bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low Expression of Human Epithelial Sodium Channel in Airway Epithelium of Preterm Infants With Respiratory Distress
Authors: Helve Otto , Pitkänen Olli M. , Andersson Sture , O’Brodovich Hugh , Kirjavainen Turkka , Otulakowski Gail 
Published: August 2004

Objective. Active ion transport is critical to postnatal clearance of lung fluid. The importance of epithelial sodium channel (ENaC) in this clearance has been demonstrated in animal studies in which α-ENaC knockout mice died postnatally as a result of respiratory insufficiency. In animals, the expression of α-ENaC in respiratory epithelium is dependent on gestational age, but when assessed by in situ hybridization in the human (h), the mRNA is present from the earliest stages of pulmonary development. Therefore, the purpose of the present investigation was to quantify mRNA of the α-, β-, and γ-hENaC subunits of newborn preterm infants with respiratory distress and compare the gene expression data against those detected in healthy term infants. In addition, the effect of systemic dexamethasone therapy on the 3 hENaC subunits was studied in 4 preterm infants who received prolonged assisted ventilation.Methods. The expression of subunits of hENaC was determined in samples taken from nasal respiratory epithelium of 7 healthy term infants (gestation age: 39.3 ± 0.9 weeks [mean ± standard deviation) and 5 preterm infants (gestational age: 27.2 ± 0.9 weeks) with respiratory distress syndrome within 5 hours of birth. Betamethasone had been given to all mothers of preterm infants. In 4 additional preterm infants who still required assisted ventilation at 43 ± 6 days postnatal age, the expression of α-hENaC was determined in samples taken before and during treatment with dexamethasone.Results. Preterm infants with respiratory distress syndrome had low expression of all hENaC subunits relative to healthy term infants (α-hENaC: 5.38 ± 2.01 [amol/fmol cytokeratin 18] vs 9.13 ± 2.26; β-hENaC: 2.44 ± 1.43 vs 4.25 ± 1.10; γ-hENaC: 2.43 ± 0.11 vs 6.81 ± 3.24). Each of the 4 preterm infants who were treated with dexamethasone at ∼1 month of age showed an increase in expression of α-hENaC and β-hENaC subunit normalized to cytokeratin 18.Conclusion. All 3 subunits of the hENaC are low in preterm relative to full-term infants. α-hENaC mRNA in respiratory epithelium is increased by therapeutic doses of glucocorticosteroid. Low expression of α-hENaC in human respiratory epithelium may play a role in the pathogenesis of respiratory distress in preterm infants.
Serum Leptin Concentration Poorly Reflects Growth and Energy and Nutrient Intake in Young Children
Authors: Hakanen Maarit , Rönnemaa Tapani , Talvia Sanna , Rask-Nissilä Leena , Koulu Markku , Viikari Jorma , Bergendahl Matti , Simell Olli 
Published: August 2004

Objective. We studied whether the serum leptin concentration at age 2 years predicts changes in relative body weight by age 8 and whether the serum leptin concentration is associated with intake of energy and nutrients at age 5.Methods. A total of 156 8-year-old participants of the Special Turku Coronary Risk Factor Intervention Project were chosen to represent children whose relative weight decreased, was stable, or increased during the preceding 6 years. Their serum leptin concentrations were measured in samples collected when they were 2 years. Serum leptin was also measured in 100 5-year-old children in the Special Turku Coronary Risk Factor Intervention Project whose energy and nutrient intakes were analyzed using 4-day food records.Results. The boys whose relative weight decreased (n = 25), was stable (n = 28), or increased (n = 26) between 2 and 8 years of age had similar serum leptin concentrations at the age of 2 years. The girls whose relative weight decreased (n = 27) had higher serum leptin concentrations at 2 years than the girls whose relative weight remained stable (n = 26) but only when the leptin values were not adjusted for body mass index. The serum leptin concentration was higher in 5-year-old girls than in 5-year-old boys even when adjusted for body mass index. Serum leptin correlated with relative weight in girls and boys (r = 0.65 and r = 0.45, respectively). Serum leptin concentration adjusted for relative weight correlated poorly with intakes of energy, fat, saturated fat, carbohydrates, sucrose, and protein.Conclusions. Serum leptin concentrations at age 2 poorly predicted changes in relative body weight during the following 6 years and poorly reflected the intake of energy or major nutrients at age 5.
Acute Hyponatremia Related to Intravenous Fluid Administration in Hospitalized Children: An Observational Study
Authors: Hoorn Ewout J. , Geary Denis , Robb Maryanne , Halperin Mitchell L. , Bohn Desmond 
Published: August 2004

