bluuebunny/crossref_metadata_2025_split huggingface dataset:
Matrix Metalloproteinases-2, -8, and -9 and TIMP-2 in Tracheal Aspirates From Preterm Infants With Respiratory Distress
Authors: Cederqvist Katariina , Sorsa Timo , Tervahartiala Taina , Maisi Päivi , Reunanen Karoliina , Lassus Patrik , Andersson Sture 
Published: August 2004

Objectives.Matrix metalloproteinases (MMPs) are a family endoproteinases that act in degradation of extracellular matrix and basement membranes. The development of bronchopulmonary dysplasia (BPD) is characterized by early pulmonary inflammation, increased microvascular permeability, and subsequently by disordered repair. The aims of our study were to characterize the presence and molecular weight forms of MMP-2, -8, and -9 and their specific inhibitor, tissue inhibitor of metalloproteinases (TIMP)-2, in lungs of preterm infants during the early postnatal period and to determine whether levels of these MMPs and TIMP-2 in tracheal aspirate fluid (TAF) are associated with acute or chronic lung morbidity of the preterm infant.Methods.TAF samples were collected from 16 intubated preterm infants (gestational age 27.0 ± 2.0 weeks; birth weight 875 ± 246 g) during their first 5 postnatal days. The presence and molecular weight forms of MMPs and TIMP-2 were identified by Western immunoblotting, and their levels were evaluated by densitometric scanning.Results.MMP-8 in TAF was higher in infants who needed treatment with surfactant (25.4 ± 6.3 vs 10.6 ± 1.5 arbitrary unit/secretory component of immunoglobulin A [AU/SC]) and in whom BPD developed (N = 6; 27.6 ± 5.2 vs 15.1 ± 5.0 AU/SC). TIMP-2 levels were lower in infants with initial arterial to alveolar oxygen tension ratios &lt;0.22 (2.7 ± 1.1 vs 16.8 ± 7.4 AU/SC) and in infants needing mechanical ventilation for &gt;1 week (5.2 ± 2.1 vs 22.8 ± 11.7 AU/SC).Conclusions.In preterm infants, an imbalance between pulmonary MMP-8 and TIMP-2 participates in the acute inflammatory process in respiratory distress syndrome and may contribute to the development of chronic lung injury.
Objective Sleepiness Measures in Pediatric Obstructive Sleep Apnea
Authors: Gozal David , Wang Mei , Pope Dennis W. 
Published: August 2004

Objectives.
Excessive daytime sleepiness (EDS) occurs frequently in adult patients with obstructive sleep apnea (OSA). However, the incidence of EDS in children with OSA is unknown.

Methods.
To determine overall daytime sleepiness in pediatric OSA, 54 children with OSA, 14 children with primary snoring (PS), and 24 controls (C) underwent an overnight diagnostic polysomnogram followed the next day by a multiple sleep latency test.

Results.
The mean apnea index was 15.1 ± 9.5 standard deviation in OSA, 1.1 ± 0.5 in PS, and 0.1 ± 0.3 in C. Mean sleep latencies were 23.7 ± 3.0 minutes in C, 23.7 ± 3.1 minute in PS, and 20.0 ± 7.1 minute in OSA patients. However, only 7 children with OSA had mean sleep latencies &lt;10 minutes. In addition, shorter sleep latencies were more likely to occur in more obese OSA patients and those with more severe apnea index, and oxyhemoglobin desaturation.

Conclusions.
Shortened sleep latencies occur in children with OSA, but EDS is infrequent and tends to develop among more severe and/or obese patients.
Breath-Holding Spells Associated With Significant Bradycardia: Successful Treatment With Permanent Pacemaker Implantation
Authors: Kelly Amy M. , Porter Co-burn J. , McGoon Michael D. , Espinosa Raul E. , Osborn Michael J. , Hayes David L. 
Published: August 2004

Objective.
To determine whether children with pallid breath-holding spells associated with bradycardia can be treated safely and successfully with permanent pacemaker implantation.

Methods.
The records of pediatric patients who had apparent breath-holding spells and associated bradycardia and were treated with permanent pacemaker implantation were reviewed.

