bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Randomized, Placebo-Controlled Trial of Granulocyte Colony-stimulating Factor Administration to Newborn Infants With Neutropenia and Clinical Signs of Early-onset Sepsis
Authors: Schibler Kurt R. , Osborne Karen A. , Leung Ling Y. , Le Trong V. , Baker Shawna I. , Thompson Dixie D. 
Published: August 2004

Objective. To determine whether recombinant human granulocyte colony-stimulating factor (G-CSF) administration: 1) accelerates production of neutrophils; 2) increases bone marrow stored and precursor neutrophils; and 3) is safe in newborn infants with neutropenia and clinical signs of early-onset sepsis.
Study Design. We randomized 20 infants with neutropenia and clinical signs of early-onset sepsis in the first 3 days of life to receive G-CSF (10 μg/kg/d) or placebo for 3 days. Entry criteria included neutropenia as defined by Manroe criteria, an elevated immature to total neutrophil ratio [(I/T) ≥0.25], and a requirement for ventilatory support. Cultures were obtained and antibiotics initiated on all study infants. Circulating absolute neutrophil count (ANC), I/T ratio, bone marrow neutrophil storage pool (NSP) and neutrophil proliferative pool (NPP), and plasma G-CSF concentrations were evaluated. Also, severity of illness as determined using the Score for Neonatal Acute Physiology (SNAP), morbidity, and mortality were recorded.
Results. Circulating ANC increased in both G-CSF and placebo recipients by day 1. Also, the I/T neutrophil ratio decreased in both G-CSF and placebo recipients. There were no significant differences in the ANC or I/T ratio between the two groups during the study period. Similarly, bone marrow NSP and NPP did not differ between G-CSF and placebo recipients at study entry or day 2. No differences were observed in the secondary outcome measures including severity of illness, morbidity, and mortality.
Conclusions. Administration of recombinant G-CSF to infants with neutropenia and clinical signs of early-onset sepsis did not increase circulating ANC, or bone marrow NSP and NPP compared with placebo. No differences were observed between G-CSF and placebo recipients in severity of illness, morbidity, or mortality. No adverse effects of G-CSF administrations were noted.
A Comparison of Supination/Flexion to Hyperpronation in the Reduction of Radial Head Subluxations
Authors: Macias Charles G. , Bothner Joan , Wiebe Robert 
Published: August 2004

Objective. To compare supination at the wrist followed by flexion at the elbow (the traditional reduction technique) to hyperpronation at the wrist in the reduction of radial head subluxations (nursemaid's elbow).
Materials and Methods. This prospective, randomized study involved a consecutive sampling of children younger than 6 years of age who presented to one of two urban pediatric emergency departments and two suburban pediatric ambulatory care centers with a clinical diagnosis of radial head subluxation. Patients were randomized to undergo reduction by one of the two methods and were followed every 5 minutes for return of elbow function. The initial procedure was repeated if baseline functioning did not return 15 minutes after the initial reduction attempt. Failure of that technique 30 minutes after the initial reduction attempt resulted in a cross-over to the alternate method of reduction. The alternate procedure was repeated if baseline functioning did not return 15 minutes after the alternate procedure was attempted. If the patient failed both techniques, radio-graphy of the elbow was performed.
Results. A total of 90 patients were enrolled in the study. Five patients were removed from further analysis secondary to a final diagnosis of fracture, 84 were reduced successfully, and 1 failed both techniques. Demographic characteristics of each group were similar. Thirty-nine of 41 patients (95%) randomized to hyper-pronation were reduced successfully on the first attempt versus 34 of 44 patients (77%) randomized to supination. Two patients in the hyperpronation group required two attempts versus 10 patients in the supination group. Hyperpronation was more successful; 40 of 41 patients (97.5%) in the hyperpronation group were reduced successfully versus 38 of 44 patients (86%) in the supination group. Of the 6 patients who crossed over from supination to hyperpronation, 5 were reduced on the first attempt and 1 was reduced on the second attempt.
Conclusions. In the reduction of radial head subluxations, the hyperpronation technique required fewer attempts at reduction compared with supination, was successful more often than supination, and was often successful when supination failed.
Clinical Features of Acute Allergic Reactions to Peanut and Tree Nuts in Children
Authors: Sicherer Scott H. , Burks A. Wesley , Sampson Hugh A. 
Published: August 2004

