bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Usage of Pediatric Information on the Internet: The Virtual Children's Hospital
Authors: D'Alessandro Donna M. , Kreiter Clarence D. 
Published: August 2004

Objective.
Digital health sciences libraries (DHSLs) bring order to the chaos of the Internet by making authoritative medical information easily and conveniently available to patrons. The goal of this project was to perform a baseline usage analysis of the pediatric-related information in a general DHSL and to determine whether reorganization of the pediatric-related information into its own pediatric DHSL could increase the usage of the pediatric-related information.

Methods.
From March through August 1997, a baseline analysis of a general DHSL (Virtual Hospital) was conducted using computer server log file analysis programs. The quantity of pediatric-related information in the general DHSL and its baseline usage were determined. In September 1997, the pediatric-related information was reorganized into its own pediatric DHSL (Virtual Children's Hospital), and server log file analyses were conducted of the pediatric DHSL from September 1997 to August 1998. Statistical analysis was performed by time series autoregression.

Results.
During the baseline, the general DHSL and the pediatric-related information received a monthly average of 2 320 782 and 141 444 qualified hits, respectively. After the intervention, the general DHSL and the pediatric DHSL received a monthly average of 2 765 454 and 256 998 qualified hits, respectively. This is an increase of 19.2% for the general DHSL and 81.7% for the pediatric DHSL. These changes were statistically significant at theP &gt; .0001 level. The most requested pediatric-related content in the pediatric DHSL did not change substantively from preintervention to postintervention.

Discussion.
On the Internet, as in real life, children's services must have their own distinct identity and must be differentiated from adult services. Therefore, pediatric-related information will receive increased usage if it is part of a pediatric DHSL rather than part of a general DHSL. Others can use this process and the lessons learned to develop and enhance their own pediatric-related information on the Internet. Internet, pediatrics, digital health sciences libraries, digital library, medical library.
Increased Susceptibility to Measles in Infants in the United States
Authors: Papania Mark , Baughman Andrew L. , Lee Susan , Cheek James E. , Atkinson William , Redd Stephen C. , Spitalny Kenneth , Finelli Lyn , Markowitz Lauri 
Published: August 2004

Background.
Women born in the United States after measles vaccine licensure in 1963 transfer less measles antibody to their infants than do older women. This may result in increased susceptibility to measles among infants.

Objective.
To determine the effect of maternal year of birth on the risk for measles in infants.

Methods.
We enrolled 128 unvaccinated infants ≤15 months of age who had documented exposure to measles from 1990 through 1992 in a retrospective cohort study. We interviewed their mothers by telephone to obtain demographic data, medical and vaccination history, and details of measles exposure and outcome. We used logistic regression analysis to estimate the effect of maternal year of birth.

Results.
Infants whose mothers were born after 1963 had a measles attack rate of 33%, compared with 12% for infants of older mothers. In logistic regression analysis, the adjusted odds ratio for maternal year of birth (born after 1963) was 7.5 (95% confidence interval 1.8, 30.6). Other significant risk factors were older infant age, mothers who developed measles after delivery, and exposure within 2 days of the rash onset of the exposing case.

Conclusions.
Infants whose mothers were born after 1963 are more susceptible to measles than are infants of older mothers. An increasing proportion of infants born in the United States may be susceptible to measles. Infants at high risk of exposure to measles should be vaccinated at 12 months of age. Vaccination programs that reduce transmission of the measles virus in the general population reduce the risk of infant exposure to measles.
Weight Gain in Infants Breastfed by Mothers Who Take Fluoxetine
Authors: Chambers Christina D. , Anderson Philip O. , Thomas Ronald G. , Dick Lyn M. , Felix Robert J. , Johnson Kathleen A. , Jones Kenneth Lyons 
Published: August 2004