Results.
Ten pediatric patients with apparent breath-holding spells associated with bradycardia were treated with a permanent ventricular demand pacemaker at the Mayo Clinic between 1985 and 1995. Patients had onset of symptoms between ages 6 days and 12 months and presented for evaluation between ages 12 months and 5 years. Duration of spells was 15 seconds to 10 minutes. Medications to prevent spells were unsuccessful. Electrocardiograms documented asystolic pauses of 1.7 to 24 seconds (mean: 11.9 seconds). Permanent ventricular demand pacemakers were implanted at 10 months to 5 years of age (median: 14.5 months): 9 endocardial and 1 epicardial. Three patients required pacemaker revision. At follow-up of 38 to 170 months (median: 65.5), 5 patients had complete resolution of spells, 2 had only mild color change without loss of consciousness or seizure activity, and 3 continued to have minor brief spells.

Conclusions.
Permanent pacemaker therapy for children with pallid breath-holding spells associated with severe bradycardia is safe, efficacious, and warranted.
Randomized Trial of Nutrient-Enriched Formula Versus Standard Formula for Postdischarge Preterm Infants
Authors: Lucas Alan , Fewtrell Mary S. , Morley Ruth , Singhal Atul , Abbott Rebecca A. , Isaacs Elizabeth , Stephenson Terence , MacFadyen Una M. , Clements Helena 
Published: August 2004

Objectives.
Preterm infants are frequently discharged from the hospital growth retarded and show reduced growth throughout childhood. In a large efficacy and safety trial, we tested the hypothesis that nutritional intervention in the first 9 months postterm would reverse postdischarge growth deficits and improve neurodevelopment without adverse safety outcomes.

Participants and intervention.
Two hundred eighty-four infants (mean gestation: 30.9 weeks) were studied; 229 were randomly assigned a protein, energy, mineral, and micronutrient-enriched postdischarge formula (PDF; N = 113) or standard term formula (TF; N = 116) from discharge (mean 36.5 weeks' postmenstrual age). A reference group (N = 65) was breastfed until at least 6 weeks' postterm.

Outcome measures.
Anthropometry was performed at 6 weeks and 3, 6, 9, and 18 months. Development was measured at 9 months (Knobloch, Passamanick, and Sherrard's developmental screening inventory) and 18 months (Bayley Scales of Infant Development II; primary outcome) postterm.

Results.
At 9 months, compared with the TF group, those fed PDF were heavier (difference 370 g; 95% confidence interval [CI]: 84–660) and longer (difference 1.1 cm; 95% CI: 0.3–1.9); the difference in length persisted at 18 months (difference 0.82 cm; 95% CI: −0.04–1.7). There was no effect on head circumference. The effect of diet was greatest in males; at 9 months length deficit with TF was 1.5cm (95% CI: 0.3–2.7), and this remained at 18 months (1.5cm [95% CI: 0.3–2.7]). There was no significant difference in developmental scores at 9 or 18 months, although PDF infants had a 2.8 (−1.3–6.8) point advantage in Bayley motor score scales. At 6 weeks' postterm, exclusively breastfed infants were already 513 g (95% CI: 310–715) lighter and 1.6cm (95% CI: 0.8–2.3) shorter than the PDF group, and they remained smaller up to 9 months' postterm.

Conclusions.
1) Improving postdischarge nutrition in the first 9 months may “reset” subsequent growth—at least until 18 months for body length. We intend to follow-up the children at older ages. The observed efficacy of PDF was not associated with adverse safety outcomes. 2) We cannot reject the hypothesis that postdischarge nutrition benefits motor development and this requires additional study. 3) Our data raise the possibility that breastfed postdischarge preterm infants may require nutritional supplementation, currently under investigation.
Relationship of Childhood Obesity to Coronary Heart Disease Risk Factors in Adulthood: The Bogalusa Heart Study
Authors: Freedman David S. , Khan Laura Kettel , Dietz William H , Srinivasan Sathanur R. , Berenson Gerald S. 
Published: August 2004

