bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison Between Two and Five Doses a Week of Recombinant Human Erythropoietin for Anemia of Prematurity: A Randomized Trial
Authors: Brown Mark S. , Keith Julian F. 
Published: August 2004

Objective.To compare the erythropoietic response between two and five times a week dosages of recombinant human erythropoietin (r-EPO) using the same weekly dose, 500 U/kg, in very low birth weight (VLBW) infants.Study Design.Eighty VLBW infants were stratified into two gestational age groups and randomized to receive 500 U/kg of r-EPO either two or five times a week; 72 infants completed at least 4 weeks of study. The primary outcome variable was absolute reticulocyte counts at 4 weeks. Secondary outcome variables were hematocrits, transfusions, iatrogenic blood losses, infections, and serum ferritins. Multiple regression analysis was used to evaluate the secondary outcome variables.Results.By 4 weeks, absolute reticulocyte counts were higher in the infants given r-EPO five times a week [mean (SEM)]: 173 000/mm3 (15 000) vs 220 000/mm3(18 000), two versus five doses per week, respectively. Hematocrits, 34.9% (0.9) vs 34.1% (0.8), and transfusions per infant, 2.06 (0.4) vs 2.11 (0.4), were not different between the groups. Additionally, 79% of the variance in the amount of blood transfused was accounted for by iatrogenic blood loss, the latter primarily associated with number of days ventilated. Episodes of sepsis and necrotizing enterocolitis were significantly associated with decreased absolute reticulocyte counts and increased transfusions.Conclusions.More frequent dosing of the same weekly amount of r-EPO produced a significant and sustained increase in stimulated erythropoiesis in VLBW infants. The importance of this finding on reducing transfusions was not able to be demonstrated because this study was not intended to differentiate transfusions. In this population of infants and at the dose level of r-EPO, iatrogenic blood loss contributed more to transfusions than a lower level of erythropoiesis, the former primarily associated with mechanical ventilation. Based on this and other studies, when VLBW infants are at risk for greater phlebotomy losses, it may be justifiable to use more vigorous r-EPO treatment, and when at lower risk to use less frequent dosing to enhance cost-effectiveness.
Natural Outcome ofHelicobacter pyloriInfection in Asymptomatic Children: A Two-year Follow-up Study
Authors: Ganga-Zandzou Patrice Serge , Michaud Laurent , Vincent Pascal , Husson Marie-Odile , Wizla-Derambure Nathalie , Delassalle Elisabeth Martin , Turck Dominique , Gottrand Frédéric 
Published: August 2004

Background and Objectives.It is known that Helicobacter pylori can be acquired in early childhood. There is not enough data to know whether or not infected children should be treated. A better knowledge of the natural outcome and implications of H pylori infection may provide evidence that eradication therapy is beneficial in childhood. This prospective study looks at clinical symptoms, endoscopic, microbial, and histologic changes during a 2-year period in infected asymptomatic children. It is hoped that some prognostic indicators will be found that select out the children that later need therapy.Patients and Methods.During epidemiologic study of the prevalence of H pylori infection, 18 children aged 7 ± 4 years (mean ± 1 SD) were discovered to have H pylori infection and enrolled in the 2-year follow-up study. These patients had received no eradication therapy because they were asymptomatic. The follow-up for each patient consisted of an initial assessment, a clinical examination every 6 months, and an endoscopic reevaluation at the end of the first and second years. Gastric mucosal samples were analyzed for bacteriologic and histologic changes. Various factors were initially recorded: individual factors included sex, age, and housing conditions; microbial factors included bacterial load and the presence of the CagA gene. Inflammatory changes were also noted, such as the presence of active gastritis and nodular formation, and these were correlated with the histology which was described using the Sydney classification. Typing polymerase chain reaction-restriction fragment length polymorphism was performed to check the persistence of the same strain of H pyloriin each patient.Results.All of the children were still infected after 2 years with the same strain as in the initial assessment with the exception of 1 child whose infection cleared spontaneously. The density of antral and fundal mucosal colonization with H pylorialso remained stable. There were progressive inflammatory changes in this cohort, particularly between the first and second year (histologic score, 3.5 ± 1.3 vs 5 ± 1). Active antral gastritis occurred in 3 out of 14 and 1 out of 8 children during the first and second year, respectively. Gastritis became active in the fundus in 2 out of 14 and 2 out of 8 children during the same period. Increases in the histologic score were found particularly in male children, and children colonized by cagA− strains of H pylori during the follow-up. The frequency of nodular gastritis significantly rose from 11% (2 out of 18 children) to 64% (9 out of 14 children) after 1 year, and to 80% (8 out of 10 children) after 2 years.Conclusion.These findings demonstrate a deterioration in the histologic features of the gastric mucosa of infected children despite stable H pylori colonization and the absence of symptoms.
Video-Assisted Thoracoscopic Surgery for Patent Ductus Arteriosus in Low Birth Weight Neonates and Infants
Authors: Burke Redmond P. , Jacobs Jeffrey P. , Cheng Wen , Trento Alfredo , Fontana Gregory P. 
Published: August 2004

