bluuebunny/crossref_metadata_2025_split huggingface dataset:
Features of Invasive Staphylococcal Disease in Neonates
Authors: Healy C. Mary , Palazzi Debra L. , Edwards Morven S. , Campbell Judith R. , Baker Carol J. 
Published: October 2004

Objective. Most clinical descriptions of invasive staphylococcal disease (ISD) in neonates date from before the mid-1980s, when neonatal viability and intensive care differed substantially from current standards. We aimed to describe the contemporary incidence, clinical features, and outcome of infants with ISD in a neonatal intensive care unit.Methods. A retrospective cohort study was conducted of infants who had ISD and were in the neonatal intensive care unit of the Woman's Hospital of Texas, Houston, from January 2000 to June 2002. Confirmed ISD was defined as clinical sepsis and Staphylococcus aureus (SA) isolated from ≥1 blood culture (BC) or a sterile body site excluding urine or coagulase-negative staphylococci (CoNS) isolated from ≥2 BC or from 1 BC and a sterile body site. Probable ISD was defined as CoNS isolated from 1 BC or a sterile body site for which clinical and laboratory data review by 3 infectious disease specialists indicated that antimicrobial treatment was appropriate. Confirmed and combined confirmed plus probable cases were analyzed.Results. A total of 149 episodes (83 confirmed [39 SA, 44 CoNS], 66 probable) in 137 infants (mean gestational age [GA]: 27.6 weeks [22.4–36.4]; mean birth weight: 981 g [350–2995]) were reviewed. Four (3%) infants had early-onset infection (2 SA, 2 CoNS). Median age at infection onset was similar (17 days SA; 18 days CoNS). Intravascular catheters (IVC) were in situ in a minority of infants with ISD episodes (38% SA, 43% CoNS). CoNS more than SA infections were associated with very low birth weight (&lt;1500 g), lower GA, a history of more IVCs and concurrent total parenteral nutrition, but IVC and parenteral nutrition days were similar. By multivariate analysis correcting for birth weight and complications of prematurity, hypoxia at the time of sepsis evaluation was significantly associated with CoNS and hypotension with SA infections; other clinical features were similar. Methicillin-resistant SA caused 8% of SA infections. Among bacteremic infants, SA more frequently than CoNS involved ≥2 sites. Overall, SA had more focal complications (primarily bone and joint) than CoNS, resulting in a 2- to 3-fold higher SA-associated morbidity rate. Mortality directly attributable to either organism was similar (5% SA; 5% confirmed, 3% confirmed/probable CoNS).Conclusion. CoNS ISD occurred in smaller, more premature infants than SA and was IVC associated in a minority of cases. Hypoxia and hypotension were the only presenting features that differentiated CoNS and SA. SA-associated morbidity was substantial, but SA infection carried no greater risk of death (5%) than CoNS.
Respiratory Syncytial Virus Hospitalizations Among American Indian and Alaska Native Infants and the General United States Infant Population
Authors: Holman Robert C. , Curns Aaron T. , Cheek James E. , Bresee Joseph S. , Singleton Rosalyn J. , Carver Karen , Anderson Larry J. 
Published: October 2004

Objective. To determine the burden of respiratory syncytial virus (RSV) disease among American Indian (AI) and Alaska Native (AN) infants, by examining RSV-associated hospitalizations.Methods. Infant hospitalizations from 1997 through 2001 with RSV listed as a diagnosis were selected by using Indian Health Service/tribal hospital discharge data for AIs/ANs and National Hospital Discharge Survey data for the general US population.Results. In 2000–2001, RSV disease was listed as a diagnosis for 14.4% of all AI/AN infant hospitalizations, with bronchiolitis attributable to RSV infection (12.2%) being among the top 5 listed diagnoses. The rate of RSV-specific hospitalizations was 34.4 hospitalizations per 1000 infants for AI/AN infants and 27.4 hospitalizations per 1000 births for the general US infant population. The hospitalization rates for AI/AN infants living in the Alaska and Southwest regions (70.9 and 48.2 hospitalizations per 1000 infants, respectively) were much higher than the overall rate for US infants.Conclusions. RSV infection is one of the leading causes of hospitalization among all infants in the United States, and AI/AN infants living in the Southwest and Alaska regions are at especially high risk for hospitalizations associated with RSV infection. Development of vaccines, antiviral agents, and other strategies to prevent RSV disease could yield substantial public health benefits.
Diffusion-Weighted Magnetic Resonance Imaging in Term Perinatal Brain Injury: A Comparison With Site of Lesion and Time From Birth
Authors: Rutherford Mary , Counsell Serena , Allsop Joanna , Boardman James , Kapellou Olga , Larkman David , Hajnal Jo , Edwards David , Cowan Frances 
Published: October 2004

