bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors for Suboptimal Infant Breastfeeding Behavior, Delayed Onset of Lactation, and Excess Neonatal Weight Loss
Authors: Dewey Kathryn G. , Nommsen-Rivers Laurie A. , Heinig M. Jane , Cohen Roberta J. 
Published: August 2004

Objective. Some mothers have difficulty initiating lactation even when highly motivated to breastfeed. The purpose of this study was to determine the incidence of and risk factors for suboptimal infant breastfeeding behavior (SIBB), delayed onset of lactation, and excess neonatal weight loss among mother-infant pairs in a population with high educational levels and motivation to breastfeed.Methods. All mothers residing in Davis, California, who gave birth to a healthy, single, term infant at 1 of 5 area hospitals during the 10-month recruitment period in 1999 were invited to participate if they were willing to attempt to breastfeed exclusively for at least 1 month. Lactation guidance was provided and data were collected in the hospital (day 0) and on days 3, 5, 7, and 14. Infant breastfeeding behavior was evaluated by trained lactation consultants using the Infant Breastfeeding Assessment Tool. Onset of lactation was defined based on maternal report of changes in breast fullness. Infant weight loss was considered excessive if it was ≥10% of birth weight by day 3.Results. Of the 328 eligible mothers, 280 (85%) participated in the study. The prevalence of SIBB was 49% on day 0, 22% on day 3, and 14% on day 7. SIBB was significantly associated with primiparity (days 0 and 3), cesarean section (in multiparas, day 0), flat or inverted nipples, infant status at birth (days 0 and 3), use of nonbreast milk fluids in the first 48 hours (days 3 and 7), pacifier use (day 3), stage II labor &gt;1 hour (day 7), maternal body mass index &gt;27 kg/m2 (day 7) and birth weight &lt;3600 g (day 7). Delayed onset of lactation (&gt;72 hours) occurred in 22% of women and was associated with primiparity, cesarean section, stage II labor &gt;1 hour, maternal body mass index &gt;27 kg/m2, flat or inverted nipples, and birth weight &gt;3600 g (in primiparas). Excess weight loss occurred in 12% of infants and was associated with primiparity, long duration of labor, use of labor medications (in multiparas), and infant status at birth. The risk of excess infant weight loss was 7.1 times greater if the mother had delayed onset of lactation, and 2.6 times greater if the infant had SIBB on day 0.Conclusions. Early lactation success is strongly influenced by parity, but may also be affected by potentially modifiable factors such as delivery mode, duration of labor, labor medications, use of nonbreast milk fluids and/or pacifiers, and maternal overweight. All breastfeeding mother-infant pairs should be evaluated at 72 to 96 hours’ postpartum.
The Neonatal Variant of Bartter Syndrome and Deafness: Preservation of Renal Function
Authors: Shalev Hanna , Ohali Melly , Kachko Leonid , Landau Daniel 
Published: August 2004

Background. A subtype of antenatal Bartter syndrome and sensorineural deafness (BSND) was originally described among families from southern Israel, and its gene (Barttin, OMIM #606412) has recently been identified. A report has suggested that these children develop chronic renal insufficiency during childhood attributable to chronic tubulointerstitial fibrosis and atrophy.
Methods. Data from 13 infants with BSND, who were born during a 20-year period in our institution, were retrospectively analyzed.
Results. All pregnancies were complicated by polyhydramnion and premature birth. All patients have sensorineural deafness, as well as hypokalemic metabolic alkalosis. Persistent hypercalciuria or nephrocalcinosis were absent in most children. All children have been treated with indomethacin (2 mg/kg/d) and potassium supplementation. The current average serum creatinine and calculated creatinine clearance from the older group (n = 8; mean age: 8.8 ± 1.4 years) is 60.8 ± 16.5 μmol/L and 95 ± 20 mL/min/1.73m2, respectively. Kidney biopsies from two 7-year-old patients revealed mild focal tubulointerstitial fibrosis and minimal mesangial proliferation but no glomerulosclerosis.
Conclusions. Early renal function deterioration is not a uniform finding among children with BSND mutations.
Spinal Congenital Dermal Sinuses: A 30-Year Experience
Authors: Ackerman Laurie L. , Menezes Arnold H. 
Published: August 2004