Background.
Video-assisted thoracoscopic surgery (VATS) has been assuming an expanded role in the management of cardiothoracic disease. As instrumentation and experience increase, VATS is being applied to treat smaller patients. We report our experience with 34 low birth weight infants undergoing VATS interruption of patent ductus arteriosus (PDA).

Methods.
VATS allows PDA interruption without the muscle cutting or rib spreading of a standard thoracotomy. Four small, 3-mm incisions are made along the line of a potential thoracotomy incision. Ports placed through these incisions admit endoscopic instruments, a camera, and a vascular clip applier.

Results.
Median age at surgery was 15.5 days (range: 1–44 days). Median weight at surgery was 930 g (range: 575-2500 g). Twenty patients weighed &lt;1 kg, and 13 weighed &lt;750 g. All patients had congestive heart failure and had either failed indomethacin therapy or had contraindications to indomethacin.
Median surgical time was 60 minutes (range: 31–171 minutes). Echocardiography documented elimination of ductal flow in all patients. Operative mortality was zero. Four patients (4/34 = 12%) required conversion to open thoracotomy: 1 because of difficult exposure, 1 because of pulmonary dysfunction and anasarca, 1 because of a large 1-cm duct, and 1 because of coagulopathy and poor pulmonary compliance. Two patients died before discharge: 1 patient (surgical weight: 605 g) died on postoperative day 2 because of intracranial hemorrhage, and 1 patient (surgical weight: 1725 g) died on postoperative day 88 because of multiple system organ failure.
Follow-up has demonstrated no PDA murmur in any patient, but echocardiography revealed trace ductal flow in 2 patients.

Conclusions.
VATS offers a minimally traumatic, safe, and effective technique for PDA interruption in low birth weight neonates and infants.
Why the Prone Position Is a Risk Factor for Sudden Infant Death Syndrome
Authors: Jeffery Heather E. , Megevand Angelique , Page Hons*‡; and Megan 
Published: August 2004