Objective.Despite the manufacturer's recommendation that fluoxetine not be used by women while breastfeeding, many women choose to do so. There is little information available in the literature to suggest that this practice is or is not safe. The purpose of this study was to examine weight gain in infants who are breastfed by mothers who take fluoxetine, compared with weight gain in infants who are breastfed by mothers who do not take any psychotherapeutic medication. A secondary goal was to assess the frequency of reported side effects in infants who are breastfed by mothers who take fluoxetine.Methodology.A retrospective cohort study design was used. Subjects were identified from an ongoing pregnancy outcome study conducted through the California Teratogen Information Service and Clinical Research Program. A total of 64 women were interviewed who had taken fluoxetine during a pregnancy between the 1989 and 1997; 26 of these women breastfed their infants and continued to take the medication, and 38 breastfed their infants but did not take the medication. Postnatal weight gain was taken from pediatric records, and the frequency of side effects was measured by maternal response to the interview questionnaire.Results.Using linear regression analysis, the infants who were breastfed by mothers taking fluoxetine demonstrated a growth curve significantly below that of infants who were breastfed by mothers who did not take the drug. The average deficit in measurements taken between 2 weeks and 6 months of age was 392 g (95% confidence interval: −5, −780). Using a repeated measures analysis of covariance for those infants with more than one postnatal weight measurement available, the difference between the two groups was similar, ∼1.2 standard deviations (P = .005). In response to interview questions regarding side effects, no mother who breastfed her infant while taking fluoxetine reported any unusual symptoms that could be attributed to the medication.Conclusions.These data do not suggest that women who breastfeed while taking fluoxetine are likely to note unusual behavior in their infants that they consider related to use of the medication. However, although there was no excess of infants in the fluoxetine group with postnatal weight measurements &gt;2 standard deviations below the mean, these data indicate that breastfeeding while taking fluoxetine is associated with reduced growth that may be of clinical importance in situations in which infant weight gain is already of concern.
Annual Summary of Vital Statistics—1998
Authors: Guyer Bernard , Hoyert Donna L. , Martin Joyce A. , Ventura Stephanie J. , MacDorman Marian F. , Strobino Donna M. 
Published: August 2004

Most vital statistics indicators of the health of Americans were stable or showed modest improvements between 1997 and 1998. The preliminary birth rate in 1998 was 14.6 births per 1000 population, up slightly from the record low reported for 1997 (14.5). The fertility rate, births per 1000 women aged 15 to 44 years, increased 1% to 65.6 in 1998, compared with 65.0 in 1997. The 1998 increases, although modest, were the first since 1990, halting the steady decline in the number of births and birth and fertility rates in the 1990s.Fertility rates for total white, non-Hispanic white, and Native American women each increased from 1% to 2% in 1998. The fertility rate for black women declined 19% from 1990 to 1996, but has changed little since 1996. The rate for Hispanic women, which dropped 2%, was lower than in any year for which national data have been available. Birth rates for women 30 years or older continued to increase. The proportion of births to unmarried women remained about the same at one third.The birth rate for teen mothers declined again for the seventh consecutive year, and the use of timely prenatal care (82.8%) improved for the ninth consecutive year, especially for black (73.3%) and Hispanic (74.3%) mothers.The number and rate of multiple births continued their dramatic rise; the number of triplet and higher-order multiple births jumped 16% between 1996 and 1997, accounting, in part, for the slight increase in the percentage of low birth weight (LBW) births. LBW continued to increase from 1997 to 1998 to 7.6%.The infant mortality rate (IMR) was unchanged from 1997 to 1998 (7.2 per 1000 live births). The ratio of the IMR among black infants to that for white infants (2.4) remained the same in 1998 as in 1997. Racial differences in infant mortality remain a major public health concern. In 1997, 65% of all infant deaths occurred to the 7.5% of infants born LBW. Among all of the states, Maine, Massachusetts, and New Hampshire had the lowest IMRs. State-by-state differences in IMR reflect racial composition, the percentage LBW, and birth weight-specific neonatal mortality rate for each state. The United States continues to rank poorly in international comparisons of infant mortality.Expectation of life at birth increased slightly to 76.7 years for all gender and race groups combined. Death rates in the United States continue to decline, including a drop in mortality from human immunodeficiency virus. The age-adjusted death rate for suicide declined 6% in 1998; homicide declined 14%. Death rates for children from all major causes declined again in 1998. A large proportion of childhood deaths, however, continue to occur as a result of preventable injuries.
The Effect of Passenger Airbags on Child Seating Behavior in Motor Vehicles
Authors: Wittenberg Eve , Nelson Toben F. , Graham John D. 
Published: August 2004

Objective.
The purpose of this study was to determine the effect of the presence of passenger airbags on places where children sit when traveling in motor vehicles.