Background.Childhood obesity is related to adult levels of lipids, lipoproteins, blood pressure, and insulin and to morbidity from coronary heart disease (CHD). However, the importance of the age at which obesity develops in these associations remains uncertain.Objective and Design.We assessed the longitudinal relationship of childhood body mass index (BMI, kg/m2) to adult levels of lipids, insulin, and blood pressure among 2617 participants. All participants were initially examined at ages 2 to 17 years and were reexamined at ages 18 to 37 years; the mean follow-up was 17 years.Results.Of the overweight children (BMI ≥95th percentile), 77% remained obese (≥30 kg/m2) as adults. Childhood overweight was related to adverse risk factor levels among adults, but associations were weak (r ∼ 0.1–0.3) and were attributable to the strong persistence of weight status between childhood and adulthood. Although obese adults had adverse levels of lipids, insulin, and blood pressure, levels of these risk factors did not vary with childhood weight status or with the age (≤8 years, 12–17 years, or ≥18 years) of obesity onset.Conclusions.Additional data are needed to assess the independent relationship of childhood weight status to CHD morbidity. Because normal-weight children who become obese adults have adverse risk factor levels and probably will be at increased risk for adult morbidity, our results emphasize the need for both primary and secondary prevention.
Increased Risk for Developmental Disabilities in Children Who Have Major Birth Defects: A Population-Based Study
Authors: Decouflé Pierre , Boyle Coleen A. , Paulozzi Leonard J. , Lary Joseph M. 
Published: August 2004

Objective.We sought to quantify the strength of associations between each of four specific developmental disabilities (DDs) and specific types of major birth defects.Methods.We linked data from 2 independent surveillance systems, the Metropolitan Atlanta Congenital Defects Program and the Metropolitan Atlanta Developmental Disabilities Surveillance Program. Children with major birth defects (n = 9142; born 1981–1991 in metro Atlanta) and 3- to 10-year-old children who were born between 1981 and 1991 in metro Atlanta and identified between 1991 and 1994 as having mental retardation, cerebral palsy, hearing impairment, or vision impairment (n = 3685) were studied. Prevalence ratio (PR), which is the prevalence of a DD in children with 1 or more major birth defects divided by the prevalence of the same DD in children without major birth defects, was measured.Results.Among the 9142 children who were born with a major birth defect, 657 (7.2%) had a serious DD compared with 0.9% in children with no major birth defect, yielding a PR of 8.3 (95% confidence interval: 7.6–9.0). In general, the more severe the DD, the higher was the PR. Birth defects that originated in the nervous system and chromosomal defects resulted in the highest PRs for a subsequent DD. For all other categories of birth defects, PRs were lowest when all major birth defects present were confined to a single category (ie, isolated defects). PRs for any DD increased monotonically with the number of coded birth defects per child or the number of different birth defect categories per child, regardless of the severity of the defect or whether defects of the nervous system, chromosomal defects, or “other syndromes” were counted.Conclusions.These data highlight the possible early prenatal origins of some DDs and suggest that both the number of coded birth defects present and the number of anatomic systems involved are strongly related to functional outcomes.
Improving Management of Diabetic Ketoacidosis in Children
Authors: Felner Eric I. , White Perrin C. 
Published: August 2004

Objective.
The optimal fluid management for diabetic ketoacidosis (DKA) is uncertain. In an effort to simplify DKA therapy, we revised the treatment protocol in our institution to use a simpler method of calculating fluid needs, use fluids with higher sodium concentration, and allow glucose concentration to be adjusted easily. We performed a retrospective study to determine the effects of these revisions.

Design.
We compared patients treated with traditional and revised protocols (∼220 and ∼300 patients, respectively, over consecutive 2.75-year intervals). Sixty patient records were randomly selected from the first group (30 treated with each of 2 protocol versions) and 30 from the second group. Biochemical and clinical parameters were analyzed.

Results.
Patients selected for detailed analysis were similar in demographics and initial laboratory measurements. Patients treated under the revised fluid protocol received less total fluid, needed fewer intravenous fluid changes, were treated at less cost, and resolved acidosis more rapidly than patients treated under the original protocols. The rate of cerebral edema (0.3%–0.5%) was unchanged.