Background. Peanut (PN) and tree nut (TN) allergies are potentially life-threatening, rarely outgrown, and appear to be increasing in prevalence. However, there is relatively little reported about the clinical features of acute reactions to these foods and their potential association.
Objective. To describe the clinical features of acute reactions during initial and subsequent accidental ingestions of PN and TN among children with a history of at least one acute allergic reaction to these foods.
Design. Questionnaire survey, examination, and serologic testing for specific IgE antibody of patients with convincing histories of acute reactions (at least one organ system involved within 60 minutes of ingestion) to PN or TN.
Results. A total of 122 patients (63% males; median age, 8 years at time of study) had acute reactions; 68 had reactions only to PN, 20 only to TN, and 34 to both PN and TN. Of those reacting to TN, 34 had reactions to one, 12 to two, and 8 to three or more different TN, the most common being walnut, almond, and pecan. Initial reactions usually occurred at home (median age, 24 months for PN and 62 months for TN) and were considered to result from a first exposure in 72% of cases. Eighty-nine percent of the reactions involved the skin (urticaria, angioedema), 52% the respiratory tract (wheezing, throat tightness, repetitive coughing, dyspnea), and 32% the gastrointestinal tract (vomiting, diarrhea). Two organ systems were affected in 31% of initial reactions, and all three in 21% of reactions. Thirty-eight of 190 first reactions to PN or TN were treated with epinephrine. Accidental ingestions occurred in 55% of PN-allergic children (average of two accidents per patient with an accidental ingestion) and in 30% of TN-allergic children over a median period of 5.5 years. On average, symptoms after accidental exposure were generally similar to those at initial exposure. Accidents occurred commonly in school but also at home and in restaurants. Modes of accidental ingestion included sharing food, hidden ingredients, cross-contamination, and school craft projects using peanut butter. Eighty-three percent of the children were breastfed, with &gt;90% of the mothers ingesting PN and at least one TN during lactation. Among patients reporting no history of exposure (&gt;60% of patients for each TN), IgE antibodies were found to a particular TN in 50% to 82% of patients and to PN in 100% of patients.
Conclusions. Acute allergic reactions to PN occur early in life. PN and TN allergic reactions coexist in one third of PN-allergic patients, frequently occur on first known exposure, and may be life-threatening, requiring emergency treatment. Accidental ingestions are common, occur frequently outside of the home, and often require emergency treatment. Consequently, early diagnosis followed by education on avoidance and treatment measures (including self-administered epinephrine) is imperative.
Educational Disabilities of Neonatal Intensive Care Graduates
Authors: Resnick Michael B. , Gomatam Shanti V. , Carter Randy L. , Ariet Mario , Roth Jeffrey , Kilgore Karen L. , Bucciarelli Richard L. , Mahan Charles S. , Curran John S. , Eitzman Donald V. 
Published: August 2004

Objective. To determine the relationship between perinatal and sociodemographic factors in low birth weight and sick infants hospitalized at regional neonatal intensive care units (NICUs) and subsequent educational disabilities.Method. NICU graduates born between 1980 and 1987 at nine statewide regionalized level III centers were located in Florida elementary schools (kindergarten through third grade) during academic year 1992–1993 (n = 9943). Educational disability was operationalized as placement into eight mutually exclusive types of special education (SE) classifications determined by statewide standardized eligibility criteria: physically impaired, sensory impaired (SI), profoundly mentally handicapped, trainable mentally handicapped, educable mentally handicapped, specific learning disabilities, emotionally handicapped, and speech and language impaired (SLI). Logistic regression was used to estimate the odds of placement in SE for selected perinatal and sociodemographic variables.Results. Placement into SE ranged from .8% for SI to 9.9% for SLI. Placement was related to four perinatal factors (birth weight, transport, medical conditions [congenital anomalies, seizures or intraventricular hemorrhage] and ventilation), and five sociodemographic factors (child's sex, mother's marital status, mother's race, mother's educational level, and family income). Perinatal factors primarily were associated with placement in physically impaired, SI, profoundly mentally handicapped, and trainable mentally handicapped. Perinatal and sociodemographic factors both were associated with placement in educable mentally handicapped and specific learning disabilities whereas sociodemographic factors primarily were associated with placement in emotionally handicapped and SLI.Conclusions. Educational disabilities of NICU graduates are influenced differently by perinatal and sociodemographic variables. Researchers must take into account both sets of these variables to ascertain the long-term risk of educational disability for NICU graduates. Birth weight alone should not be used to assess NICU morbidity outcomes.
Abnormal Magnetic Resonance Signal in the Internal Capsule Predicts Poor Neurodevelopmental Outcome in Infants With Hypoxic-Ischemic Encephalopathy
Authors: Rutherford Mary A. , Pennock Jacqueline M. , Counsell Serena J. , Mercuri Eugenio , Cowan Frances M. , Dubowitz Lilly M. S. , Edwards A. David 
Published: August 2004