Introduction.The laryngeal chemoreflex may explain why prone sleeping increases the risk of sudden infant death syndrome (SIDS). Swallowing and arousal are crucial to prevent laryngeal chemoreflex stimulation. Our aim was to examine these reflexes and breathing responses in healthy neonates after pharyngeal infusion of water in the supine versus the prone position, controlling for sleep state.Methods.A total of 10 term infants were recruited after parental consent and ethics approval. Polygraphic recordings included sleep state (active and quiet sleep by electroencephalogram, eye movements, breathing, and behavior), cardiorespiratory measurements (nasal airflow, chest wall movements, heart rate, and oxygen saturation), swallowing, and esophageal activity (solid state pressure catheter). Initial sleeping position was assigned randomly. Measurements were made for 1 minute before and after 0.4 mL of water was instilled into the oropharynx. To detect a 30% decrease in swallowing, power analysis indicated that ≥10 babies were required. Analysis, blinded to position, was made using nonparametric statistics.Results.Of the 164 infusions, the most commonly evoked airway protective responses to pharyngeal infusion were swallowing (95%) and arousal (54%). After infusion in active sleep, there was a significant reduction in swallowing and breathing when the prone position was compared with the supine position (prone: 21.3 [1.0] swallows/min and −9.6 [2.1] breaths/min; and supine: 32 (2.2) and −2.9 (1.5), respectively). However, there was no difference in the occurrence of arousal after water infusion.Conclusion.These data suggest that airway protection is compromised in the prone sleeping position during active sleep, even in healthy infants exposed to minute pharyngeal fluid volumes of 0.4 mL. This is because swallowing rate is reduced significantly, and there is no compensatory increase in arousal. The reduction in airway protective reflexes when in the prone position and in active sleep may be the mechanism for the increased risk of SIDS in the prone position.
Addressing Sexual Abuse in the Primary Care Setting
Authors: Leder Mary Ranee , Emans S. Jean , Hafler Janet Palmer , Rappaport Leonard Alan 
Published: August 2004

Objective.To describe factors that prompt pediatric practitioners to suspect child sexual abuse, the barriers to inquiry, and the approach to management of cases of possible abuse.Design.Qualitative, descriptive, and case-based.Methods.Six focus group interviews were conducted. Maternal and Child Health Bureau-sponsored collaborative office rounds groups nationwide participated in discussions of five vignettes. Each group interview lasted 1.5 hours and had 7 to 16 participants (n = 65). Audiotaped data were transcribed and analyzed independently for themes by two reviewers.Results.Five themes emerged from the group interviews: anticipatory guidance, red flags, approach to management, terminology used in discussions, and barriers to inquiry. All groups discussed giving anticipatory guidance about sexual abuse. Half (3/6) believed girls were more likely to be victimized, and some (2/6) gave more anticipatory guidance to girls for this reason. Although some groups reported giving anticipatory guidance about sexual abuse, many reported inconsistencies in their practice. All groups identified historical, behavioral, and physical red flags for sexual abuse but believed that they were not trained in residency to recognize these signs. There was no consensus regarding the approach to management of cases of possible sexual abuse, and many participants did not know the types of questions that they should be asking children when they suspect abuse. Members of all groups reported using imprecise terms when they discuss sexual issues with families. Most (4/6) believed that it was a practitioner's responsibility to inquire about abuse but believed that their discomfort with sexual topics was a barrier to inquiry. All believed that the most significant barrier to inquiry was inadequate training in the area of sexual abuse and that cases are missed because of lack of training.Conclusions.Highly motivated pediatric practitioners reported that they give anticipatory guidance about sexual abuse inconsistently, that they were not trained to recognize red flags for sexual abuse, and that they do not have a consistent approach to cases of suspected abuse. Additionally, they reported that they are not comfortable discussing sexual issues and that they miss cases of sexual abuse primarily because of lack of training. Educational interventions that target these themes are essential to improve the ability of pediatricians to screen children and to intervene when sexual abuse is identified.
Vaccines for Children Program, United States, 1997
Authors: Santoli Jeanne M. , Rodewald Lance E. , Maes Edmond F. , Battaglia Michael P. , Coronado Victor G. 
Published: August 2004

