bluuebunny/crossref_metadata_2025_split huggingface dataset:
Shifts in Percentiles of Growth During Early Childhood: Analysis of Longitudinal Data From the California Child Health and Development Study
Authors: Mei Zuguo , Grummer-Strawn Laurence M. , Thompson Diane , Dietz William H. 
Published: August 2004

Objective. To document growth-velocity changes across major percentiles during the preschool years.Design. Analyses of longitudinal data using height-for-age, weight-for-age, weight-for-height, and body mass index (BMI)-for-age percentiles were performed to examine crossing of major percentiles of the Centers for Disease Control and Prevention 2000 growth charts. The 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles were defined as the major percentiles.Setting. Data from the California Child Health and Development Study were used.Subjects. A total of 10 844 children up to 60 months of age, with 44 296 height and weight measurements, were included in our final analysis.Results. For height-for-age, 32% of children between birth and 6 months of age, 13% to 15% of children between 6 and 24 months of age, and 2% to 10% of children between 24 and 60 months of age crossed 2 major percentiles. For weight-for-age, 39% of children between birth and 6 months of age, 6% to 15% of children between 6 and 24 months of age, and 1% to 5% of children between 24 and 60 months of age crossed 2 major percentiles. In contrast, for weight-for-height, 62% of children between birth and 6 months of age, 20% to 27% of children between 6 and 24 months of age, and 6% to 15% of children between 24 to 60 months of age crossed 2 major percentiles. Similar to the pattern observed for weight-for-height, 8% to 15% of children between 24 and 60 months of age crossed 2 major BMI-for-age percentiles. During the preschool years, weight-for-height had the highest percentages of children who crossed 2 major percentiles, and weight-for-age had the lowest percentages of children who crossed 2 major percentiles among these 3 indices.Conclusions. Shifts in growth rates were very common for children from birth to 6 months of age, somewhat less common for children 6 to 24 months of age, and least common for children 24 to 60 months of age. Shifts in weight-for-height occurred more frequently than did other growth changes. Pediatricians must consider the prevalence of growth rate shifts during infancy and early childhood before they counsel parents regarding growth or refer children for additional evaluations of growth.
Measurement of Interleukin 8 in Combination With C-Reactive Protein Reduced Unnecessary Antibiotic Therapy in Newborn Infants: A Multicenter, Randomized, Controlled Trial
Authors: Franz Axel R. , Bauer Karl , Schalk Andreas , Garland Suzanne M. , Bowman Ellen D. , Rex Kerstin , Nyholm Calle , Norman Mikael , Bougatef Adel , Kron Martina , Mihatsch Walter Andreas , Pohlandt Frank ,   for the International IL-8 Study Group
Published: August 2004

Objective. Neonatal bacterial infections carry a high mortality when diagnosed late. Early diagnosis is difficult because initial clinical signs are nonspecific. Consequently, physicians frequently prescribe antibiotic treatment to newborn infants for fear of missing a life-threatening infection. This study was designed to test the hypotheses that a diagnostic algorithm that includes measurements of interleukin 8 (IL-8) and C-reactive protein (CRP) 1) reduces antibiotic therapy and 2) does not result in more initially missed infections compared with standard management that does not include an IL-8 measurement.Methods. Term and preterm infants who were &lt;72 hours of age and had clinical signs or obstetric risk factors suggesting neonatal bacterial infection but stable enough to wait for results of diagnostic tests were enrolled into the study. A total of 1291 infants were randomly assigned to receive antibiotic therapy according to the guidelines of each center (standard group) or to receive antibiotic therapy when IL-8 was &gt;70 pg/mL and/or CRP was &gt;10 mg/L (IL-8 group). The primary outcome variables were 1) the number of infants treated with antibiotics and 2) the number of infants with infections missed at the initial evaluation.Results. In the IL-8 group, fewer infants received antibiotic therapy than in the standard group (36.1% [237 of 656] vs 49.6% [315 of 635]). In the IL-8 group, 24 (14.5%) of 165 infants with infection were not detected at the initial evaluation, compared with 28 (17.3%) of 162 in the standard group.Conclusions. The number of newborn infants who received postnatal antibiotic therapy can be reduced with a diagnostic algorithm that includes measurements of IL-8 and CRP. This diagnostic strategy seemed to be safe.
Overweight Children and Adolescents: A Risk Group for Iron Deficiency
Authors: Nead Karen G. , Halterman Jill S. , Kaczorowski Jeffrey M. , Auinger Peggy , Weitzman Michael 
Published: August 2004

