bluuebunny/crossref_metadata_2025_split huggingface dataset:
Opisthotonic Posturing With Neuromuscular Irritability Attributable to 4-Aminopyridine Ingestion by a Healthy Pediatric Patient
Authors: Velez Larissa , Shirazi Farshad , Goto Collin , Shepherd Greene , Roth Brett A. 
Published: August 2004

Introduction. 4-Aminopyridine (4-AP) is a potassium channel blocker used to increase muscle strength in the treatment of demyelinating diseases such as multiple sclerosis. We describe a case of ingestion by an 8-month-old child that resulted in severe but transient symptoms.
Case Report. An 8-month-old boy was found with greenish saliva, and a capsule with green 4-AP powder was missing. On arrival to an emergency department, he was jittery, tachycardic, and tachypneic. Activated charcoal, a cathartic, and midazolam (0.5 mg/kg) were administered before transfer to a tertiary pediatric hospital. On arrival, the infant remained tachycardic and tachypneic. His eyes deviated upward and he was noted to have 3+ deep tendon reflexes bilaterally. He was administered 0.9% normal saline (20 mL/kg) for a wide pulse pressure with low diastolic blood pressure. The patient developed dramatic opisthotonic posturing and vermiform tongue fasciculations. The symptoms responded well to repeated intravenous doses of benzodiazepines. In this case, we used 2 doses of lorazepam (0.05 mg/kg each). During opisthotonic posturing, an electroencephalogram performed in the intensive care unit revealed no evidence of seizure activity. Within 20 hours after admission, the patient became asymptomatic.
Conclusion. This case is, to our knowledge, the first documented pediatric 4-AP ingestion. Clinical signs and symptoms are described as well as the response to therapy with benzodiazepines. The electroencephalogram performed while the patient was symptomatic was negative for seizures.
Classification and Definition of Disorders Causing Hypertonia in Childhood
Authors: Sanger Terence D. , Delgado Mauricio R. , Gaebler-Spira Deborah , Hallett Mark , Mink Jonathan W. ,   Task Force on Childhood Motor Disorders
Published: August 2004

Objective. This report describes the consensus outcome of an interdisciplinary workshop that was held at the National Institutes of Health in April 2001. The purpose of the workshop and this article are to define the terms “spasticity,” “dystonia,” and “rigidity” as they are used to describe clinical features of hypertonia in children. The definitions presented here are designed to allow differentiation of clinical features even when more than 1 is present simultaneously.
Methods. A consensus agreement was obtained on the best current definitions and their application in clinical situations.
Results. “Spasticity” is defined as hypertonia in which 1 or both of the following signs are present: 1) resistance to externally imposed movement increases with increasing speed of stretch and varies with the direction of joint movement, and/or 2) resistance to externally imposed movement rises rapidly above a threshold speed or joint angle. “Dystonia” is defined as a movement disorder in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both. “Rigidity” is defined as hypertonia in which all of the following are true: 1) the resistance to externally imposed joint movement is present at very low speeds of movement, does not depend on imposed speed, and does not exhibit a speed or angle threshold; 2) simultaneous co-contraction of agonists and antagonists may occur, and this is reflected in an immediate resistance to a reversal of the direction of movement about a joint; 3) the limb does not tend to return toward a particular fixed posture or extreme joint angle; and 4) voluntary activity in distant muscle groups does not lead to involuntary movements about the rigid joints, although rigidity may worsen.
Conclusion. We have provided a set of definitions for the purpose of identifying different components of childhood hypertonia. We encourage the development of clinical rating scales that are based on these definitions, and we encourage research to relate the degree of hypertonia to the degree of functional ability, change over time, and societal participation in children with motor disorders.
Prevention of Hospital-Acquired Hyponatremia: A Case for Using Isotonic Saline
Authors: Moritz Michael L. , Ayus Juan Carlos 
Published: August 2004