Objective. The aim of this study was to establish a more objective method for confirming tissue injury in term neonates who present with early seizures that are believed to be hypoxic-ischemic in origin.
Methods. We studied the relationship between contemporaneous diffusion-weighted magnetic resonance imaging and conventional magnetic resonance imaging in 63 symptomatic term-born neonates and 15 control term infants performed in the neonatal period. Apparent diffusion coefficients (ADC) were obtained for multiple regions of the brain.
Results. ADC values in the 15 control infants were 1 (1–1.15) (median [range]) × 10−3/mm2/second in the thalami and 1.1 (1–1.3) × 10−3/mm2/second in the lentiform nuclei, 1.5 (1.3–1.7) × 10−3/mm2/second in the centrum semiovale, 1.6 (1.46–1.7) × 10−3/mm2/second in the anterior white matter (WM), and 1.55 (1.35–1.85) × 10−3/mm2/second in the posterior WM with little variation over time. ADC values were significantly reduced in the first week after severe injury to either WM or basal ganglia and thalami (BGT), but values normalized at the end of the first week and then increased during week 2. ADC values were either normal or increased in moderate BGT and WM lesions when compared with controls. ADC values &lt; 1.1 × 10−3/mm2/second were always associated with WM infarction and values &lt;0.8 × 10−3/mm2/second with thalamic infarction.
Conclusion. A reduced ADC soon after delivery allows the presence of tissue infarction to be confirmed at a time when conventional imaging changes may be subtle. However, as both moderate WM and BGT lesions may have normal or increased ADC values, a normal ADC value during the first week does not signify normal tissue. ADC values should always be measured in combination with visual analysis of both conventional and diffusion-weighed images for maximum detection of pathologic tissue, and the timing of the scan needs to be taken into account when interpreting the results.
Summary of the Presentations at the Conference on Preventing Childhood Obesity, December 8, 2003
Authors: Lederman Sally Ann , Akabas Sharon R. , Moore Barbara J. , Bentley Margaret E. , Devaney Barbara , Gillman Matthew W. , Kramer Michael S. , Mennella Julie A. , Ness Andrew , Wardle Jane 
Published: October 2004

Objective. Because of the rising rates of childhood obesity, we set out to determine what is known about its causes and what could be done to prevent additional increases.Methodology. A meeting was convened of experts in areas that bear on prevention of obesity development during intrauterine life, infancy, and very early childhood. They presented recent data and their interpretations of the stage of our current knowledge in related areas. They also proposed possible useful interventions and future directions for research.Findings. The speakers’ talks indicated that (1) breastfeeding as currently practiced seems to be significantly (albeit weakly) protective against obesity and should be encouraged as the preferred method of feeding infants for as long a duration as practical during the first year of life; (2) infant-feeding practices are changing in a way that may predispose to obesity (eg, soda and french fries are being fed to infants as young as 7 months of age), possibly altering taste preferences for foods and beverages that are energy dense and nutrient poor; (3) although little is known about parenting styles (eg, authoritative versus permissive), parenting style is likely to be a fruitful area of current research into childhood obesity etiology; and (4) the pattern of weight changes in the first few years of life may contribute to later risk of obesity.Conclusions. Children’s obesity will continue to be a growing problem unless we improve understanding of the key factors likely to be operative during intrauterine life, infancy, and very early childhood, identify those in whom intervention would have the greatest effect, design and evaluate preventive interventions, and promote those that are successful.
Newborn Screening for Lysosomal Storage Disorders: Clinical Evaluation of a Two-Tier Strategy
Authors: Meikle Peter J. , Ranieri Enzo , Simonsen Henrik , Rozaklis Tina , Ramsay Steve L. , Whitfield Phillip D. , Fuller Maria , Christensen Ernst , Skovby Flemming , Hopwood John J. 
Published: October 2004

