Results.Questionnaire results were obtained from 115 of 138 eligible children (83%; mean age: 9.0 ± 2.0 years). Standardized testing was performed in 28 of 34 (82%) eligible local patients (mean age: 8.6 ± 2.1 years). The majority of parents or guardians described their child's health as good (34%) or excellent (45%) and their academic performance as average (42%) or above average (42%). One third of the children, however, were receiving some form of special education. Chronic medication usage was common (64%); the incidence of medical complications was comparable to that previously reported in children with Fontan physiology. Cognitive testing of the local group demonstrated a median full scale IQ of 86 (range: 50–116). Mental retardation (IQ: &lt;70) was noted in 18% of patients. In multivariate analysis, only the occurrence of preoperative seizures predicted lower full scale IQ.Conclusions.Although the majority of school-aged children with HLHS had IQ scores within the normal range, mean performance for this historical cohort of survivors was lower than that in the general population.
Electrocardiographic Findings in Adolescents With Eating Disorders
Authors: Panagiotopoulos Constadina , McCrindle Brian W. , Hick Katherine , Katzman Debra K. 
Published: August 2004

Objectives.We sought to determine the prevalence and clinical correlates of electrocardiographic findings in adolescents with eating disorders.Study Design.We undertook matched case–control study of electrocardiographic findings at initial assessment in 62 adolescents with anorexia nervosa, 9 with bulimia nervosa, and 26 with eating disorder not otherwise specified presenting from March 1995 to September 1996.Results.Mean (± 1 standard deviation) age was 15.0 ± 1.4 years (95% were female). Patients with anorexia nervosa had significantly lower heart rates (mean case–control difference: −20 ± 17 beats per minute), lower R in V6(−2.6 ± 5.5 mm), longer QRS interval (+.004 ± .010 seconds), shorter mean QTc (−.0136 ± .033 seconds) and lesser QTc dispersion (−.010 ± .031 seconds). The bulimia nervosa group had slightly longer mean QTc (.019 ± .020 seconds), with no significant case–control differences in the eating disorder not otherwise specified group.Conclusion.Electrocardiographic findings are abnormal in adolescents with anorexia nervosa but not in adolescents with bulimia nervosa or eating disorder not otherwise specified.
Undiluted Albuterol Aerosols in the Pediatric Emergency Department
Authors: Gutglass David J. , Hampers Louis , Roosevelt Genie , Teoh Doreen , Nimmagadda Sai R. , Krug Steven E. 
Published: August 2004

Objective.To evaluate the efficacy and efficiency of a short treatment method of administering albuterol aerosols.Methods.Fifty children 6 to 18 years of age with severe acute asthma (peak flow rates &lt;60% of predicted) were enrolled in a single-blind, controlled trial in an urban pediatric emergency department. Patients were randomized to receive either the study short treatment (3.5 mL of undiluted albuterol nebulized for 20 inhalations) or the control treatment (albuterol diluted [.5 mL] and nebulized in normal saline [3 mL]) every 20 minutes for a total of 3 treatments. Peak flow and spirometric measurements were performed before and after each treatment.Results.There were 25 patients in the study group and 25 in the control group. There were no demographic differences between groups; both had comparable pulmonary function at presentation. The mean forced expiratory volume in 1 second percent predicted improvement between 0 and 60 minutes was 18.8% in the study group and 14.5% in the control group. The total time of treatment delivery for the study group was 6.4 minutes versus 32.7 minutes for the control group.Conclusion.Undiluted albuterol short treatments seem to be as effective as standard diluted albuterol in severe asthmatics, while offering the ease and efficiency of shorter treatment administration time.
Presentation of Low Anorectal Malformations Beyond the Neonatal Period
Authors: Kim H. L. Nancy , Gow Kenneth W. , Penner Janice G. , Blair Geoffrey K. , Murphy James J. , Webber Eric M. 
Published: August 2004

Objective.Anorectal malformations are usually diagnosed at birth, but some patients have presented to this institution beyond the early newborn period without recognition of their anorectal malformations. To quantify the extent of this problem, we undertook a review of all patients presenting to this hospital with anorectal malformations.Methods.We reviewed all new cases of anorectal malformations treated at British Columbia's Children's Hospital during the past 11 years. We looked specifically at the time of diagnosis, patient age, sex and mode of presentation, the type of anorectal malformations, and any associated anomalies.Results.One hundred twenty new cases of anorectal malformations were seen here, of whom, 15 patients (9 girls and 6 boys) presented beyond the early newborn period. Of these, 1 male infant was diagnosed at 2 weeks of age and another girl at 14 years of age. The remaining 13 presented between 3 and 11 months of age because of increasing constipation, usually associated with the introduction of solid foods. All had low anorectal malformations. Nine patients had at least 1 other feature of the VACTERL complex.Conclusions.Most anorectal malformations are identified at birth, but a significant number of the milder lesions may not be recognized until later. Therefore, this condition must be considered in older infants and children presenting with constipation, particularly if they also have cardiac or genitourinary anomalies. constipation, imperforate anus, VACTERL.