Conclusion.
A DKA protocol that necessitates less fluid delivery and fewer calculations simplifies therapy and is associated with more rapid correction of acidosis.
Improving Preventive Service Delivery Through Office Systems
Authors: Bordley W. Clayton , Margolis Peter A. , Stuart Jayne , Lannon Carole , Keyes Lynette 
Published: August 2004

Objective.Rates of childhood immunizations and other preventive services are lower in many practices than national goals and providers' own estimates. Office systems have been used in adult settings to improve the delivery of preventive care, but their effectiveness in pediatric practices is unknown. This study was designed to determine whether a group of primary care practices in 1 community could implement office-based quality improvement systems that would significantly improve their delivery of childhood preventive services. The study was part of a larger community-wide intervention study reported in a preceding study.Methods.All the major providers of primary care to children in 1 community were recruited and agreed to participate (N = 8 practices). Project staff worked onsite with improvement teams in each practice to develop tailored systems to assess and improve the delivery of immunizations and screening for anemia, tuberculosis, and lead exposure. Office-based quality improvement systems typically involved some combination of chart prescreening, risk assessment forms, Post-it prompts, flowsheets, reminder/recall systems, and patient education materials. Office systems also often involved redistributing responsibilities among office staff.Results.All 8 participating practices created improvement teams. Project staff met with the practices 10 to 15 times over 12 months. After the period of office assistance, the overall rates for all preventive services except tuberculosis screening increased by amounts that were both clinically and statistically significant. Absolute percent improvements included: complete immunizations at 12 months, 7%; complete immunizations at 24 months, 12%; anemia screening, 30%; lead screening, 36%. The amount of improvement achieved varied considerably between practices.Conclusions.Office systems and the principles of quality improvement that underlie them seem to be effective in improving the delivery of childhood preventive services. Important predisposing factors may exist within practices that affect the likelihood that an individual practice will make significant improvements. prevention, immunizations, improvement, office systems, primary care.
The Practice of Pediatric Sleep Medicine: Results of a Community Survey
Authors: Owens Judith A. 
Published: August 2004

Objective.To assess knowledge, screening, evaluation, treatment practices, and attitudes regarding sleep disorders in children and adolescents in a large sample of community-based and academic pediatricians.Design.Cross-sectional survey.Participants.Six hundred twenty-six pediatricians in Rhode Island, Massachusetts, and Connecticut.Instrument.The Pediatric Sleep Survey, a 42-item questionnaire assessing general and specific sleep knowledge categories; clinical screening, diagnostic, and treatment practices for common pediatric sleep disorders; and practitioner attitudes regarding the impact of sleep disorders in the clinical setting and as a public health issue.Results.On the knowledge section, the mean Total Knowledge score for the respondents was 18.1 ± 3.5 out of 30 items, with 23.5% of the sample responding correctly on half or less of the items. Pediatricians scored highest on items relating to developmental and behavioral aspects of sleep and parasomnias, whereas the mean percentage of correct responses was &lt;50% for items relating to sleep disordered breathing, excessive daytime sleepiness, and sleep movement disorders. Although only 16.5% and 18.2% of the sample reported not screening routinely for sleep disorders in infants and toddlers, this percentage rose to 43.9% in adolescents. Furthermore, only 38.3% regularly question the adolescents themselves about their sleep. Only about one quarter of the respondents screen toddlers and school-aged children for snoring. In evaluating and treating pediatric sleep problems, 53.2% of the sample never or rarely order overnight sleep studies to assess for obstructive sleep apnea and few use alternative treatment strategies, such as continuous positive airway pressure. A quarter of the sample at least occasionally recommends diphenhydramine and almost half suggests a psychological evaluation for children with night terrors. Finally, the percent of pediatricians rating the impact on children of sleep problems in a variety of domains as important or very important ranged from 49.7% (nonintentional injuries) to 92.6% (academic performance). However, only 46% of the sample felt confident or very confident about their own ability to screen for sleep problems, whereas 34.2% and 25.3% similarly rated their ability to evaluate and treat sleep problems in children.Conclusions.The results of this survey suggest that there are still significant gaps among practicing pediatricians both in basic knowledge about pediatric sleep disorders, and in the translation of that knowledge into clinical practice. Despite their acknowledgment of the importance of sleep problems, many pediatricians fail to screen adequately for them, especially in older children and adolescents. Additional educational efforts regarding pediatric sleep issues are warranted, and should be targeted at the medical school, postgraduate training, and continuing medical education levels.
Acetaminophen Toxicity in Children
Authors:   Committee on Drugs
Published: August 2004

