bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Safety of Acetaminophen and Ibuprofen Among Children Younger Than Two Years Old
Authors: Lesko Samuel M. , Mitchell Allen A. 
Published: August 2004

Background.
Recently ibuprofen has been introduced as a nonprescription analgesic/antipyretic for use in children.

Objective.
To compare the incidence of serious adverse clinical events among children &lt;2 years old given ibuprofen and acetaminophen to control fever.

Study Design.
A practitioner-based, randomized clinical trial. A total of 27 065 febrile children were randomized to receive acetaminophen (12 mg/kg), ibuprofen (5 mg/kg), or ibuprofen (10 mg/kg). Rates of hospitalization for acute gastrointestinal bleeding, acute renal failure, anaphylaxis, Reye's syndrome, asthma, bronchiolitis, and vomiting/gastritis were compared by randomization group.

Results.
The risk of hospitalization with any diagnosis in the 4 weeks after enrollment was 1.4% (95% confidence interval, 1.3%–1.6%) and did not vary by antipyretic assignment. No children were hospitalized for acute renal failure, anaphylaxis, or Reye's syndrome. Three children were hospitalized with gastrointestinal bleeding; all 3 had been assigned to treatment with ibuprofen. The risk of hospitalization with gastrointestinal bleeding among children randomized to ibuprofen was 17 per 100 000 (95% confidence interval, 3.5–49 per 100 000) but was not significantly greater than the risk among children given acetaminophen. The risk of hospitalization with asthma, bronchiolitis, or vomiting/gastritis did not differ by antipyretic assignment.

Conclusions.
The risk of serious adverse clinical events among children &lt;2 years old receiving short-term treatment with either acetaminophen or ibuprofen suspension was small and did not vary by choice of medication. These data do not provide any information on the safety of these medications when used for prolonged periods or when used together, regardless of duration.
Intact Survival in Extremely Low Birth Weight Infants After Delivery Room Resuscitation
Authors: Finer Neil N. , Tarin Thomas , Vaucher Yvonne E. , Barrington Keith , Bejar Raul 
Published: August 2004

Objective.None of the 20 previously reported infants weighing &lt;750 g at birth who received cardiopulmonary resuscitation (CPR) in the delivery room (DR) survived. To clarify whether such resuscitation is futile in our center, we evaluated our experience with DR-CPR over a 4-year period.Study Design.We retrospectively reviewed the outcomes of all inborn infants with birth weights &lt;1000 g at University of California, San Digeo Medical Center from January 1993 to December 1996. Surviving infants and matched control infants were followed for ≤40 months' adjusted age using standardized neurodevelopmental assessments.Results.Of the infants with birth weight &lt;1000 g born during this period, 29% (51/177) died, including 44% of those &lt;750 g and 16% of those ≥750 g. Overall, 19 infants received DR-CPR, of whom 12 were &lt;750 g. Of the infants who received DR-CPR, 79% (15/19) survived, including 10 of 13 infants &lt;750 g and 5 of 6 infants ≥750 g. Of the 15 survivors, 10 were followed beyond 10 months' adjusted age (median: 28 months). At last examination, 70% were both neurologically and developmentally normal. Two infants had cerebral palsy with mild cognitive and severe motor developmental delay. Of 7 infants with birth weight &lt;750 g, 6 had normal neurodevelopmental outcomes. The mean composite mental and motor scores of DR-CPR survivors were 93 ± 10 and 89 ± 25, respectively. No differences were found in neurologic or developmental outcome between DR-CPR survivors and control infants matched for gestational age, sex, and year of birth.Conclusions.Our results indicate that intact survival is possible for infants weighing &lt;750 g at birth after DR-CPR.
The Validity of the Uriscreen Test for Early Detection of Urinary Tract Infection in Children
Authors: Waisman Yehezkel , Zerem Elisheva , Amir Lisa , Mimouni Marc 
Published: August 2004

Objective.
To determine the validity of the Uriscreen, a rapid diagnostic test based on the detection of urine catalase for the early detection of urinary tract infection (UTI) in children, compared with standard urinalysis and dipstick tests.