Objective. The current standard of care in pediatrics is to administer hypotonic saline in maintenance parenteral fluids. The safety of this approach has never been evaluated.Methods. A review of the literature reveals that the administration of hypotonic fluids is potentially dangerous and may not be physiologic for the hospitalized child.Results. There have been &gt;50 reported cases of neurologic morbidity and mortality, including 26 deaths, in the past 10 years resulting from hospital-acquired hyponatremia in children who were receiving hypotonic parenteral fluids. Common childhood conditions requiring parenteral fluids, such as pulmonary and central nervous system infections, dehydration, and the postoperative state, are associated with a nonosmotic stimulus for antidiuretic hormone production, which can lead to free water retention and hyponatremia. Children are at particularly high risk of developing symptomatic hyponatremia as they have a larger brain-to-skull size ratio.Conclusions. The administration of isotonic saline in maintenance parenteral fluids is the most important prophylactic measure that can be taken to prevent the development of hyponatremia in children who receive parenteral fluids.
Misconceptions About Colds and Predictors of Health Service Utilization
Authors: Lee Grace M. , Friedman Jennifer F. , Ross-Degnan Dennis , Hibberd Patricia L. , Goldmann Donald A. 
Published: August 2004

Objective. Colds accounted for 1.6 million emergency department (ED) visits and 25 million ambulatory visits by children and adults in 1998. Although most colds are caused by viruses and do not require medical intervention, many families seek health care for the treatment of colds. Parental misconceptions about the cause and appropriate treatment of colds may contribute to unnecessary health service utilization. The objective of this study was to determine predictors of reported ED use and ambulatory care use for colds among families with young children.Methods. This study was an observational, prospective cohort study to determine attack rates for respiratory illnesses within families that have at least 1 child who is 6 months to 5 years of age and enrolled in out-of-home child care. Families were randomly selected from 5 pediatric practices in Massachusetts and were considered eligible when the child was enrolled in child care with at least 5 other children for ≥10 hours per week. Enrolled families were asked to complete a survey that assessed knowledge about colds, antibiotic indications, and frequency of health service utilization. Predictors of self-reported use of health care services were assessed in multivariate logistic regression models.Results. Of the 261 families enrolled in the study, 197 families (75%) returned completed surveys. Although 93% of parents understood that viruses caused colds, 66% of parents also believed that colds were caused by bacteria. Fifty-three percent believed that antibiotics were needed to treat colds. Parents reported that they would visit the ED (23%) or their doctor’s office (60%) when their child had a cold. Predictors of ED use on multivariate analysis included Medicaid insurance (odds ratio [OR]: 17.6 [2.2–139.3]), history of wheezing (OR: 18.3 [4.4–75.8]), and belief that antibiotics treat colds (OR: 4.2 [1.4–12.9]). Predictors of ambulatory care use included parent younger than 30 years (OR: 10.0 [1.6–64.3]), history of wheezing (OR: 5.6 [1.1–29.7]), and belief that antibiotics treat colds (OR: 3.8 [1.7–8.5]).Conclusions. Misconceptions about the appropriate treatment of colds are predictive of increased health service utilization. Targeted educational interventions for families may reduce inappropriate antibiotic-seeking behavior and unnecessary health service utilization for colds.
Geographic Variation in the Prevalence of Stimulant Medication Use Among Children 5 to 14 Years Old: Results From a Commercially Insured US Sample
Authors: Cox Emily R. , Motheral Brenda R. , Henderson Rochelle R. , Mager Doug 
Published: August 2004

Objective. The purpose of this study was to evaluate geographic variation in the prevalence of prescription stimulant use and predictors of use among a nationally representative, commercially insured population 5 to 14 years old.Methods. Prescription claims activity from January 1, 1999 through December 31, 1999 for a continuously eligible population 5 to 14 years old was evaluated. Age-gender adjusted prevalence rates were estimated for each state. Multivariate logistic regression using hierarchical linear modeling was used to evaluate the impact of age, gender, number of child dependents, and region of the country on stimulant prevalence. The contextual effects of urban or rural residence, median income, percent white, and physician rate per 100 000 residents were also controlled for.Results. The 1-year prevalence of stimulant treatment for the entire study sample was 4.2%. Multivariate logistic regression indicated that stimulant prescription use was positively associated with age, male gender, fewer child dependents, living in higher income communities, and living in communities with greater percent white. Compared with children living in the Western region of the country, children living in the Midwest and South were 1.55 (99% confidence interval: 1.28–1.87) and 1.71 (99% confidence interval: 1.42–2.06) times more likely to consume at least 1 stimulant medication, respectively. Differences in stimulant prevalence across urban and rural residence were also noted.Conclusions. Geographic variation in the prevalence of stimulant use exists nationally, despite controlling for important predictors of use including age and gender. Possible reasons for the variation are discussed as are calls for additional research.
Treatment of Term Infants With Head Cooling and Mild Systemic Hypothermia (35.0°C and 34.5°C) After Perinatal Asphyxia
Authors: Battin Malcolm R. , Penrice Juliet , Gunn Tania R. , Gunn Alistair J. 
Published: August 2004