This Policy Statement was retired June 2013.
Acetaminophen is widely used in children, because its safety and efficacy are well established. Although the risk of developing toxic reactions to acetaminophen appears to be lower in children than in adults, such reactions occur in pediatric patients from intentional overdoses. Less frequently, acetaminophen toxicity is attributable to unintended inappropriate dosing or the failure to recognize children at increased risk in whom standard acetaminophen doses have been administered. Because the symptoms of acetaminophen intoxication are nonspecific, the diagnosis and treatment of acetaminophen intoxication are more likely to be delayed in unintentional cases of toxicity. This statement describes situations and conditions that may contribute to acetaminophen toxicity not associated with suicidal intentions.
Relation Between Infantile Colic and Asthma/Atopy: A Prospective Study in an Unselected Population
Authors: Castro-Rodrı́guez José A. , Stern Debra A. , Halonen Marilyn , Wright Anne L. , Holberg Catharine J. , Taussig Lynn M. , Martinez Fernando D. 
Published: August 2004

Objective.
To assess whether children with history of infantile colic may be at increased risk of subsequently developing asthma and/or atopy.

Methods.
We used data collected in a large, prospective study from an unselected population. Infantile colic and concurrent feeding method were determined from the 2-month well-infant visit form completed by the physician for 983 children who were enrolled at birth. Markers of atopy (total serum immunoglobulin E and allergy skin prick test), allergic rhinitis, asthma, wheezing, and peak flow variability were the main outcome measures studied at different ages between infancy and 11 years.

Results.
Ninety (9.2%) children had infantile colic. Prevalence of colic was similar among children fed either breast milk or formula. There was no association between infantile colic and markers of atopy, asthma, allergic rhinitis, wheezing, or peak flow variability at any age.

Conclusion.
Our data cannot support the hypothesis that infantile colic provides increased risk for subsequent allergic disease or atopy.
Who Cares for Medicaid-Enrolled Children With Chronic Conditions?
Authors: Kuhlthau Karen , Ferris Timothy G. G. , Beal Anne C. , Gortmaker Steven L. , Perrin James M. 
Published: August 2004

Objective.
To estimate generalist, pediatric subspecialist, and any subspecialist use by Medicaid-enrolled children with chronic conditions and to determine the correlates of use.

Methods.
We analyzed Medicaid claims data collected from 1989 to 1992 from 4 states for 57 328 children and adolescents with 11 chronic conditions. We calculated annual rates of generalist, subspecialist, and pediatric subspecialist use. We used logistic regression to determine the association of demographics, urban residence, and case-mix (Adjusted Clinical Groups) with the use of relevant pediatric and any subspecialist care.

Results.
Most children with chronic conditions had visits to generalists (range per condition: 78%–90% for children with Supplemental Security Income [SSI] and 85%–94% for children without SSI) during the year studied. Fewer children visited any relevant subspecialists (24%–59% for children with SSI and 13%–56% for children without SSI) or relevant pediatric subspecialists (10%–53% for children with SSI and 3%–37% for children without SSI). In general, children who were more likely to use pediatric subspecialists were younger, lived in urban areas, were white (only significant for non-SSI children), and had higher Adjusted Clinical Groups scores. Use of any subspecialists followed a similar pattern except that urban residence is statistically significant only for children with SSI and the youngest age group does not differ from the oldest age group for children without SSI.

Conclusions.
Children who had chronic conditions and were enrolled in Medicaid received a majority of their care from generalist physicians. For most conditions, a majority of children did not receive any relevant subspecialty care during the year and many of these children did not receive care form providers with pediatric-specific training.