Study Design.
Cross-sectional study.

Study Population.
Children 1 month to 17 years of age who presented to the emergency department of a pediatric tertiary care center between March and November of 1996 with symptoms suggestive of UTI.

Methods.
Urine specimens obtained from a random sample of 121 patients were evaluated simultaneously for possible UTI by Uriscreen (catalase test), urinalysis (microscopic pyuria), dipstick (leukocyte esterase and nitrite), and quantitative urine culture. All specimens were collected by one of three sterile techniques (midstream void technique, bladder catheterization, or suprapubic aspiration), as appropriate for age, and tested immediately. Using the quantitative urine culture as the gold standard (reference test), the sensitivity, specificity, and positive and negative predictive values of all the screening tests were determined and compared. Age, sex, temperature, presenting symptoms, and method of urine collection were recorded for each participant.

Results.
Of the 121 patients, 35 (28.9%) had positive culture results: 30 girls (85.7%) and 5 boys (14.3%). Compared with urinalysis and dipstick tests, Uriscreen had the highest sensitivity (100% vs 88.6% and 97.1%, respectively) and the highest negative predictive value (100% vs 95% and 98.6%, respectively), but the poorest specificity (68.6% vs 88.4% and 82.5%, respectively) and positive predictive value (56.4% vs 75.6% and 69.4%, respectively).

Conclusions.
The clinical use of Uriscreen for the presumptive diagnosis of UTI in children is limited and not significantly superior to urinalysis or the dipstick test. However, because of its 100% sensitivity and negative predictive value and its ease of use, rapidity, and low cost, it is recommended highly for ruling out the diagnosis of UTI. In laboratories, a negative Uriscreen result may prevent the need for performing expensive urine cultures.
Smoking During Pregnancy and Hospitalization of the Child
Authors: Wisborg Kirsten , Henriksen Tine Brink , Obel Carsten , Skajaa Elisabet , Østergaard John R. 
Published: August 2004

Objectives.To study the association between smoking during pregnancy and hospitalization of the child before 8 months of age.Design.A follow-up study of 1974 children born in 1991 and 1992.Results.Overall, 158 (8%) of the children were hospitalized during the first 8 months of life. Compared with children whose mothers did not smoke during pregnancy, children with mothers who smoked 1 to 14 cigarettes per day had no increased risk of being hospitalized (relative risk: 1.1; 95% confidence interval: 0.8–1.5), whereas children whose mothers smoked 15 or more cigarettes per day had twice as high a risk of being hospitalized (relative risk: 2.0; 95% confidence interval: 1.2–3.3). When only hospitalizations before 2 months of age were analyzed, smoking during pregnancy was associated an increased risk similar to that described above. Hospitalization of the child was independent of the smoking habits of the father, and an increased risk of hospitalization associated with smoking was found not only among children with symptoms from the respiratory system but also among children with symptoms from the gastrointestinal system and the skin. The association between smoking during pregancy and hospitalization of the child persisted after adjustment for postpartum smoking habits and a number of socio-demographic and lifestyle factors.Conclusions.Smoking 15 or more cigarettes per day during pregnancy influenced the health of the children, and several points indicated that the effect of in utero exposure was independent of postpartum smoking habits. If all pregnant women smoking 15 or more cigarettes per day stopped smoking, ∼5% of all admissions to hospitals before 8 months of age could be avoided. smoking during pregnancy, hospitalization of children.
Parent-reported Language and Communication Skills at One and Two Years of Age in Relation to Otitis Media in the First Two Years of Life
Authors: Feldman Heidi M. , Dollaghan Christine A. , Campbell Thomas F. , Colborn D. Kathleen , Kurs-Lasky Marcia , Janosky Janine E. , Paradise Jack L. 
Published: August 2004