Objective. Dermal sinus tracts are an uncommon form of spinal dysraphism often presenting in childhood with skin findings, neurologic deficit, or infection. We reviewed our surgical experience, examining presenting symptomatology, operative findings, and patient outcomes.Methods. A retrospective analysis of operated dermal sinus tract cases by the senior author (A.H.M.) from 1970 to present was made.Results. Twenty-eight patients were identified; 17 female and 11 male. Five cervical, 4 thoracic, 9 lumbar, and 9 lumbosacral tracts were explored. Sixteen patients presented at &lt;1 year of age, and 12 were &gt;1 year. Reasons for referral included cutaneous findings (15), neurologic deficit (8), foot abnormalities (4), infection (3), pain (2), and scoliosis (1). Our initial examination revealed cutaneous findings (eg, sinus ostea, pigmentation changes, erythema, skin tags, subcutaneous masses) in 27 patients and neurologic deficit in 19. Age-related differences were apparent. Patients &gt;1 year were more likely to have neurologic deficit (92%) as compared with those &lt;1 year (50%). Bifid spinous processes were noted at dural tract entry in 17 patients. Twenty-two tethered cords, 14 inclusion tumors, and 6 patients with evidence of arachnoiditis were found intraoperatively. Mean follow-up was 33 months. Eleven (39%) remained neurologically intact, 12 (43%) improved, 2 (7%) were unchanged, and 3 (11%) were worse with 2 having decreased perianal sensation and 1 slightly worsened motor function postoperatively.Conclusions. Although most patients were referred for cutaneous stigmata evaluation, &gt;50% had neurologic deficit, intradural tumors, or tethered cords. Skin findings identification should initiate prompt radiologic evaluation and neurosurgical intervention with intradural exploration. Timely intervention may preserve or improve neurologic function in these patients.
Cognitive Decline With Immunologic and Virologic Stability in Four Children With Human Immunodeficiency Virus Disease
Authors: Tamula Mary Anne Toledo , Wolters Pamela L. , Walsek Claire , Zeichner Steven , Civitello Lucy 
Published: August 2004

This case series describes 4 children with vertically acquired human immunodeficiency virus (HIV) infection who exhibited immunologic, virologic, and clinical stability while on a protease inhibitor-containing highly active antiretroviral therapy (HAART) regimen, yet demonstrated significant cognitive decline as measured by standardized intelligence tests.A retrospective review of 107 patient records of children with HIV infection on HAART treatment protocols was conducted. Four patients were identified who responded to protease inhibitor-containing HAART therapy with sustained viral load suppression, and stable immunologic and medical parameters, yet demonstrated significant cognitive decline. Such discordance between biological and clinical markers previously has been reported in adults with HIV disease but not in children. This observed decline in neurocognitive functioning despite stable medical parameters suggests that HAART regimens that are effective for systemic disease may not be as effective for the central nervous system (CNS), perhaps because the antiretrovirals do not penetrate adequately into the CNS.Of note, 3 of these 4 patients did not have zidovudine (ZDV) included in their HAART regimen. The only patient who was treated with ZDV containing regimen received 90 mg/m2 every 6 hours, which is at the lower end of the recommended ZDV pediatric full-dose range (90 mg/m2 to 120 mg/m2). Two of the 4 patients began ZDV at 120 mg/m2 every 6 hours following the decline in their cognitive test scores and subsequently showed improved or stable functioning as evidenced by the results of follow-up psychometric testing.Long-term prospective studies using both systemic and CNS measures are necessary to further investigate the effects of HAART in children with HIV disease. Longitudinal cognitive assessments of children receiving HAART appear indicated to identify cognitive decline and to provide appropriate therapeutic intervention when manifestations of HIV-related CNS disease progression occur.
Risk Factors Associated With Severe Influenza Infections in Childhood: Implication for Vaccine Strategy
Authors: Quach Caroline , Piché-Walker Lorraine , Platt Robert , Moore Dorothy 
Published: August 2004