Objective. To develop hyponatremia (plasma sodium concentration [PNa] &lt;136 mmol/L), one needs a source of water input and antidiuretic hormone secretion release to diminish its excretion. The administration of hypotonic maintenance fluids is common practice in hospitalized children. The objective of this study was to identify risk factors for the development of hospital-acquired, acute hyponatremia in a tertiary care hospital using a retrospective analysis.Methods. All children who presented to the emergency department in a 3-month period and had at least 1 PNa measured (n = 1586) were evaluated. Those who were admitted were followed for the next 48 hours to identify patients with hospital-acquired hyponatremia. An age- and gender-matched case-control (1:3) analysis was performed with patients who did not become hyponatremic.Results. Hyponatremia (PNa &lt;136 mmol/L) was documented in 131 of 1586 patients with ≥1 PNa measurements. Although 96 patients were hyponatremic on presentation, our study group consisted of 40 patients who developed hyponatremia in hospital. The case-control study showed that the patients in the hospital-acquired hyponatremia group received significantly more EFW and had a higher positive water balance. With respect to outcomes, 2 patients had major neurologic sequelae and 1 died.Conclusion. The most important factor for hospital-acquired hyponatremia is the administration of hypotonic fluid. We suggest that hypotonic fluid not be given to children when they have a PNa &lt;138 mmol/L.
Measurement of Percentage of Body Fat in 411 Children and Adolescents: A Comparison of Dual-Energy X-Ray Absorptiometry With a Four-Compartment Model
Authors: Sopher Aviva B. , Thornton John C. , Wang Jack , Pierson Richard N. , Heymsfield Steven B. , Horlick Mary 
Published: August 2004

Objective. Pediatricians are encountering body composition information more frequently, with percentage of body fat (%BF) measurement receiving particular attention as a result of the obesity epidemic. One confounding issue is that different methods may yield different %BF results in the same person. The objective of this study was to compare dual-energy X-ray absorptiometry (DXA) with the criterion 4-compartment model (4-CM) for measurement of %BF in a large pediatric cohort and to assist pediatricians in appropriate interpretation of body composition information by recognizing differences between techniques.Methods. Height, weight, anthropometrics, body density by underwater weighing, total body water by deuterium dilution, and bone mineral content and %BF by DXA (Lunar DPX/DPX-L) were measured in 411 healthy subjects, aged 6 to 18 years. Values for %BF by 4-CM and DXA were compared using regression analysis.Results. The mean ± standard deviation values for %BF by DXA (22.73% ± 11.23%) and by 4-CM (21.72% ± 9.42%) were different, but there was a strong relationship between the 2 methods (R2 = 0.85). DXA underestimated %BF in subjects with lower %BF and overestimated it in those with higher %BF. The relationship between the 2 methods was not affected by gender, age, ethnicity, pubertal stage, height, weight, or body mass index. The standard error of the estimate was 3.66%.Conclusion. This analysis demonstrates a predictable relationship between DXA and 4-CM for %BF measurement. Because of its ease of use, consistent relationship with 4-CM, and availability, we propose that DXA has the capacity for clinical application including prediction of metabolic abnormalities associated with excess %BF in pediatrics.
A Cost-Effectiveness Analysis of Bacterial Endocarditis Prophylaxis for Febrile Children Who Have Cardiac Lesions and Undergo Urinary Catheterization in the Emergency Department
Authors: Caviness A. Chantal , Cantor Scott B. , Allen Coburn H. , Ward Mark A. 
Published: August 2004