Objective.As part of a study of possible effects of early life otitis media on children's development, we attempted to determine whether levels of language and communication skills at 1 and 2 years of age are associated with the cumulative duration of middle ear effusion (MEE) in the first 2 years of life.Methods.Subjects (N = 2156) were followed at one of eight study sites in the Pittsburgh area. Middle ear status was monitored closely throughout the first 2 years of life. For each child, the cumulative percentage of days with MEE was estimated based on diagnoses at visits and interpolations for intervals between visits. For each child also, 1 or both parents completed the MacArthur Communicative Development Inventory–Words and Gestures (CDI–WG) when the child was 1 year of age and the MacArthur Communicative Development Inventory–Words and Sentences (CDI–WS) when the child was 2 years of age.Results.Unadjusted correlations between scores on the CDI–WG and percentage of days with MEE in the first year of life were close to zero, and there were no statistically significant negative correlations. Unadjusted correlations between scores on the CDI–WS and the cumulative percentage of days with MEE in year 2 and in years 1 and 2 combined were generally negative and statistically significant, but the magnitudes of those correlations were no higher than 0.09. After adjustment for sociodemographic variables, only the Vocabulary Production Scale of the CDI–WS remained correlated significantly with the percentage of days with MEE, and the percentage of days with MEE accounted for only a negligible percentage of the variance in scores on this scale.Conclusions.In this diverse sample of children, parent-reported levels of language skills at 1 and 2 years of age were correlated negligibly with the cumulative percentage of days with MEE in the children's first and second years of life. otitis media, otitis media with effusion, language, communication.
The Changing Pattern of Neonatal Mortality in a Regionalized System of Perinatal Care: A Current Update
Authors: Hein Herman A. , Lofgren Maria A. 
Published: August 2004

Objective.Our earlier studies about the changing pattern of neonatal mortality were based on data from 1978–1979 and 1982–1983. In this report, we provide a modern update of the causes of neonatal deaths to help focus prevention measures.Study Design.We reviewed neonatal deaths for the years 1995 and 1996 and assigned a clinical cause of death. Deaths were reviewed and analyzed by place of birth and death, according to level of care. We provided an estimate of the change in causes of death between 1982–1983 and 1995–1996 and calculated an idealized neonatal mortality rate for each level of care and for the entire state.Results.The major changes in causes of death occurred in the respiratory distress syndrome (RDS) and extremely low birth weight (ELBW) categories. RDS showed a substantial decline, but ELBW deaths increased by nearly the same amount that RDS declined. The idealized neonatal mortality rate calculations suggest that fewer potentially medically preventable deaths occur now than in 1982–1983. Currently, more neonatal deaths of level I births occur in level III facilities than in 1982–1983. However, at that time, Iowa had only one tertiary facility, and the level II regional hospitals were the site of more deaths.Conclusion.We believe that assigning deaths to a clinical category rather than to a catastrophic final event helps focus on sources of preventable death in the medical care system. To reduce neonatal mortality, the incidence of lethal congenital malformations and ELBW infants must be impacted.
Determination of Timing of Brain Injury in Preterm Infants With Periventricular Leukomalacia With Serial Neonatal Electroencephalography
Authors: Hayakawa Fumio , Okumura Akihisa , Kato Toru , Kuno Kuniyoshi , Watanabe Kazuyoshi 
Published: August 2004

Objective.The aim of this study was to determine the timing of brain injury in infants with periventricular leukomalacia (PVL) with serial electroencephalography (EEG) recordings during the neonatal period.Patients and Methods.We evaluated 172 preterm infants having a gestational age &lt;33 weeks and weighing &lt;2000 g. Initial EEG was recorded within 72 hours of life and then recorded once every 1 to 4 weeks. Serial cranial ultrasonography was performed and cystic PVL was diagnosed when multiple cystic formations of &gt;3 mm in diameter were observed.Results.Of the172 infants studied, 26 were diagnosed as having cystic PVL by ultrasonography. EEG abnormalities were observed in 25 of 26 infants with PVL, although EEG abnormalities were seen in 20 of 146 infants without PVL. The initial EEG recordings were normal in 7 infants, but EEG abnormalities were observed later in 6 of these infants. In these 6 infants, the timing of injury was presumed to be postpartum. Only acute stage abnormalities were observed on initial EEG recording in 14 infants, and the timing of injury was presumed to be just before or around birth. Chronic stage abnormalities were recognized already on initial EEG recordings in the other 5 infants, and the timing of injury was presumed to be some time before birth.Conclusions.Our study indicates that it may be possible to determine the timing of injury in infants with PVL by serial EEG recordings.
Randomized Trial of Permissive Hypercapnia in Preterm Infants
Authors: Mariani Gonzalo , Cifuentes Javier , Carlo Waldemar A. 
Published: August 2004