Infections caused by influenza virus lead to an excess rate of hospitalization of children during winter months. Current recommendations for vaccination target only children &gt;6 months who belong to specific risk groups.
Objective. To identify possible benefits of universal influenza vaccination, this study aims to determine characteristics of children hospitalized at the Montreal Children’s Hospital (MCH) because of an infection attributable to influenza virus as well as risk factors associated with hospitalization.
Methods. We retrospectively reviewed records of all children with a laboratory-proven diagnosis of influenza seen at MCH between April 1, 1999, and April 1, 2002. Data were analyzed using the Student t test and logistic regression.
Results. We identified 182 patients hospitalized because of influenza and 114 patients who were not. Admission diagnoses were suspected sepsis (31%), lower respiratory tract infections (27%), and asthma or bronchiolitis (15%). Mean age of hospitalized patients was 26.1 month (median: 12 months), which was similar to that of patients not hospitalized, and 34% were &lt;6 months. Seventy percent of those hospitalized did not have any underlying medical disorder and only 18% (33) were vaccine candidates according to current recommendations. Of the latter, less than half had been vaccinated. Factors associated with hospitalization were age &lt;12 months (odds ratio [OR]: 2.3; 95% confidence interval [CI]: 1.1–4.8), male gender (OR: 1.9; 95% CI: 1.0–3.7), dehydration (OR: 4.3; 95% CI: 1.2–16.0), and decreased oxygen saturation (OR: 32.1; 95% CI: 4.1–249).
Conclusions. Considering that the majority of children hospitalized for influenza do not belong to the specific risk groups targeted by current recommendations, and that one third are &lt;6 months of age, the target population for vaccination needs to be reexamined. Extending vaccination to all young children, to additional high-risk groups, and to pregnant women has potential to reduce the impact of influenza on children.
Efficacy of Implantable Loop Recorders in Establishing Symptom-Rhythm Correlation in Young Patients With Syncope and Palpitations
Authors: Rossano Joseph , Bloemers Beatrijs , Sreeram Narayanswami , Balaji Seshadri , Shah Maully J. 
Published: August 2004

Objective. To evaluate efficacy of the recently introduced implantable loop recorder (ILR) in establishing symptom-rhythm correlation in young patients with syncope, near syncope, palpitations, and acute life-threatening events (ALTEs).
Methods. A retrospective study was conducted with patients with ILR from 3 pediatric centers. Inclusion criteria were age ≤25 years and a minimum follow-up of 1 month. All ILR-stored events were analyzed regularly for the presence or absence of an arrhythmia at the time of the symptomatic event.
Results. Twenty-one patients (12 male, 9 female) with an average age of 12.3 ± 5.3 years (range: 0.8–22 years) were included in the study. Five (24%) patients had structural heart disease, 2 (10%) had a family history of sudden cardiac death, 3 (14%) had QT prolongation on electrocardiogram, and 11 had no cardiovascular disease. Indications for ILR were recurrent syncope and near syncope (n = 15), palpitations (n = 2), and ALTE (n = 2). Fourteen (67%) patients continued to have symptoms, and 7 (33%) had no symptoms after ILR over a follow-up period of 8.4 ± 4.7 months (range: 1.9–16 months). Symptom-rhythm correlation was possible in all 14 patients who continued to have symptoms (supraventricular tachycardia in 4, ventricular tachycardia in 2, torsades de points in 1, asystole in 1, junctional bradycardia in 1, and sinus rhythm in 5).
Conclusions. ILR is useful in determining the presence or absence of an arrhythmia during symptoms of syncope, near syncope, and palpitations as well as ALTEs in patients with and without structural heart disease when conventional diagnostic testing, such as electrocardiogram, Holter monitoring, and/or external loop recording, is inconclusive.
Sustained Breastfeeding Rates at a US Baby-Friendly Hospital
Authors: Philipp Barbara L. , Malone Kirsten L. , Cimo Sabrina , Merewood Anne 
Published: August 2004