Objective. To assess the safety of selective head cooling in birth-asphyxiated term newborn infants while maintaining the rectal temperature at 35.0°C or 34.5°C.Methods. Twenty-six term infants with Apgar ≤6 at 5 minutes or cord/first arterial pH &lt;7.1, plus evidence of encephalopathy, were studied. After parental consent had been obtained, 13 infants received selective head cooling with the rectal temperature maintained at 35.0°C in 6 infants and at 34.5°C in 7 infants. The remaining 13 infants were normothermic. Cooling was achieved by circulating water at 10°C through a cap placed around the head. Rectal, fontanelle, and nasopharyngeal temperatures were monitored.Results. One cooled infant died 2 days after rewarming, and 3 control infants died. Seizures occurred in 9 (69%)of 13 cooled infants and 5 (38%) of 13 control infants. Respiratory support within the first 72 hours of life was required in 10 of 13 infants in both the cooled and control groups. Three cooled infants and 1 control infant received nitric oxide for persistent pulmonary hypertension. During the same interval, 6 of the cooled infants and 4 of the control infants had episodes in which their blood pressure fell to &lt;40 mm Hg; in 2 infants in each group, the lowest blood pressure was below 35 mm Hg. No requirement for volume expansion or increased inotropic support was seen in any infant during stepwise rewarming. All of the cooled infants demonstrated a fall in heart rate during cooling, but the rate was &lt;80/min in only 2 cases and no infant had a rate &lt;70/min. No infant demonstrated an abnormal rhythm or was clinically compromised by the change in heart rate. One infant cooled to a rectal temperature of 34.5°C had a prolonged QT interval of 570 ms associated with a heart rate of 85/min on electrocardiogram aged 34 hours. This returned to normal after rewarming. Platelet counts below 150 × 109/L, hypoglycemia below 2.6 mmol/L, and highest creatinine were not statistically different between cooled and control infants. Positive precooling blood cultures were found in 1 cooled and 1 control infant. The mean cap water input temperature used during cooling was 10 ± 1°C. During active cooling, the mean difference between rectal and nasopharyngeal temperature was 1.4°C in the infants who were not receiving respiratory support, but this gradient could not be measured in those who were receiving respiratory support that involved delivery of warmed gases to the nasopharynx.Conclusions. This study suggests that selective head cooling combined with mild systemic hypothermia of 34.4°C or 35.0°C is a stable, well-tolerated method of reducing cerebral temperature in term newborn infants after perinatal asphyxia.
Blood Pressure in Late Adolescence and Very Low Birth Weight
Authors: Doyle Lex W. , Faber Brenda , Callanan Catherine , Morley Ruth 
Published: August 2004

Objectives. To determine whether blood pressure (BP) differed between very low birth weight (VLBW; birth weight ≤1500 g) subjects and normal birth weight (NBW; birth weight &gt;2499 g) subjects in late adolescence, and to determine whether growth restriction in utero was related to BP in VLBW survivors at this age.
Methods. This was a cohort study of 210 preterm survivors with birth weights &lt;1501 g born from January 1, 1977, to March 31, 1982, and 60 randomly selected NBW subjects from the Royal Women’s Hospital, Melbourne. BP was measured at 18+ years of age in 156 (74%) VLBW subjects and 38 (63%) NBW subjects with both a standard mercury sphygmomanometer and an ambulatory BP monitor.
Results. VLBW subjects had higher sphygmomanometer systolic and diastolic BPs than NBW subjects (mm Hg; mean difference [95% confidence interval]; systolic, 8.6 [3.4, 13.9]; diastolic, 4.3 [1.0, 7.6]). VLBW subjects also had significantly higher mean systolic ambulatory BPs (mm Hg; mean difference [95% confidence interval]) for the 24-hour period (4.7 [1.4, 8.0]), and for both the awake (5.0 [1.6, 8.5]) and asleep (3.6 [0.04, 7.1]) periods. There were no significant differences between the birth weight groups for any ambulatory diastolic BPs. Within the VLBW subjects, there was no significant relationship between birth weight standard deviation score and any measure of BP.
Conclusions. BP was significantly higher in late adolescence in VLBW survivors than in NBW subjects. Growth restriction in utero was not significantly related to BP in VLBW survivors.
Childhood Behavior Disorders and Injuries Among Children and Youth: A Population-Based Study
Authors: Brehaut Jamie C. , Miller Anton , Raina Parminder , McGrail Kimberlyn M. 
Published: August 2004