Objective. To evaluate the use of protein markers using immune-quantification assays and of metabolite markers using tandem mass spectrometry for the identification, at birth, of individuals who have a lysosomal storage disorder.
Methods. A retrospective analysis was conducted of Guthrie cards that were collected from newborns in Denmark during the period 1982–1997. Patients whose lysosomal storage disorder (LSD; 47 representing 12 disorders) was diagnosed in Denmark during the period 1982–1997 were selected, and their Guthrie cards were retrieved from storage. Control cards (227) were retrieved from the same period. Additional control cards (273) were collected from the South Australian Screening Centre (Australia).
Results. From 2 protein and 94 metabolite markers, 15 were selected and evaluated for their use in the identification of LSDs. Glycosphingolipid and oligosaccharide markers showed 100% sensitivity and specificity for the identification of Fabry disease, α-mannosidosis, mucopolysaccharidosis (MPS) IVA, MPS IIIA, Tay-Sachs disease, and I-cell disease. Lower sensitivities were observed for Gaucher disease and sialidosis. No useful markers were identified for Krabbe disease, MPS II, Pompe disease, and Sandhoff disease. The protein markers LAMP-1 and saposin C were not able to differentiate individuals who had an LSD from the control population.
Conclusions. Newborn screening for selected LSDs is possible with current technology. However, additional development is required to provide a broad coverage of disorders in a single, viable program.
Effects of a Primary Care-Based Intervention on Violent Behavior and Injury in Children
Authors: Borowsky Iris Wagman , Mozayeny Sara , Stuenkel Kristen , Ireland Marjorie 
Published: October 2004

Objective. Although many major health care organizations have made recommendations regarding physicians' roles in preventing youth violence, the efficacy of violence prevention strategies in primary care settings remains to be empirically tested.Methods. We conducted a randomized, controlled trial to evaluate the effects of an office-based intervention on children's violent behaviors and violence-related injuries. Children 7 to 15 years of age who presented at 8 pediatric practices and scored positive on a brief psychosocial screening test (n = 224) were randomly assigned to an intervention group (clinicians saw the screening test results during the visit and a telephone-based parenting education program was made available to clinicians as a referral resource for parents) or a control group (clinicians did not see the screening test results).Results. Compared with control subjects, at 9 months after study enrollment, children in the intervention group exhibited decreases in aggressive behavior (adjusted mean difference: −1.71; 95% confidence interval [CI]: −2.89 to −0.53), delinquent behavior (adjusted mean difference: −0.71; 95% CI: −1.28 to −0.13), and attention problems (adjusted mean difference: −1.02; 95% CI, −1.77 to −0.26) on the Child Behavior Checklist. Children in the intervention group had lower rates of parent-reported bullying (adjusted odds ratio: 4.43; 95% CI: 1.87-10.52), physical fighting (adjusted odds ratio: 1.79; 95% CI: 1.11-2.87), and fight-related injuries requiring medical care (adjusted odds ratio: 4.70; 95% CI: 1.33-16.59) and of child-reported victimization by bullying (adjusted odds ratio: 3.23; 95% CI: 1.96-5.31).Conclusions. A primary care-based intervention that includes psychosocial screening and the availability of a parenting education resource can decrease violent behavior and injury among youths.
Clinical Spectrum, Morbidity, and Mortality in 113 Pediatric Patients With Mitochondrial Disease
Authors: Scaglia Fernando , Towbin Jeffrey A. , Craigen William J. , Belmont John W. , Smith E. O’Brian , Neish Stephen R. , Ware Stephanie M. , Hunter Jill V. , Fernbach Susan D. , Vladutiu Georgirene D. , Wong Lee-Jun C. , Vogel Hannes 
Published: October 2004