Methodology.
An observational and driver interview survey of 503 passenger vehicles was conducted in five New England states at randomly selected long- and short-distance travel sites during the summer of 1998. Each vehicle was occupied by at least 1 child &lt;13 years of age. Seating position, vehicle information, and driver and passenger characteristics were collected. Logistic regression analysis was used to identify the association between the presence of passenger airbags in vehicles and the seating positions of children.

Results.
Controlling for the effects of the driver and vehicle characteristics, children &lt;13 years of age were less likely to be observed riding in the front right seat when a passenger airbag was present in the vehicle (odds ratio: .34; 95% confidence interval: .19–.61). Of the vehicles carrying children, 23% had at least 1 child riding in the front seat. Children rode in the front seat in 17% of vehicles with a passenger airbag, and in 30% of those without a passenger airbag. Half of all vehicles without a teenage or adult passenger carried a child in the front seat. In 91% of vehicles with a child riding in the front seat, there was at least one available seat in the rear. Driver safety belt use, younger child age, and the presence of an adult passenger in the vehicle were all associated with children being seated in the rear.

Conclusions.
Some New England drivers are protecting children from the risks of passenger airbags by seating them in the rear. There remains, however, a substantial number of children who are being exposed to the risk of passenger airbag deployment.
Prophylaxis Against Early Adrenal Insufficiency to Prevent Chronic Lung Disease in Premature Infants
Authors: Watterberg Kristi L. , Gerdes Jeffrey S. , Gifford Kathleen L. , Lin Hung-Mo 
Published: August 2004

Background.Many extremely low birth weight infants (&lt;1000 g) show biochemical evidence of adrenal insufficiency in the first week of life, correlating with subsequent development of chronic lung disease (CLD).Methods.We conducted a randomized, double-masked, placebo-controlled pilot study to test whether early treatment with low-dose hydrocortisone for 12 days (1 mg/kg/day for 9 days followed by .5 mg/kg/day for 3 days), begun before 48 hours of life, would increase the likelihood of survival without CLD.Results.Forty patients were enrolled at two centers. Birth weight and gestation were similar for treatment and placebo groups: 732 ± 135 g versus 770 ± 135 g and 25.2 ± 1.3 weeks versus 25.4 ± 1.5 weeks. More infants treated with hydrocortisone achieved study success, defined as survival without supplemental oxygen at 36 weeks' postconception (12/20 [60%] vs 7/20 [35%]). Lower birth weight, histologic chorioamnionitis, and preeclampsia were significant risk factors, whereas study center, prenatal steroids, sex, and ethnicity were not significant. Hydrocortisone treatment decreased days on &gt;40% oxygen, days on &gt;25% oxygen, days on ventilator, and oxygen at discharge. Among infants exposed to chorioamnionitis, hydrocortisone treatment also was associated with increased enteral intake during the first month of life and with increased weight at 36 weeks' postconception. Five treated infants and 6 placebo infants developed sepsis; 3 in each group died.Conclusions.First, early treatment with low-dose hydrocortisone in this population of extremely low birth weight infants increased the likelihood of survival without CLD. Second, the benefit was particularly apparent in infants with chorioamnionitis. Third, a larger multicenter trial is needed to verify the primary outcome and to better evaluate risks and benefits.
Human Immunodeficiency Virus and Other Blood–borne Viral Pathogens in the Athletic Setting
Authors:   Committee on Sports Medicine and Fitness
Published: August 2004

This Policy Statement was retired September 2019.
Because athletes and the staff of athletic programs can be exposed to blood during athletic activity, they have a very small risk of becoming infected with human immunodeficiency virus, hepatitis B virus, or hepatitis C virus. This statement, which updates a previous position statement of the American Academy of Pediatrics,1 discusses sports participation for athletes infected with these pathogens and the precautions needed to reduce the risk of infection to others in the athletic setting. Each of the recommendations in this statement is dependent upon and intended to be considered with reference to the other recommendations in this statement and not in isolation.
Neisseria gonorrhea Infections in Girls Younger Than 12 Years of Age Evaluated for Vaginitis
Authors: Shapiro Robert A. , Schubert Charles J. , Siegel Robert M. 
Published: August 2004

Objective.
This study examined the prevalence of gonorrhea in girls &lt;12 years of age who presented with vaginitis and in whom sexual abuse was not suspected.