Objectives.1) To determine the proportion of preschool children receiving immunizations from providers enrolled in the Vaccines for Children (VFC) program; 2) to assess whether their immunization providers serve as their medical home for primary care; and 3) to examine the relationship between various provider characteristics and immunization status.Design. Two-phase national survey consisting of parent interviews verified by provider record check.Setting.A total of 78 survey areas (50 states, the District of Columbia, and 27 urban areas).Patients or Other Participants.Noninstitutionalized children from 19 to 35 months of age in 1997.Interventions.None.Outcome Measures.VFC penetration rate (the percentage of children who received all or some vaccines from a VFC-enrolled provider); the frequency with which children received all or some vaccines within a medical home; the number of parent-reported immunization providers; and 4:3:1:3 up-to-date status at 19 to 35 months of age.Results.Of 28 298 children interviewed for whom consent to contact providers was obtained, complete provider data were available for 21 522 (76%). Of these children, ∼75% received all or some immunizations from a VFC-enrolled provider, 73% received all or some immunizations within a medical home, and 75% had one immunization provider. Children received all or some immunizations from a VFC-enrolled provider more frequently when vaccinated by pediatricians versus family physicians or in public facilities versus private practice. After controlling for poverty, immunization coverage varied only slightly with receipt of vaccines from a VFC-enrolled provider, receipt of vaccines within a medical home, and the number of parent-reported providers. Among children vaccinated within a medical home, those vaccinated solely by pediatricians were 1.63 times as likely to be 4:3:1:3 up-to-date than were those vaccinated solely by family physicians after removing the effects of poverty.Recommendations.Greater numbers of children are likely to benefit from an even higher participation rate among immunization providers in the VFC program, particularly among family physicians and private physicians. The public–private collaboration developed by the VFC program should be capitalized on so that public sector resources can help pediatricians and family physicians practice according to theStandards for Pediatric Immunization Practices.
Predicting the Need for Topical Anesthetic in the Pediatric Emergency Department
Authors: Fein Joel A. , Callahan James M. , Boardman Chris R. , Gorelick Marc H. 
Published: August 2004

Objective.To investigate the potential for pediatric emergency department (ED) triage nurses to apply a topical anesthetic (ie, eutectic mixture of local anesthetic) for intravenous catheter (IV) insertion.Methods.Prospective cross-sectional survey over a 2-month period, with post hoc application of internally developed prediction rules. Eligible patients were children presenting to the ED triage area of an urban children's hospital.Results.A total of 2596 (86.7% of eligible children) had a triage nursing prediction performed. Nurse prediction of IV insertion had a sensitivity of 72% (95% CI: 66,78), a specificity of 90% (88,91), and a positive predictive value (PPV) of 49% (44,54). Objective factors such as high-risk medical history (chronic neurologic, hematologic, cardiac, endocrine, or gastrointestinal illness) and high-risk chief complaint (gastrointestinal illness, skin infection, and previous seizure) were incorporated into a predictive score used to predict IV insertion independently with a sensitivity of 33% (27,39) and a PPV of 43% (44,54). Addition of the objective predictors to nursing prediction increased the sensitivity to 76% (70,81) with a PPV of 43% (38,47). Of the patients, 95% received an IV insertion ≤45 minutes after triage, 89% ≤60 minutes after triage. Of the IV insertions, 68% were placed in the dorsum of the hand.Conclusions.The prediction of an experienced triage nurse can identify most patients requiring an IV in a pediatric ED. Incorporation of objective criteria other than nursing prediction into this decision process can decrease the amount of wasted product at the expense of less sensitive identification. The timing of IV insertion in our ED would allow for full medication effect of the currently marketed topical anesthetics in the majority of ED patients. topical anesthetic, intravenous cannulation, children, eutectic mixture of local anesthetic.
Dendritic Spine Pathology in Infants With Severe Protein-Calorie Malnutrition
Authors: Benı́tez-Bribiesca Luis , De la Rosa-Alvarez Irma , Mansilla-Olivares Armando 
Published: August 2004