Objective. Boston Medical Center (BMC) became the 22nd US Baby-Friendly hospital in 1999. Previous research found that breastfeeding initiation rates increased significantly from 58% in 1995 to 86.5% in 1999. The objective of this study was to establish whether Baby-Friendly status would sustain elevated breastfeeding initiation rates at this US hospital beyond the year of designation. Breastfeeding rates in 1999 were compared with rates in 2000 and 2001.
Methods. A total of 200 medical records of full-term, healthy infants who were born at BMC in 2000 and 2001 were reviewed using the same criteria as the study conducted for 1999. Records were selected randomly by a computer-generated list. All infant feedings during the hospital postpartum stay were tallied, and each infant was categorized into 1 of 4 groups: 1) exclusive breast milk, 2) mostly breast milk, 3) mostly formula, and 4) exclusive formula.
Results. Maternal and infant demographics for all 3 years were comparable. The breastfeeding initiation rates, defined as an infant’s receiving any amount of breast milk, remained at high levels: 87% (1999), 82% (2000), and 87% (2001). Infants who received more breast milk than formula also was sustained: 73% (1999), 67% (2000), and 67% (2001). Infants who were breastfed exclusively across the 4 years did not differ significantly: 34% (1999), 26% (2000), and 25% (2001).
Conclusions. Full implementation and continued application of the “Ten Steps to Successful Breastfeeding,” the framework of the Baby-Friendly Hospital Initiative, has an extended positive impact on breastfeeding rates in a US hospital setting.
Accuracy of Analog Telephonic Stethoscopy for Pediatric Telecardiology
Authors: Belmont John M. , Mattioli Leone F. 
Published: August 2004

Objective. Wide-bandwidth electronic stethoscopy is reliable and accurate for pediatric telecardiology. We tested a much less expensive and more convenient system for the same purpose, a narrow-bandwidth telephonic stethoscope (TS).
Methods. Seventy-six consecutive patients (mean age: 10.0; standard deviation: 6.5 years) in a pediatric cardiology outpatient clinic were studied. One pediatric cardiologist examined the patients with his acoustic stethoscope (AS); a second examined them within a few minutes using a remote TS. A nurse placed the TS chest piece as directed by the remote examiner via intercom, but neither video examination nor conversation with the parent/patient were permitted. Examiners independently recorded the stethoscope findings for all heart sounds, all murmurs, and heart disease (present/absent). TS accuracy was indexed using the κ statistic for TS/AS agreement and for TS agreement with auscultatory findings predicted from echocardiographic (echo) studies (N = 49).
Results. TS/AS agreement was satisfactory for presence/absence of heart disease (κ = 0.63) and for organic, functional, vibratory, diastolic aortic, and diastolic pulmonic murmurs (κ range: 0.65–0.75). For other specific murmurs and all heart sounds, TS/AS agreement was either unsatisfactory (κ ≤ 0.60) or indeterminate because prevalence was 0. TS-AS agreement improved when the TS was used by the more-experienced TS examiner and with patients at least 5 years of age. When the older children were examined by the more TS-experienced examiner, the TS-echo comparison yielded κ = 0.90, raw agreement = 0.96, sensitivity = 0.94, and specificity = 1.00.
Conclusions. In pediatric patients, a narrow-bandwidth telephonic stethoscope can accurately distinguish between functional and organic murmurs and thus can detect heart disease. Accuracy is greatest when the instrument is used by an experienced examiner with patients at least 5 years of age.
Pediatric Training and Job Market Trends: Results From the American Academy of Pediatrics Third-Year Resident Survey, 1997–2002
Authors: Cull William L. , Yudkowsky Beth K. , Shipman Scott A. , Pan Richard J. 
Published: August 2004

Objectives. To examine trends in pediatric residents’ training and job search experiences from 1997–2002.
Methods. Annual national random samples of 500 graduating pediatric residents were surveyed, and responses were compared across survey years to identify trends. The overall response rate was 71%.
Results. From 1997–2002, there were more female residents and US underrepresented minorities and fewer international medical graduates. Each successive group of residents rated higher their preparation for fellowship training, for child advocacy, and for assessing community needs. These increases paralleled an increase in resident exposure to community sites as part of their residency education. Educational debt (in 2002 dollars) for residents increased substantially across survey years from an average of $64 070 in 1997 to $87 539 in 2002. Meanwhile, starting salaries (in 2002 dollars) for residents entering general pediatrics actually decreased. Interest in general pediatrics among residents decreased, whereas interest in subspecialty practice increased during this time period. Fewer residents with general pediatrics as a career goal had a job when surveyed, and fewer obtained their first-choice positions across years.
Conclusions. Experiences of graduating residents over the past 6 years provide insights into changes in pediatric residency education and the pediatric workforce. Efforts by pediatric educators and academic leaders to increase community experiences and child advocacy and to encourage greater interest in pediatric subspecialty careers seem to be succeeding. Unfortunately, demand for general pediatricians is weakening, and residents are experiencing increasing debt burdens.
Early Reversal of Pediatric-Neonatal Septic Shock by Community Physicians Is Associated With Improved Outcome
Authors: Han Yong Y. , Carcillo Joseph A. , Dragotta Michelle A. , Bills Debra M. , Watson R. Scott , Westerman Mark E. , Orr Richard A. 
Published: August 2004