Objective. To prevent bacterial endocarditis (BE) in those at risk, the American Heart Association recommends antibiotics for patients who have a known urinary tract infection and are about to undergo urinary catheterization (UC). In young children who have cardiac lesions and undergo UC for fever without a source, the problem with prophylaxis only in the presence of infected urine is that the presence of urinary tract infection is unknown before testing. This study was conducted to determine the cost-effectiveness of BE prophylaxis before UC in febrile children aged 0–24 months with moderate-risk cardiac lesions.Methods. We evaluated the cost-effectiveness of BE prophylaxis compared with no prophylaxis from the societal perspective. Clinical outcomes were based on BE incidence and quality-adjusted life years (QALYs). Probabilities were derived from the medical literature. Costs were derived from national and local sources in US dollars for the reference year 2000, using a discount rate of 3%.Results. On the basis of the analysis, prophylaxis prevents 7 BE cases per 1 million children treated. When antibiotic-associated deaths were included, the no-prophylaxis strategy was more effective and less costly than the prophylaxis strategy. When antibiotic-associated deaths were excluded, amoxicillin cost $10 million per QALY gained and $70 million per case prevented. For vancomycin, it was $13 million per QALY gained and $95 million per case prevented. The results were robust to variations in the prophylactic efficacy of antibiotics, incidence of bacteremia after UC, incidence of BE after bacteremia, and costs associated with BE prophylaxis and treatment.Conclusion. In the emergency department, BE prophylaxis before UC in febrile children who are aged 0 to 24 months and have moderate-risk cardiac lesions is not a cost-effective use of health care resources.
Outcomes in Children and Young Adults Who Are Hospitalized for Firearms-Related Injuries
Authors: DiScala Carla , Sege Robert 
Published: August 2004

Objectives. To compare outcomes by intent of nonfatal firearms-related injuries in a hospitalized population, newborn to 19 years of age, and estimate the national incidence of ensuing disability.
Methods. Descriptive statistics and comparative analysis using χ2, odds ratio, and t test were applied to data from the National Pediatric Trauma Registry (NPTR) and the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission. Demographics, preinjury medical history, scene of injury, primary body part injured, severity of injury, utilization of resources, short-term and long-term disability, medical cause of disability, and disposition at discharge were studied.
Results. NPTR unintentional (n = 268) and assault-related firearms-related injuries (n = 506) were compared. In both groups, the majority of patients were male (80%). Compared with the unintentionally injured, the assaulted children were older and more frequently black (59.3% vs 32.5%). Approximately 17% in both groups had a preinjury history of medical/psychosocial problems. Unintentional injuries occurred mainly in private dwellings (75.7%), and assaults occurred in public places/street (53.8%). In both groups, injuries to multiple body regions were prevalent, and a substantial proportion sustained injuries of serious to critical level. Most children were transported by ambulance, but a significant proportion in the unintentional group were transported by helicopter. The rate of admission to the intensive care unit was ∼40% for both groups. The unintentionally injured had a higher rate of surgical intervention (66.8% vs 50.8%) and stayed in the hospital longer than the assaulted ones (median: 5 days vs 3 days). Almost half of the children in both groups were discharged with disability, and ∼87% returned to their home. Applying the NPTR disability rate to National Electronic Injury Surveillance System estimates of hospitalization suggests that ∼3200 children nationwide develop disability from firearms-related injuries annually.
Conclusions. Nonfatal firearms-related injuries in a pediatric population are associated with a high use of medical resources and lasting disability. Public policies should be developed and implemented to reduce the occurrence of these catastrophic events.
Depressive Symptoms and Health Risk Among Rural Adolescents
Authors: Burns James J. , Cottrell Lesley , Perkins Kathaleen , Pack Robert , Stanton Bonita , Hobbs Gerald , Hobby Lela , Eddy Derrick , Hauschka Andrew 
Published: August 2004