Objective. The aim of this study was to establish whether abnormal signal intensity in the posterior limb of the internal capsule (PLIC) on magnetic resonance imaging is an accurate predictor of neurodevelopmental outcome at 1 year of age in infants with hypoxic-ischemic encephalopathy (HIE).Methods. We have examined 73 term neonates with HIE between 1 and 17 days after birth with cranial magnetic resonance imaging and related the magnetic resonance imaging findings to neurodevelopmental outcome at 1 year of age.Results. All infants with an abnormal signal intensity in the PLIC developed neurodevelopmental impairment although in 4 infants with very early scans the abnormal signal was not apparent until up to 4 days after birth. A normal signal intensity was associated with a normal outcome in all but 4 cases; 3 of these infants had minor impairments and all had persistent imaging changes within the white matter. The 4th infant with a normal signal intensity on day 2 died before a further image could be obtained. The absence of normal signal predicted abnormal outcome in term infants with HIE with a sensitivity of 0.90, a specificity of 1.0, a positive predictive value of 1.0, and a negative predictive value of 0.87. The test correctly predicted outcome in 93% of infants with grade II HIE, according to the Sarnat system. Applying a Bayesian approach, the predictive probability of the test (the probability that the test would predict an outcome correctly) was distributed with a mean of 0.94 and 95% confidence limits of 0.89 to 1.0.Conclusion. Abnormal signal intensity in the PLIC is an accurate predictor of neurodevelopmental outcome in term infants suffering HIE.
Cerebral Blood Flow Is Independent of Mean Arterial Blood Pressure in Preterm Infants Undergoing Intensive Care
Authors: Tyszczuk Lidia , Meek Judith , Elwell Clare , Wyatt J. S. 
Published: August 2004

Objective. Preterm infants are often presumed to have a pressure passive cerebral circulation implying that a low mean arterial blood pressure (MABP) results in reduced cerebral perfusion. The aim of this study was to determine whether cerebral blood flow (CBF) was compromised in preterm infants whose MABP fell below 30 mm Hg (4 kPa).Methods. Thirty preterm infants undergoing intensive care were studied within the first 24 hours of life. CBF was measured using near infrared spectroscopy. The infants were analyzed in two groups on the basis of their MABP at the time of study: group 1 had a MABP below 30 mm Hg and group 2 more than 30 mm Hg. CBF in the two groups was compared.Results. There was no significant difference in the mean CBF between the two groups. In group 1 the median MABP was 27.2 mm Hg (range, 23.7–29.9 mm Hg) and CBF was 13.9 (standard deviation, ±6.9) mL · 100 g−1 · min−1. In group 2 the median MABP was 35.3 mm Hg (range, 30.1–39.3 mm Hg) and CBF was 12.3 (standard deviation, ±6.4) mL · 100 g−1 · min−1. Mortality and incidence of cranial ultrasound scan abnormalities were also not significantly different.Conclusion. These results indicate that preterm infants undergoing intensive care are able to maintain adequate cerebral perfusion at a MABP in the range of 23.7 to 39.3 mm Hg.
Birth Weight Influences the Initial Response to Growth Hormone Treatment in Growth Hormone-insufficient Children
Authors: Achermann John C. , Hamdani Karima , Hindmarsh Peter C. , Brook Charles G. D. 
Published: August 2004