Objective. Experimental and clinical studies of septic shock support the concept that early resuscitation with fluid and inotropic therapies improves survival in a time-dependent manner. The new American College of Critical Care Medicine-Pediatric Advanced Life Support (ACCM-PALS) Guidelines for hemodynamic support of newborns and children in septic shock recommend this therapeutic approach. The objective of this study was to determine whether early septic shock reversal and use of resuscitation practice consistent with the new ACCM-PALS Guidelines by community physicians is associated with improved outcome.
Methods. A 9-year (January 1993–December 2001) retrospective cohort study was conducted of 91 infants and children who presented to local community hospitals with septic shock and required transport to Children’s Hospital of Pittsburgh. Shock reversal (defined by return of normal systolic blood pressure and capillary refill time), resuscitation practice concurrence with ACCM-PALS Guidelines, and hospital mortality were measured.
Results. Overall, 26 (29%) patients died. Community physicians successfully achieved shock reversal in 24 (26%) patients at a median time of 75 minutes (when the transport team arrived at the patient’s bedside), which was associated with 96% survival and &gt;9-fold increased odds of survival (9.49 [1.07–83.89]). Each additional hour of persistent shock was associated with &gt;2-fold increased odds of mortality (2.29 [1.19–4.44]). Nonsurvivors, compared with survivors, were treated with more inotropic therapies (dopamine/dobutamine [42% vs 20%] and epinephrine/norepinephrine [42% vs 6%]) but not increased fluid therapy (median volume; 32.9 mL/kg vs 20.0 mL/kg). Resuscitation practice was consistent with ACCM-PALS Guidelines in only 27 (30%) patients; however, when practice was in agreement with guideline recommendations, a lower mortality was observed (8% vs 38%).
Conclusions. Early recognition and aggressive resuscitation of pediatric-neonatal septic shock by community physicians can save lives. Educational programs that promote ACCM-PALS recommended rapid, stepwise escalations in fluid as well as inotropic therapies may have value in improving outcomes in these children.
Is Interleukin-6 −174 Genotype Associated With the Development of Septicemia in Preterm Infants?
Authors: Harding David , Dhamrait Sukhbir , Millar Ann , Humphries Steve , Marlow Neil , Whitelaw Andrew , Montgomery Hugh 
Published: August 2004

Objective. Systemic infection affects one quarter of preterm infants. Defense from infection is in part mediated by the cytokine interleukin-6 (IL-6). We tested the hypothesis that the IL-6 −174 GG genotype, associated with lower IL-6 response to inflammation, is also associated with the development of septicemia in preterm infants.
Methods. The study group comprised 157 infants who were born at ≤32 weeks. Genotype distribution (34% [54] GG, 46% [72] GC, 20% [31] CC) and C allele frequency (0.43; 95% confidence interval [CI]: 0.37–0.48) were similar to the UK adult population. Among the patients who developed bacterially confirmed septicemia (n = 51 [33%]), there was a significantly higher prevalence of the IL-6 −174 GG genotype than that observed in those who did not develop infection (47% vs 28% for GG: odds ratio [OR]: 2.3; 95% CI: 1.1–4.5). This association remained statistically significant (OR: 2.7; 95% CI: 1.2–6.3) after multiple binary logistic regression adjustment for other significant predictors of the development of septicemia. Late infection alone was similarly associated with GG genotype (septicemia 47% vs no septicemia 29% for GG: OR: 2.2; 95% CI: 1.1–4.3).
Conclusions. Variation in the IL-6 gene seems to influence the defense against bacterial pathogens in the very preterm infant.