Design.
A prospective, consecutive patient series was performed in a pediatric emergency department with 90 000 visits per year and in 2 affiliated pediatric continuity clinics. All girls (Tanner I or II) between the ages of 12 months and 12 years, presenting with a chief complaint of vaginal discharge, burning, pain, or itching, were enrolled (n = 93). Patients were excluded (n = 6) if there was a history of sexual abuse. The presence or absence of vaginal discharge, vaginal erythema, or trauma was recorded. Physicians were instructed to collect cultures forNeisseria gonorrhea (GC), Chlamydia trachomatis, and bacteria/yeast. Wet prep, urinalysis, urine culture, serum rapid plasma reagin, and fungal culture were obtained at the physician's discretion.

Results.
Of the girls, 43 had a vaginal discharge on examination. Of these girls, 4 (9%) had GC, 9 (26%) had group A, B, or F streptococcus and 1 had Staphylococcus aureus. Of the girls, 44 had no discharge on examination. In this group, 3 had streptococcus infection and 2 had Candida albicans. Both children with C albicans had been treated recently with systemic antibiotics. Those girls with a vaginal discharge on examination had a microbial etiology significantly more often than did those without discharge. All of the girls with infection were Tanner I on genital examination.

Conclusions.
The prevalence of unsuspected GC infection was high and emphasizes the importance of culturing Tanner I girls for GC when they have a vaginal discharge along with routine bacterial cultures. Testing and/or treating for C albicans should be considered when there has been recent antibiotic use. Girls with vaginal complaints but without vaginal discharge may have a bacterial infection, but such diagnoses occur less frequently than with girls who have a discharge.
Evaluation of the Effects of Oxandrolone on Malnourished HIV-Positive Pediatric Patients
Authors: Fox-Wheeler Sarah , Heller Linda , Salata Cathleen M. , Kaufman Francine , Loro M. Louisa , Gilsanz Vincente , Haight Michael , Umman Gwenn C. , Barton Norman , Church Joseph A. 
Published: August 2004

Objective.To determine the safety and efficacy of anabolic therapy to prevent or reverse wasting and malnutrition in human immunodeficiency virus (HIV)-infected pediatric patients. The anabolic steroid, oxandrolone, was evaluated because of its safe and effective use in other pediatric conditions.Methods.Nine HIV-positive children who were malnourished or at risk for malnutrition (4 females, 5 males; 4–14 years of age) took oxandrolone for 3 months (.1 mg/kg/day orally). Quantitative HIV ribonucleic acid polymerase chain reaction and CD4+ T-cell levels, complete blood cell count (CBC) and chemistry profile, endocrinologic studies, resting energy expenditure, respiratory quotient, nutritional measures, body composition assessment with quantitative computed tomography, and skinfold body composition measurements were determined before treatment, during treatment (3 months), and for 3 months after treatment. Statistical analyses were completed using the Friedman two-way analysis of variance and Spearman correlation tests.Results.No adverse clinical or laboratory events or changes in Tanner staging or virilization occurred. Quantitative HIV ribonucleic acid polymerase chain reaction and CD4+ T-cell levels did not change significantly. Insulin-like growth factor 1 increased, suggesting an anabolic effect of treatment. The rate of weight gain increased during treatment and was maintained after treatment. Linear growth continued and was maintained throughout treatment, whereas bone age did not increase significantly. Anthropometric assessments indicated an increase in muscle mass and a decrease in fat while patients were on treatment, and a mild decrease of muscle and increased fat posttreatment. Likewise, computed tomography scan results demonstrated similar changes in muscle mass. Resting energy expenditure and respiratory quotient remained stable throughout treatment and follow-up. No significant changes were seen in the quality of life questionnaire.Conclusions.Treatment with oxandrolone for 3 months in HIV-infected children was well-tolerated, safe, and associated with markers of anabolism. The latter effect was maintained partially for 3 months after discontinuation of a 3-month course of therapy. Additional studies are needed to assess the potential benefits and risks of a longer course of therapy or a higher dose of oxandrolone in HIV-infected children.
Plasma Creatinine Rises Dramatically in the First 48 Hours of Life in Preterm Infants
Authors: Miall Lawrence S. , Henderson Michael J. , Turner Alison J. , Brownlee Keith G. , Brocklebank J. Trevor , Newell Simon J. , Allgar Vicki L. 
Published: August 2004