Objectives. The aim of this study was to elucidate the frequency of major clinical manifestations in children with mitochondrial disease and establish their clinical course, prognosis, and rates of survival depending on their clinical features.
Methods. We performed a retrospective review of the medical records of 400 patients who were referred for evaluation of mitochondrial disease. By use of the modified Walker criteria, only patients who were assigned a definite diagnosis were included in the study.
Results. A total of 113 pediatric patients with mitochondrial disease were identified. A total of 102 (90%) patients underwent a muscle biopsy as part of the diagnostic workup. A significant respiratory chain (RC) defect, according to the diagnostic criteria, was found in 71% of the patients who were evaluated. In this cohort, complex I deficiency (32%) and combined complex I, III, and IV deficiencies (26%) were the most common causes of RC defects, followed by complex IV (19%), complex III (16%), and complex II deficiencies (7%). Pathogenic mitochondrial DNA abnormalities were found in 11.5% of the patients. A substantial fraction (40%) of patients with mitochondrial disorders exhibited cardiac disease, diagnosed by Doppler echocardiography; however, the majority (60%) of patients had predominant neuromuscular manifestations. No correlation between the type of RC defect and the clinical presentation was observed. Overall, the mean age at presentation was 40 months. However, the mean age at presentation was 33 months in the cardiac group and 44 months in the noncardiac group. Twenty-six (58%) patients in the cardiac group exhibited hypertrophic cardiomyopathy, 29% had dilated cardiomyopathy, and the remainder (13%) had left ventricular noncompaction. Patients with cardiomyopathy had an 18% survival rate at 16 years of age. Patients with neuromuscular features but no cardiomyopathy had a 95% survival at the same age.
Conclusions. This study gives strong support to the view that in patients with RC defects, cardiomyopathy is more common than previously thought and tends to follow a different and more severe clinical course. Although with a greater frequency than previously reported, mitochondrial DNA mutations were found in a minority of patients, emphasizing that most mitochondrial disorders of childhood follow a Mendelian pattern of inheritance.
Cost-Effectiveness of Strategies That Are Intended to Prevent Kernicterus in Newborn Infants
Authors: Suresh Gautham K. , Clark Robin E. 
Published: October 2004

Objective. There is concern about an increasing incidence of kernicterus in healthy term neonates in the United States. Although the incidence of kernicterus is unknown, several potential strategies that are intended to prevent kernicterus have been proposed by experts. It is necessary to assess the costs, benefits, and risks of such strategies before widespread policy changes are made. The objective of this study was to determine the direct costs to prevent a case of kernicterus with the following 3 strategies: (1) universal follow-up in the office or at home within 1 to 2 days of early newborn discharge, (2) routine predischarge serum bilirubin with selective follow-up and laboratory testing, and (3) routine predischarge transcutaneous bilirubin with selective follow-up and laboratory testing.Methods. We performed an incremental cost-effectiveness analysis of the 3 strategies compared with current practice. We used a decision analytic model and a spreadsheet to estimate the direct costs and outcomes, including the savings resulting from prevented kernicterus, for an annual cohort of 2 800 000 healthy term newborns who are eligible for early discharge. We used a modified societal perspective and 2002 US dollars. With each strategy, the test and treatment thresholds for hyperbilirubinemia are lowered compared with current practice.Results. With the base-case assumptions (current incidence of kernicterus 1:100 000 and a relative risk reduction [RRR] of 0.7 with each strategy), the cost to prevent 1 case of kernicterus was $10 321 463, $5 743 905, and $9 191 352 respectively for strategies 1, 2, and 3 listed above. The total annual incremental costs for the cohort were, respectively, $202 300 671, $112 580 535, and $180 150 494. Sensitivity analyses showed that the cost per case is highly dependent on the population incidence of kernicterus and the RRR with each strategy, both of which are currently unknown. In our model, annual cost savings of $46 179 465 for the cohort would result with strategy 2, if the incidence of kernicterus is high (1:10 000 births or higher) and the RRR is high (≥0.7). If the incidence is lower or the RRR is lower, then the cost per case prevented ranged from $4 145 676 to as high as $77 650 240.Conclusions. Widespread implementation of these strategies is likely to increase health care costs significantly with uncertain benefits. It is premature to implement routine predischarge serum or transcutaneous bilirubin screening on a large scale. However, universal follow-up may have benefits beyond kernicterus prevention, which we did not include in our model. Research is required to determine the epidemiology, risk factors, and causes of kernicterus; to evaluate the effectiveness of strategies intended to prevent kernicterus; and to determine the cost per quality-adjusted life year with any proposed preventive strategy.
Counseling Parents and Children on Sun Protection: A National Survey of Pediatricians
Authors: Balk Sophie J. , O’Connor Karen G. , Saraiya Mona 
Published: October 2004