Objective. To determine the influence of birth weight on the first year response to growth hormone (GH) replacement in children with isolated GH insufficiency.
Study Design. A longitudinal study of response to daily GH treatment (15–26 IU/m2/week) was performed in 16 singleton Caucasian prepubertal children (11 boys, 5 girls) with isolated GH insufficiency (peak GH response to insulin tolerance test &lt;13.5 mU/L) attending a pediatric endocrinology clinic. Change in height velocity standard deviation scores, during the 6 to 12 months before starting GH and the 12 months after, were used to reflect responsivity to GH treatment. Potential influencing variables considered by regression analysis were birth weight standard deviation score (BWSDS), peak GH response to insulin tolerance testing, midparental height standard deviation score, age at treatment, and dose of GH administered.
Results. Mean BWSDS was −0.51 (SD, 1.0). Change in height velocity standard deviation score was correlated positively with BWSDS (r = 0.64) and negatively with peak GH (r = −0.59). Stepwise linear regression analysis confirmed the influence of BWSDS on response to GH treatment.
Conclusions. The continuum of birth weight influences initial responsivity to GH treatment in GH-insufficient children. This may reflect relative insensitivity in the growth hormone or insulin-like growth factor axis. The influence of birth weight on final height and benefit of using higher doses of GH in these children remains to be seen.
Otitis Media, the Caregiving Environment, and Language and Cognitive Outcomes at 2 Years
Authors: Roberts Joanne E. , Burchinal Margaret R. , Zeisel Susan A. , Neebe Eloise C. , Hooper Stephen R. , Roush Jackson , Bryant Donna , Mundy Martha , Henderson Frederick W. 
Published: August 2004

Objective. To examine the relationship between otitis media with effusion (OME) and associated hearing loss between 6 and 24 months of age and children's language and cognitive development at 2 years of age.
Study Design. A prospective cohort design in which 86 African-American infants who attended group child-care centers were recruited between 6 and 12 months of age. Between 6 and 24 months, assessments included serial ear examinations using otoscopy and tympanometry, serial hearing tests, two ratings of the childrearing environment at home and in child care, and language and cognitive outcomes at 2 years.
Results. Children experienced either unilateral or bilateral OME an average of 63% and reduced hearing sensitivity an average of 44% of the time between 6 and 24 months of age. Although proportion of time with OME or with hearing loss was modestly correlated with measures of language and cognitive skills, these relationships were no longer significant when the ratings of the home and child-care environments were also considered. Children with more OME or hearing loss tended to live in less responsive caregiving environments, and these environments were linked to lower performance in expressive language and vocabulary acquisition at 2 years.
Conclusions. Both OME and hearing loss were more strongly related to the quality of home and child-care environments than to children's language and cognitive development. Study results might be explained either by suggesting that children in less responsive caregiving environments experience conditions that make them more likely to experience OME and/or by suggesting that it may be more difficult for caregivers to be responsive and stimulating with children with more OME.
Who Gets Missed: Coverage in a Provincial Newborn Screening Program for Metabolic Disease
Authors: Spady Donald W. , Saunders L. Duncan , Bamforth Fiona 
Published: August 2004

Objective. To determine coverage of the newborn screening program (NSP) for metabolic disease in Alberta, Canada, and to determine reasons for not being screened.Study Design. Coverage was estimated by deterministic matching of live birth registration data with newborn screening data for the year 1992. Demographic characteristics of not-matched infants were compared with good-match infants using logistic regression.Results. For 42 392 live births, there were 41 553 screening records, of which 40 593 infants were very good matches to NSP records. Another 960 were possible matches. A total of 839 infants were not matched at all, and coverage was estimated at 98.0%. Determinants of infant not-matched status were death in week 1 (adjusted odds ratio [OR]: 383); birth weight of &lt;1500 g (adjusted OR: 18.9) or between 1500 and 2500 g (adjusted OR: 3.2); having a mother who was single (adjusted OR: 2.7) or formerly married (adjusted OR: 12.9); or being born out of hospital (OR: 19.2). The calculated 98% coverage is close to an estimate of 98.3% made by the NSP comparing total births with initial screenings.Conclusion. The matched data give insight as to who was missed and point to the need for closer attention for infants at greater risk of not being screened for metabolic disease.
Children's Contributions to Pediatric Outpatient Encounters
Authors: van Dulmen Alexandra Maria 
Published: August 2004

Objective.
Generally, increasing attention is being paid to the quality of doctor-patient communication. However, children's contributions have been, until now, primarily ignored in communication research, although there are indications that considering their views increases satisfaction and compliance. In the present study, we examined how children contributed to communication during outpatient pediatric encounters and what factors were associated with children's contributions.