Objective.To determine whether a ventilatory strategy of permissive hypercapnia (PHC) reduces the duration of assisted ventilation in surfactant-treated neonates weighing 601 to 1250 g at birth.Design.Forty-nine surfactant-treated preterm infants (birth weight: 854 ± 163 g; gestational age: 26 ± 1.4 weeks) receiving assisted ventilation were randomized during the first 24 hours of age to a PHC group (Paco2: 45–55 mm Hg) or to a normocapnia group (NC; Paco2: 35–45 mm Hg). The primary outcome measure was the total number of days on assisted ventilation. Uniform extubation and reintubation criteria were used for both groups. All patients received aminophylline before extubation.Results.The total number of days on assisted ventilation expressed as median (25th–75th percentiles) was 2.5 (1.5–11.5) in the PHC group and 9.5 (2.0–22.5) in the NC group (Mann-Whitney U test). The number of patients on assisted ventilation throughout the first 96 hours after randomization was lower in the PHC group (log rank test). During that period, the ventilated patients in the PHC group had a higher Paco2 and lower peak inspiratory pressure, mean airway pressure, and ventilator rate than did those in the NC group. The percentage of patients requiring reintubation within 24 hours postextubation (PHC 17% vs NC 28%) and supplemental oxygen at 28 days of life (PHC 43% vs NC 64%) and the total days of oxygen supplementation (PHC 15 [4–53] vs NC 32 [17–50]) did not differ between the groups. There were no differences in mortality, air leaks, intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity, or patent ductus arteriosus.Conclusion.A ventilatory strategy of PHC in preterm infants who receive assisted ventilation is feasible, seems safe, and may reduce the duration of assisted ventilation. assisted ventilation, respiratory distress syndrome, gentle ventilation, lung injury.
Assessment of Medical Personnel Exposure to Nitrogen Oxides During Inhaled Nitric Oxide Treatment of Neonatal and Pediatric Patients
Authors: Phillips Margaret L. , Hall Thomas A. , Sekar Krishnamurthy , Tomey Jeanine L. 
Published: August 2004

Objective.
This study was an assessment of potential exposures of medical personnel to nitrogen oxides during simulated and actual inhaled nitric oxide treatment of newborn and pediatric patients.

Design.
Breathing zone exposures to nitric oxide (NO) and nitrogen dioxide (NO2) were monitored using data-logging personal dosimeters during simulated and actual administration of NO gas to patients in an intensive care setting.

Sample.
A total of 28 bedside nurses and 18 respiratory therapists were monitored during 6 different patient treatments.

Analysis.
The highest measured concentrations of NO and NO2 in the personal breathing zones of the nurses and respiratory therapists were peak readings (&lt;1 minute in duration) of 6.7 parts per million (ppm) NO and 3.1 ppm NO2. Exposures averaged throughout 15 minutes and throughout the work shift were below the limit of detection (0.8-ppm NO and 0.5-ppm NO2).