Context. While an association between pediatric behavioral disorders and injuries is generally acknowledged, no studies have measured the risk for injury in the context of a large, population-based study that is free of cohort biases.Objectives. To examine the association between childhood behavior disorders ([CBDs] as indicated by prescription for methylphenidate [MPH]) and a variety of injury outcomes, and to evaluate the risk for injury among these children after controlling for known demographic correlates.Design. Population-based database analysis of all children in British Columbia (BC) under the age of 19 as of December 31, 1996; comparison of those who had been prescribed MPH and therefore placed in the CBD group (n = 16 806) and those who were not (n = 1 010 067). Demographic information collected was as follows: age, sex, measures of socioeconomic status, and region of residence.Outcome Measures. Common types of childhood injury in BC: International Classification of Diseases, Ninth Revision N-codes (fractures, open wounds, poisoning/toxic effect, concussion, intracranial, burns) and E-codes (falls, postoperative complications, motor vehicle accidents, struck by object, adverse effects of drugs, suffocation, drowning).Data Source. BC Linked Health Data Set and the BC Triplicate Prescription Program.Results. After controlling for known demographic correlates, odds for injury was greater among those treated with MPH and presumed to have a behavioral disorder, when injury was characterized either by type (1.67; 99% confidence interval: 1.54–1.81) or cause (1.52; 99% confidence interval: 1.40–1.66) of injury. This increased risk extended to unexpected categories of injury such as postoperative complications and adverse effects of drugs.Conclusions. Children with CBDs have &gt;1.5 times the odds of sustaining injuries of a variety of types from a variety of causes, even after controlling for known demographic correlates, than those without behavioral disorders. The risks for these children extend beyond those that might be directly associated with impulsivity and overactivity. Injury prevention strategies aimed at this group of children and youth would be beneficial. Policy-makers should account for increased risk of a wide variety of injuries in this group of children and youth.
Stunting of Growth as a Major Feature of Anorexia Nervosa in Male Adolescents
Authors: Modan-Moses Dalit , Yaroslavsky Amit , Novikov Ilia , Segev Sharon , Toledano Anat , Miterany Edith , Stein Daniel 
Published: August 2004

Objective. To assess growth retardation in male adolescent patients who have a diagnosis of anorexia nervosa (AN) and the effect of weight restoration on catch-up growth.Methods. Medical charts of all male adolescent AN patients (n = 12) who were admitted to the Pediatric Psychosomatic Department at the Sheba Medical Center from January 1, 1994, to December 31, 1998, were reviewed. Height and weight measurements were obtained before the onset of AN, at admission, and thereafter routinely during hospitalization and follow-up.Results. Eleven patients exhibited growth retardation during the course of their illness, as evident in a decrease in their height standard deviation score (SDS). The mean height SDS at the time of admission (−0.81 ± 0.93) was significantly lower than the premorbid SDS (−0.21 ± 0.91). Weight restoration resulted in accelerated linear growth (up to 2 cm/mo) in all patients. Positive weight gain (weight gain rate &gt;1 kg/y) was associated with a mean height gain of 6.97 ± 6.48 cm/y, whereas weight loss or failure to gain weight (weight gain rate ≤1 kg/y) was associated with a mean of 2.7 ± 3.9 cm/y. This between-group difference was highly significant. Complete catch-up growth was not achieved in 9 of 12 patients. There was a trend for the mean adult final height SDS (−0.52 ± 0.84) to be higher than the admission height SDS but lower than both the premorbid height SDS and the midparental target height SDS (−0.21 ± 0.79).Conclusions. Linear growth retardation was a prominent feature of AN in our sample of male adolescent patients, preceding, in some cases, the reported detection of the eating disorder. Weight restoration, particularly when target weight is based on the premorbid height percentile, may be associated with significant catch-up growth, but complete catch-up growth may not be achieved.
Effect of Newborn Hospitalization on Family and Child Behavior: A 12-Year Follow-up Study
Authors: Rautava Päivi , Lehtonen Liisa , Helenius Hans , Sillanpää Matti 
Published: August 2004