Patients.
Twenty-one consulting pediatricians videotaped a total of 302 consecutive outpatient encounters.

Design.
Multilevel analysis was used to take into account the similarity among encounters with the same pediatrician.

Results.
Children's contributions to the outpatient encounters were limited to 4%. Pediatricians directed one out of every four statements to the child. Although pediatricians asked children a lot of medical questions (26%), only a small part of the medical information (13%) was directed at the children. Apart from social talk and laughter, the amount of pediatrician-child communication increased with children's age. Communication with children suffering from disorders of the nervous system seemed to differ from that with children suffering from other diseases. Allowing children more room in the medical visit did not seem to increase the duration of the visit.

Conclusions.
Although recent legislation requires children to be adequately informed, in pediatric outpatient encounters information still tends to be directed primarily at the parents. Children do get the opportunity to talk about social and psychosocial issues. Pediatricians may need to acquire similar communication skills to discuss medical-technical issues with the children. conversational contribution, information exchange, pediatrician-child communication, social talk, video recordings.
Height as a Marker of Childhood Development and Late-life Cognitive Function: The Honolulu–Asia Aging Study
Authors: Abbott Robert D. , White Lon R. , Ross G. Webster , Petrovitch Helen , Masaki Kamal H. , Snowdon David A. , Curb J. David 
Published: August 2004

Objective.
Growing evidence suggests that structural and functional brain reserves, thought to develop in childhood and adolescence, may be crucial in determining when cognitive impairment begins. The purpose of this report is to examine the relationship of height, as a marker of childhood development, to late-life cognitive function in a sample of elderly Japanese-American men.

Method.
Cognitive performance was assessed from 1991 to 1993 in the Honolulu–Asia Aging Study in 3733 men aged 71 to 93 years and related to height that was measured 25 years earlier.

Results.
Among the study sample, shorter men were older, leaner, and less educated than taller men. Shorter men also spent more years of their childhood living in Japan and were more likely to have had fathers in unskilled professions. After adjustment for age, the prevalence of poor cognitive performance declined consistently with increasing height from 25% in men shorter than 154 cm (61 in) to 9% in those taller than 174 cm (69 in). Excluding men with stroke or dementia did not alter the association between height and cognitive performance. Apolipoprotein E4 was unrelated to height and did not effect the association between height and cognitive function. The prevalence of Alzheimer's disease was higher in men who were 154 cm (61 in) or shorter as compared with men who were taller (4.7% vs 2.9%, respectively). There was no association between height and vascular dementia.

Conclusion.
Efforts to improve prenatal and early life conditions to maximize growth in childhood and adolescence could diminish or delay the expression of cognitive impairments that occur later in life. Prevention of some late-life cognitive impairments may have pediatric origins.
Unrecognized Microscopic Hyphema Masquerading as a Closed Head Injury
Authors: Coats David K. , Paysse Evelyn A. , Kong Jerome 
Published: August 2004

Objective.
To present a child with an unrecognized microscopic traumatic hyphema and acute glaucoma who was initially treated as a closed head injury patient.

Design.
Case report and discussion.

Results.
Symptoms attributable to unrecognized occult ocular injury in a child with sickle cell trait resulted in evaluation and treatment of the child for a closed head injury. Evaluation included a computed tomography scan of the head and lumbar puncture. An ophthalmologic consultation later revealed a microscopic hyphema and acute glaucoma as the etiology of the child's signs and symptoms.

Conclusions.
Children who present with neurologic symptoms and a history of ocular trauma should undergo an ophthalmologic examination as soon as possible. Hyphema, even if not readily visible on physical examination, can result in the development of acute glaucoma with signs and symptoms that resemble a closed head injury.