Background.Experimental undernutrition in animals, during the critical brain development period, produces retardation of brain growth as well as a number of different morphologic and functional abnormalities in neurons, mainly in the dendritic synaptic apparatus. These alterations are the cause of the poor neurointegrative development that occurs in experimental malnutrition. Severe malnutrition during early postnatal life in humans is known to produce similar neurointegrative disorders as well as mental retardation, but there are very few studies describing the morphology of the dendritic apparatus in infants suffering from this condition.Objective.To study the dendritic spine density and morphology in dendrites from cortical neurons in infants dying from severe malnutrition.Methodology.Brain sections from the somestesic, motor, and occipital cortical areas of 13 infants who died of severe malnutrition and 7 eutrophic infants who died of other causes were studied by means of the rapid Golgi method. Apical dendritic spines from neurons of the fifth cortical layer were studied and counted in all sections.Results.Apical dendrites were significantly shorter in malnourished infants than in the control group (581.54 ± 54.32 μm in severe malnutrition vs 846.3 μm in normal infants). The number of dendritic spines per dendrite was also significantly diminished (185.3 ± 36.1 in malnourished vs 374.3 ± 41.6 in eutrophic infants). There were marked morphologic abnormalities in the dendritic spines of infants dying of severe malnutrition that were classified as dysplastic.Conclusions.Short apical dendrites, fewer spines, and dendritic spine abnormalities occur in severe infant malnutrition. These anatomic anomalies might be related to the neuropsychological deficits that occur in these children.
Cardiopulmonary Resuscitation in the Very Low Birth Weight Infant: The Vermont Oxford Network Experience
Authors: Finer Neil N. , Horbar Jeffrey D. , Carpenter Joseph H. ,   for the Vermont Oxford Network
Published: August 2004

Objective.The limited literature available to date suggests that the use of delivery room cardiopulmonary resuscitation (DR-CPR) is associated with very poor outcomes, especially for extremely low birth weight infants. We reviewed the cumulative experience of the Vermont Oxford Network to determine the actual utilization of DR-CPR and the neonatal outcomes of such infants.Methods.A retrospective review of information available in the Vermont Oxford Network Database for the years 1994 to 1996. The data set was collected from 196 neonatal units who participate in the Network (data for infants 401 to 500 g were from 1996 only). Infants were eligible for study if they received DR-CPR defined as the administration of chest compressions and/or epinephrine in the delivery room as noted on the Vermont Oxford Network Database record.Results.Information regarding survival was available for 27 707 newborns with birth weights from 501 to 1500 g, and 497 infants with birth weights from 401 to 500 g. There were 24 001 (86.6%) survivors. Overall DR-CPR was given to 9.3% of infants from 401 to 500 g and 6% of infants from 501 to 1500 g, 82.1% receiving chest compressions, and 66.7% receiving epinephrine. Survival of infants receiving DR-CPR was 23.9% for infants of 401 to 500 g, and 63.3% for infants of 501 to 1500 g, compared with 16.7% and 87.9% for infants in these weight groups not receiving DR-CPR. Survival was greater for infants of 501 g or greater without DR-CPR compared with those who received this intervention within each 250-g birth weight subgroup. For infants of &lt;1000 g, survival was 53.8% with DR-CPR compared with 74.9% without. Head ultrasounds were available for 95.5% of all surviving infants and 96.7% of infants who received DR-CPR. Overall, any grade of intraventricular hemorrhage (IVH) occurred more frequently in infants who received DR-CPR (38%) than in those who did not (21%). Grade 3 or 4 (severe) IVH was seen in 15.3% of infants who received DR-CPR compared with 4.9% of the infants who did not. Overall, survival without severe IVH occurred in 52.2% of DR-CPR infants compared with 81.3% of infants who did not require this intervention.Conclusion.The majority of very low birth weight and extremely low birth weight infants who receive DR-CPR survive, and at least half of such infants who survive do not have evidence of severe IVH. Further follow-up studies are required to determine the long-term neurodevelopmental outcome of such infants. The current study does not support the previously noted poor outcome in extremely low birth weight infants who receive DR-CPR.