Objective.Published data show that plasma creatinine falls steadily during the first 28 days of life and that creatinine levels in the neonatal period are higher in more premature infants. However, the best reference data commence on day 2 of life. The objective of this study was to document how plasma creatinine changes in the first 48 hours of life and to examine the reason for the apparently high levels of creatinine in preterm infants, compared with maternal levels.Design.A prospective observational study on a regional neonatal intensive care unit.Patients.A total of 42 preterm infants, mean gestational age of 29.4 weeks (range: 23–35), mean birth weight of 1.42 kg (.55–2.77), divided into 4 gestation groups: 23 to 26 weeks (n = 9), 27 to 29 weeks (n = 13), 30 to 32 weeks (n = 12), and 33 to 35 weeks (n = 8).Interventions.Measurement of plasma creatinine and urea concentration in cord blood and in serial samples taken for routine arterial blood gas analysis.Outcome Measurements.Changes in creatinine concentration with time and relationship to gestational age, birth weight, and illness severity.Results.Mean creatinine at birth was 73 μmol/L (95% confidence interval [CI]: 68–79 μmol/L). Plasma creatinine rose significantly over the first 48 hours. Mean peak creatinine in the most preterm infants (23–26 weeks) was 221 μmol/L (CI: 195–247 μmol/L). Peak plasma creatinine was inversely related to gestation (Spearman's coefficient: −.73) and birth weight (Spearman's coefficient: −.76). Significant differences in creatinine concentration were seen among different gestational groups at 24 and 48 hours of life. Peak creatinine correlated with a high Clinical Risk Index for Babies score (Spearman's coefficient: .64). The fall in creatinine began later in more premature infants. All 38 surviving infants had normal renal function; their mean plasma creatinine at discharge was 52 μmol/L (CI: 46–58 μmol/L).Conclusions.Rather than falling steadily from birth, creatinine rises dramatically in the first 48 hours of life, especially in infants of &lt;30 weeks' gestation. Even large rises in creatinine in the first 48 hours may be expected and should not be used in isolation to diagnose renal failure.
Steroid Therapy of a Proliferating Hemangioma: Histochemical and Molecular Changes
Authors: Hasan Qurratulain , Tan Swee T. , Gush Jason , Peters Sue G. , Davis Paul F. 
Published: August 2004

Objectives.
Hemangioma is a primary tumor of the microvasculature in which angiogenesis is initially excessive, followed by regression of the newly formed vessels. Intervention is necessary in up to 20% of cases, high-dose systemic or intralesional steroids being the first-line treatment. As the mechanism of action of steroids is unknown, we undertook an investigation of the cellular and molecular effects of their action.

Study Design.
A unique opportunity to study the effect of steroid treatment was presented when biopsy material was obtained from an infant with an ulcerated proliferating hemangioma before and after intralesional triamcinolone injection, which resulted in an accelerated regression of the lesion. Histochemical quantitation of mast cells, molecular analysis by reverse transcriptase-polymerase chain reaction (RT-PCR) for 7 growth factor transcripts and differential display RT-PCR (DD RT-PCR) were conducted.

Results.
After steroid therapy, the mast cell number increased (untreated x̄ = 2.22 ± .27 [standard error of the mean {SEM}]; treated x̄ = 8.7± .71 [SEM] mast cells per field, respectively;P &lt; .0001; n = 40 fields for each group), and the transcriptional expression of cytokines: platelet-derived growth factor-A and -B; interleukin-6; transforming growth factor-β1 and -β3 decreased, while that of basic fibroblast growth factor (bFGF) and vascular endothelial cell growth factor remained unaltered. Elevated urinary bFGF levels noted in cases of proliferating hemangioma, persisted even after steroid treatment. Using DD RT-PCR an amplicon that shared 100% sequence homology with the human mitochondrial cytochromeb gene was detected in the hemangioma biopsy after steroid treatment.

Conclusions.
The regression of this hemangioma subsequent to steroid therapy was accompanied by a significant increase in mast cell density, reduced transcription of several cytokines, and an enhanced expression of the mitochondrial cytochrome bgene.