Objective. To describe pediatricians’ attitudes toward skin cancer (SC), sun protection (SP) counseling, and the quantity and content of such counseling and to identify barriers to counseling.Methods. An American Academy of Pediatrics Periodic Survey was mailed to 1616 randomly selected US members between October 2001 and February 2002. The response rate was 54.6%.Results. More than 90% of pediatricians agreed that SC is a significant public health problem and that preventing episodic high exposures to the sun during childhood will reduce the risk of adult melanoma. However, only 22.3% of respondents reported counseling most patients in all age groups. Female pediatricians were more likely to counsel most patients; pediatricians located in the South and West and those who practice in hospital/clinic settings were least likely to counsel compared with those in other regions. Approximately half (53%) of pediatricians reported selectively counseling on the basis of patient characteristics The most important SP recommendation named was using a sunscreen with a sun protection factor ≥15. Only 38% of pediatricians rated SP as very important to their patients’ health compared with other topics such as use of car seats (86%), nutrition (79%), immunization issues (76%), and smoking/avoidance of environmental tobacco smoke (74%). The most frequently named barrier to SP counseling was lack of time (58% reporting).Conclusions. Although the majority of pediatricians believe that SC prevention is a worthy issue, only a minority reported providing routine SP counseling to most patients in every age group, and most ranked SP lower in importance than other issues. Interventions might include programs and materials to educate patients and pediatricians alike. To have an effect on increasing rates of SC and SC mortality, a broader public health approach is needed as a complement to pediatricians’ counseling efforts.
The Pediatrician’s Role in the Prevention of Missing Children
Authors: Howard Barbara J. , Broughton Daniel D. ,   Committee on Psychosocial Aspects of Child and Family Health
Published: October 2004

This Clinical Report was retired December 2020.
In 2002, the Second National Incidence Studies of Missing, Abducted, Runaway, and Thrownaway Children report was released by the US Department of Justice, providing new data on a problem that our nation continues to face. This clinical report describes the categories of missing children, the prevalence of each, and prevention strategies that primary care pediatricians can share with parents to increase awareness and education about the safety of their children.
Guidelines and Levels of Care for Pediatric Intensive Care Units
Authors: Rosenberg David I. , Moss M. Michele ,   Section on Critical Care,   Committee on Hospital Care
Published: October 2004

This Policy Statement was retired January 2013.
The practice of pediatric critical care medicine has matured dramatically during the past decade. These guidelines are presented to update the existing guidelines published in 1993. Pediatric critical care services are provided in level I and level II units. Within these guidelines, the scope of pediatric critical care services is discussed, including organizational and administrative structure, hospital facilities and services, personnel, drugs and equipment, quality monitoring, and training and continuing education.
Fluoroethers and Fluoroamines
Authors: Costello Michael G. , Flynn Richard M. , Owens John G. 
Published: October 2004

Abstract

Perfluoroaliphatic ethers and tertiary amines are members of a class of unreactive compounds known in the industry as inert fluids. These compounds are prepared by electrochemical fluorination, direct fluorination using elemental fluorine or cobalt trifluoride fluorination. They are nontoxic, nonflammable, have densities of 1.7–1.9 g/cm
3
, surface tensions of 9–19 dyn/cm and lower kinematic viscosities than hydrocarbons. Their thermal stabilities are comparable to the perfluoroalkanes. Their chemical properties are characterized by their extreme unreactivity. The lower molecular weight compounds are used in the electronics industry as heat‐transfer fluids and electronic testing fluids. The higher molecular weight polymers are used as hazardous duty vacuum pump oils, specialty greases, and lubricants.

Hydrofluoroethers and hydrofluoropolyethers are new classes of highly fluorinated ethers having properties intermediate between the perfluoroethers and hydrocarbon ethers. They are low in toxicity, nonflammable, with densities of 1.4–1.7 g/cm
3
, surface tensions of 13–16 dyn/cm and low kinematic viscosity. The hydrofluoropolyethers are used as heat‐transfer fluids. The hydrofluoroethers are used as heat‐transfer fluids as well as precision cleaning solvents and solvents for specialty applications such as coating deposition.