Objective. To determine the stability of depression and its relationship with health risk factors among rural adolescents.Methods. A clinic-based longitudinal study was conducted to test for depression and risk factors in 64 participants who attended a rural, primary care, adolescent medicine clinic. The primary measure of risk and depression was the Perkins Adolescent Risk Screen (PARS). Adolescent patients who were aged 12 to 18 years and had PARS assessments during a previous visit to the adolescent clinic were invited to complete a follow-up PARS assessment.Results. The mean age of adolescents at baseline was 12.79 years; 14.59 years at follow-up. With age and gender being controlled, adolescent depression and various adolescent risk indices were significantly related at baseline. Longitudinally, baseline depression score on PARS were related to follow-up: depression, school problems, substance abuse, tobacco use, sexual activity, and violent behavior scores and a history of physical/sexual abuse. On multivariate analysis controlling for other significantly associated variables, the relationship persisted for baseline depression and follow-up: tobacco, substance abuse, depression, and history of physical/sexual abuse.Conclusion. This study confirms a strong longitudinal relationship between baseline depressive symptoms and several important risk behaviors/factors measured at follow-up in a clinic population of rural adolescents. Also, longitudinal stability of depression over time is supported.
Comparison of Two Educational Interventions on Pediatric Resident Auscultation Skills
Authors: Mahnke C. Becket , Nowalk Andrew , Hofkosh Dena , Zuberbuhler James R. , Law Yuk M. 
Published: August 2004

Objective. Multiple cross-sectional physician surveys have documented poor cardiac auscultation skills. We evaluated the impact of 2 different educational interventions on pediatric resident auscultation skills.Methods. The auscultation skills of all first-year (PGY1; n = 20) and second-year pediatric residents (PGY2; n = 20) were evaluated at the beginning and end of the academic year. Five patient recordings were presented: atrial septal defect, ventricular septal defect, pulmonary valve stenosis, bicuspid aortic valve with insufficiency, and innocent murmur. Residents were asked to classify the second heart sound, identify a systolic ejection click, describe the murmur, and provide a diagnosis. All PGY1 and most PGY2 (14 of 20) participated on the inpatient cardiology service for 1 month. PGY2 on the cardiology service also attended outpatient clinic. PGY1 did not attend outpatient clinic but were allotted 2 hours/week to use a self-directed cardiac auscultation computer teaching program.Results. Resident auscultation skills on initial evaluation were dependent on training level (PGY1: 42 ± 15% correct; PGY2: 53 ± 13% correct), primarily as a result of better classification of second heart sound (PGY1: 45%; PGY2: 63%) and diagnosis of an innocent murmur (PGY1: 35%; PGY2: 65%). There was no difference in the ability to identify correctly a systolic ejection click (20% vs 23%) or to arrive at the correct diagnosis (35% vs 40%). At the end of the academic year, the PGY1 scores improved by 21%, primarily as a result of improved diagnostic accuracy of the innocent murmur (35% to 65%). PGY2 scores remained unchanged (53% vs 51%), regardless of participation in a cardiology rotation (cardiology rotation: 50%; no cardiology rotation: 51%). Combined, diagnostic accuracy was best for ventricular septal defect (55%) and innocent murmur (60%) and worst for atrial septal defect (18%) and pulmonary valve stenosis (15%). However, 40% identified the innocent murmur as pathologic and 21% of pathologic murmurs were diagnosed as innocent.Conclusions. Pediatric resident auscultation skills were poor and did not improve after an outpatient cardiology rotation. Auscultation skills did improve after the use of a self-directed cardiac auscultation teaching program. These data have relevance given the American College of Graduate Medical Education's emphasis on measuring educational outcomes and documenting clinical competencies during residency training.
Does Pediatric Surgical Specialty Training Affect Outcome After Ramstedt Pyloromyotomy? A Population-Based Study
Authors: Langer Jacob C. , To Teresa 
Published: August 2004