Conclusion.
Detectable exposures to NO and NO2were brief, infrequent, and well below Occupational Safety and Health Administration permissible exposure limits or any other exposure guideline, eg, American Conference of Governmental Hygienists Threshold Limit Values.
Level of In Utero Cocaine Exposure and Neonatal Ultrasound Findings
Authors: Frank Deborah A. , McCarten Kathleen M. , Robson Caroline D. , Mirochnick Mark , Cabral Howard , Park Henry , Zuckerman Barry 
Published: August 2004

Objective. To assess whether there is an association between the level of in utero cocaine exposure and findings on neonatal cranial ultrasound, controlling for potentially confounding variables.Study Design.In a prospective longitudinal study, three cocaine exposure groups were defined by maternal report and infant meconium assay: unexposed, heavier cocaine exposure (&gt;75th percentile self-reported days of use or of meconium benzoylecogonine concentration) or lighter cocaine exposure (all others). Neonatal ultrasounds from 241 well, term infants were read by a single radiologist who was masked to the exposure group.Results.Infants with lighter cocaine exposure did not differ from the unexposed infants on any ultrasound findings. After controlling for infant gender, gestational age, and birth weightz scores and for maternal parity, blood pressure in labor, ethnicity, and use of cigarettes, alcohol, and marijuana during pregnancy, the more heavily cocaine-exposed infants were more likely than the unexposed infants to show subependymal hemorrhage in the caudothalamic groove (covariate adjusted odds ratio: 3.88; 95% confidence interval: 1.45, 10.35).Conclusions.This is the first study to demonstrate that ultrasound findings suggestive of vascular injury to the neonatal central nervous system are related to the level of prenatal cocaine exposure. Inconsistency in previous research in identifying an association between prenatal cocaine exposure and neonatal cranial ultrasound findings may reflect failure to consider dose effects.
The Treatment of Neurologically Impaired Children Using Patterning
Authors:   Committee on Children With Disabilities
Published: August 2004

This Policy Statement was retired December 2022.
This statement reviews patterning as a treatment for children with neurologic impairments. This treatment is based on an outmoded and oversimplified theory of brain development. Current information does not support the claims of proponents that this treatment is efficacious, and its use continues to be unwarranted.
Natural History of Human Immunodefiency Virus Type 1 Infection in Children: A Five-Year Prospective Study in Rwanda
Authors: Spira Rosemary , Lepage Philippe , Msellati Philippe , Van de Perre Philippe , Leroy Valeriane , Simonon Arlette , Karita Etienne , Dabis François ,   for the Mother-to-Child HIV-1 Transmission Study Group
Published: August 2004

Objective.To compare morbidity and mortality of human immunodeficiency virus type 1 (HIV-1)-infected and HIV-1-uninfected children and to identify predictors of acquired immunodeficiency syndrome (AIDS) and death among HIV-1-infected children in the context of a developing country.Design.Prospective cohort study.Setting.Maternal and child health clinic of the Centre Hospitalier de Kigali, Rwanda.Participants.Two hundred eighteen children born to HIV-1-seropositive mothers and 218 born to seronegative mothers of the same age and parity were enrolled at birth.Outcome Measures.Deaths, clinical AIDS, nonspecific HIV-related manifestations, and use of health care services.Results.Fifty-four infected and 347 uninfected children were followed up for a median of 27 and 51 months, respectively. With the exception of chronic cough, the risk of occurrence of nonspecific HIV-related conditions was 3 to 13 times higher in infected than in uninfected children. The recurrence rate and severity of these findings were increased systematically in infected infants. Estimated cumulative risk of developing AIDS was 28% and 35% at 2 and 5 years of age, respectively. Estimated risk of death among infected children at 2 and 5 years of age was 45% and 62%, respectively, a rate 21 times higher than in uninfected children. Median survival time after estimated infection was 12.4 months. Early infection, early onset of HIV-related conditions, failure to thrive, and generalized lymphadenopathy were associated with subsequent risk of death and/or AIDS, whereas lymphoid interstitial pneumonitis was predictive of a milder disease.Conclusions.In Africa, HIV-1-infected children develop disease manifestations early in life. Specific clinical findings are predictive of HIV-1 disease, AIDS stage, and death. Bimodal expression of HIV-1 pediatric disease is encountered in Africa, as in industrialized countries, but prognosis is poorer. human immunodeficiency virus infection, children, vertical transmission, natural history, Africa.