Objective. To study the effects of a critical illness and hospitalization of a newborn on family functioning and child behavior during the subsequent 12 years.Methods. With the use of a randomized stratified cluster sampling, a follow-up of 1443 pregnant women was started at early pregnancy. These pregnancies resulted in 1294 deliveries. A total of 170 infants were admitted to neonatal units and were classified according to their medical risk, and 1112 healthy-born infants were eligible for the control group. After excluding the children with disabilities at 3 years of age, 134 remained in the risk groups and 952 children remained in the control group. The follow-up examinations were performed at the ages of 3 and 9 months and at 3 and 12 years. The main outcome measures were parents’ subjective well-being and adjustment to the child, family functioning, and child’s behavioral problems.Results. The families with a critically ill newborn experienced more need for support and maladaptation during the first year after delivery. They reported more child behavior problems at 3 years, but no differences were found at 12 years of age. The families with a hospitalized, low-risk infant coped as well as the controls.Conclusions. A critical illness of a newborn had long-lasting effects on the family and child behavior. The hospitalization of a newborn with a low medical risk did not have any negative consequences on family or child behavior. This is encouraging for a large group of families that experience early separation from their newborn infant as a result of hospitalization.
Infant Susceptibility of Mortality to Air Pollution in Seoul, South Korea
Authors: Ha Eun-Hee , Lee Jong-Tae , Kim Ho , Hong Yun-Chul , Lee Bo-Eun , Park Hye-Sook , Christiani David C. 
Published: August 2004

Objective. Susceptibility of target populations to air pollution is an important issue, because air pollution policies and standards should be based on the susceptibilities of those at particular risk. To evaluate which age group is more susceptible to the adverse health effects of air pollution, we compared the effects of air pollution on mortality among postneonates, those aged 2 to 64 years, and those over 65 years of age.
Design. Daily counts of total and respiratory death along with daily levels of meteorological variables and air pollutants were analyzed using generalized additive Poisson regression. The relative risks (RR) of mortality for interquartile changes of the levels of particulate matter &lt;10 μm (PM10) were calculated on the same day.
Results. For postneonates, the RR of total mortality for an interquartile change (42.9 μg/m3) in PM10 (RR: 1.142; 95% confidence interval [CI]: 1.096–1.190) was greatest among age groups. Next were the elderly over 65 years of age (RR: 1.023; 95% CI: 1.022–1.024). Regarding respiratory mortality, RR for an interquartile change of PM10 in postneonates (RR: 2.018; 95% CI: 1.784–2.283) was also greater than those in the other groups.
Conclusions. These results agree with the hypothesis that infants are most susceptible to PM10 in terms of mortality, particularly respiratory mortality.
Polio Extraimmunization in Children Younger Than 2 Years After Changes in Immunization Recommendations
Authors: Mell Loren K. , Davis Robert L. , Mullooly John P. , Black Steven B. , Shinefield Henry R. , Zangwill Kenneth M. , Ward Joel I. , Marcy S. Michael , Chen Robert T. ,   for the CDC Vaccine Safety Datalink Project
Published: August 2004

Objective. To investigate trends over time in polio extraimmunization among children in 4 large health maintenance organizations and to study the association with recent changes in polio immunization policy.
Methods. Using 176 169 children who were born after 1994 and enrolled for their first 2 years of life, we assessed rates and trends of polio extraimmunization in the Vaccine Safety Datalink project. We used logistic regression to test the association of extraimmunization with different polio immunization schedules and with sociodemographic characteristics and used Poisson regression to test changes in rates over time.
Results. Overall, 10.5% were extraimmunized for poliovirus; children on the all inactivated polio virus or sequential schedule were one half as likely as those on the all oral polio virus schedule to be extraimmunized by 2 years of age. There was a significant decrease in extraimmunization over time, with &lt;5% of children born at the end of 1997 being extraimmunized, compared with &gt;15% at the beginning of 1994.
Conclusions. Poliovirus extraimmunization rates have fallen dramatically in association with the change-over to the all inactivated polio virus schedule.