Objective. Ramstedt pyloromyotomy is a common operation in infants and is often done by general surgeons. We wished to determine whether there are any differences in outcome when this procedure is done by subspecialist pediatric general surgeons as compared with general surgeons.
Methods. All Ramstedt pyloromyotomies in the province of Ontario between 1993 and 2000 were reviewed. Children with complex medical conditions or prematurity were excluded. Cases done by general surgeons were compared with those done by pediatric surgeons, specifically examining hospital stay and complications.
Results. Of 1777 eligible infants, 67.9% were operated on by pediatric surgeons and 32.1% by general surgeons. Total and postoperative lengths of stay were longer in the general surgeon group compared with the pediatric surgeons (4.31 vs 3.50 days for length of stay; 2.95 vs 2.25 days for postoperative length of stay). The general surgeons had a higher overall complication rate (4.18% vs 2.58%). The incidence of duodenal perforation among general surgeons was almost 4 times that of pediatric surgeons (relative risk: 3.65; 95% confidence interval: 1.43-9.32). Of the 4 infants who required repeat surgery because of an incomplete pyloromyotomy, all were originally operated on by a general surgeon. Analysis of the effect of surgeon volume on outcomes suggested that higher volume resulted in better outcome in both groups.
Conclusion. Subspecialist pediatric general surgeons achieve superior outcomes for children who undergo Ramstedt pyloromyotomy.
Placenta Growth Factor Elevation in the Cord Blood of Premature Neonates Predicts Poor Pulmonary Outcome
Authors: Tsao Po-Nien , Wei Shu-Chen , Su Yi-Ning , Lee Chien-Nan , Chou Hung-Chieh , Hsieh Wu-Shiun , Hsieh Fon-Jou 
Published: August 2004

Objective. To determine whether an elevated placenta growth factor (PlGF) level in cord blood is associated with increased risk for preterm infants to develop bronchopulmonary dysplasia (BPD).
Methods. Sixty-three preterm infants who were born at 34 weeks' gestation or earlier were enrolled. Two infants who died before 28 days' postnatal age could not be assigned a BPD status and were excluded. PlGF levels in cord blood were measured using enzyme-linked immunosorbent assay. Mann-Whitney rank sum test, Spearman correlation coefficients, and multivariable linear or logistic regression analyses were used for statistical analysis.
Results. The BPD group had a higher PlGF level, lower gestational age, lower birth weight (BW), higher incidence of endotracheal tube intubation, and longer duration of intubation. The PlGF levels in cord blood correlated negatively with gestational age and BW. However, multivariable logistic regression analyses revealed that only elevated cord blood PlGF levels and BW were associated with BPD after adjusting for all contributing factors. Furthermore, an increased PlGF level in cord blood was significantly correlated with the clinical severity of BPD, as measured by duration of intubation. At 17 mg/dL, the specificity of cord blood PlGF level in predicting BPD was 95%, the sensitivity was 53%, the positive predictive value was 83%, and the negative predictive value was 82%.
Conclusions. Measuring cord blood PlGF level at birth might be a biological marker for predicting the occurrence of BPD and allowing early therapeutic intervention.
Initial and Follow-up Costs by Treatment Outcome for Children With Respiratory Infections
Authors: Howard David H. , McGowan John E. 
Published: August 2004

Objective. To estimate the initial and follow-up costs of treatment of respiratory infections among pediatric patients and the relationship between costs and outcomes.
Methods. A total of 3677 episodes of care from 2328 patients who were &lt;17 years of age and had respiratory or ear infections that were treated with an antibiotic initially. The sample was drawn from the Medical Expenditure Panel Surveys for the years 1996 through 1999. Treatment failure was defined as the receipt of a second antibiotic, different from the first, in a 4-week window. We compared follow-up costs by outcome (treatment failure vs success) using a 2-part model of medical costs. We also performed a paired analysis by selecting 2 episodes, one in which the outcome was failure and the other in which the outcome was success, for patients with at least 1 of each type and computing the difference in costs.
Results. Follow-up costs for provider visits for episodes for which the patient experienced treatment failure were $216 versus $53 for episodes for which the patient did not experience treatment failure. Follow-up drug costs, including the cost of the second antibiotic, were $75 for children who experienced treatment failure versus $23, respectively. Cost estimates from the paired analysis were similar, confirming that results are not biased by unobserved time-invariant patient characteristics.
Conclusion. Children who have respiratory infections and experience treatment failure incur substantially higher costs.