Background. The prevalence of obesity has increased at an epidemic rate, and obesity has become one of the most common health concerns in the United States. A few small studies have noted a possible association between iron deficiency and obesity.
Objective. To investigate the association between weight status, as measured by body mass index (BMI), and iron deficiency in a nationally representative sample of children and adolescents.
Design. National Health and Nutrition Examination Survey III (1988–1994) provides cross-sectional data on children 2 to 16 years of age. Recorded measures of iron status included transferrin saturation, free erythrocyte protoporphyrin levels, and serum ferritin levels. Children were considered iron-deficient if any 2 of these values were abnormal for age and gender. With the use of age- and gender-specific BMI percentiles, at risk for overweight was defined as a BMI of ≥85th percentile and &lt;95th percentile, and overweight was defined as a BMI of ≥95th percentile. The prevalence of iron deficiency was compared across weight groups. Logistic regression was used to estimate the association between iron status and overweight, controlling for age, gender, ethnicity, poverty status, and parental education level.
Results. In this sample of 9698 children, 13.7% were at risk for overweight and 10.2% were overweight. Iron deficiency was most prevalent among 12- to 16-year-old subjects (4.7%), followed by 2- to 5-year-old subjects (2.3%) and then 6- to 11-year-old subjects (1.8%). Overweight 2- to 5-year-old subjects (6.2%) and overweight 12- to 16-year-old subjects (9.1%) demonstrated the highest prevalences of iron deficiency. Overall, the prevalence of iron deficiency increased as BMI increased from normal weight to at risk for overweight to overweight (2.1%, 5.3%, and 5.5%, respectively), and iron deficiency was particularly common among adolescents (3.5%, 7.2%, and 9.1%, respectively). In a multivariate regression analysis, children who were at risk for overweight and children who were overweight were approximately twice as likely to be iron-deficient (odds ratio: 2.0; 95% confidence interval: 1.2–3.5; and odds ratio: 2.3; 95% confidence interval: 1.4–3.9; respectively) as were those who were not overweight.
Conclusions. In this national sample, overweight children demonstrated an increased prevalence of iron deficiency. Given the increasing numbers of overweight children and the known morbidities of iron deficiency, these findings suggest that guidelines for screening for iron deficiency may need to be modified to include children with elevated BMI.
Violators of a Child Passenger Safety Law
Authors: Agran Phyllis F. , Anderson Craig L. , Winn Diane G. 
Published: August 2004

Background. Nonuse of child car safety seats (CSSs) remains significant; in 2000, 47% of occupant fatalities among children &lt;5 years of age involved unrestrained children. Nonusers and part-time users of CSSs represent small proportions of the US population that have not responded to intervention efforts. Our study examined the factors contributing to nonuse or part-time use of CSSs and the effects of exposure to a class for violators of the California Child Passenger Safety (CPS) law.Methods. Focus groups (in English and Spanish) were conducted with individuals cited for violation of the law (N = 24). A thematic analysis of notes made by an observer, supplemented by audiotapes of the sessions, was conducted. In addition, a study of the effects of exposure to a violator class on knowledge and correct CSS use was conducted among violators. Certified CPS technicians conducted the classes and interviews. Subjects were parents cited as the driver with a child of 20 to 40 pounds, between 12 and 47 months of age. One hundred subjects recruited from the class were compared with 50 subjects who did not attend a class. Follow-up home interviews, with inspection of CCS use, were conducted 3 months after payment of the fine and completion of all court requirements. Fisher’s exact test was used for 2 × 2 tables, because some of the tables had small cell sizes. The Mann-Whitney rank sum test was used for child restraint use, knowledge, and correct use scales, because some of these variables were not normally distributed. Linear and logistic regression models were used to examine the effects of several variables on these parameters.Results. Factors influencing CSS nonuse were 1) lifestyle factors, 2) transportation and trip circumstances, 3) nonparent or nondriver issues, 4) parenting style, 5) child’s behavior, and 6) perceived risks of nonuse. Violator subjects were mostly Hispanic and female, with incomes of less than $30 000 per year. Those exposed to the class (citation and education group) scored 1 point higher on a knowledge test and had 1 more item correct on a CSS use instrument than did the group not exposed to the class (citation only group). In the logistic model, the citation and education group scored higher on the 2 items that were corrected by the instructor during the class.Conclusion. Our focus group study of CPS law violators revealed that multiple complex factors influence consistent use of a CSS. The interplay of the particular vehicle, the trip circumstances, and family/parent/child factors affected the use of a CSS at the time of parent citation. Addressing transportation issues and parenting skills in CPS programs is necessary. Among parents who had been ticketed for not restraining their children, exposure to a violator class demonstrated some benefit, compared with a fine alone. Correct CSS use improved most on items corrected by the instructor. Violator classes that include “hands-on” training show promise for improving rates of correct use of CSSs.
Evaluation of a Type 2 Diabetes Screening Protocol in an Urban Pediatric Clinic
Authors: Drobac Stephanie , Brickman Wendy , Smith Tiy , Binns Helen J. 
Published: August 2004

Background. In 2000, the American Diabetes Association issued recommendations for type 2 diabetes mellitus screening among children. They recommended testing children ≥10 years of age who have a body mass index (BMI) of &gt;85th percentile for age and at least 2 other risk factors (family history of type 2 diabetes, high-risk race/ethnicity, or evidence of insulin resistance, such as acanthosis nigricans).
Objective. To describe the application of a type 2 diabetes mellitus screening protocol in an urban pediatric clinic.
Design/Methods. Medical records for patients 10 to 18 years of age who were examined in health maintenance visits during a 13-month period were reviewed; 997 subjects were included in the analyses. Data collected included demographic features, medical history, family history, physical examination findings, dietary and physical activity counseling, and results of laboratory tests. BMI percentiles for age were determined from national references.
Results. Subjects were 50% male (median age: 13.2 years), 96% Hispanic, and 48% (n = 477) had a &gt;85th percentile BMI (including 26% with a ≥95th percentile BMI). Of the 477 subjects, 100% were in high-risk racial/ethnic groups, 29% had a family history of diabetes, and 20% demonstrated evidence of insulin resistance; 194 (41%) met the criteria for screening. Of those who met the criteria, 38% (n = 73) had screening ordered and 65 of those subjects (89%) completed screening. Acanthosis nigricans was more common among subjects for whom screening was ordered (69%), compared with subjects who were not screened (3%). Three screened subjects exhibited impaired glucose tolerance; none had overt diabetes. Subjects for whom screening was ordered were more likely to have received counseling than were subjects not recognized as qualifying for screening (84% vs 52%).
Conclusions. At this high-risk clinical site, the American Diabetes Association type 2 diabetes screening protocol was inconsistently applied. Acanthosis nigricans was a driving factor in identification and screening. Recognition of the need for screening was associated with a higher rate of documentation of nutritional counseling. Additional evaluation of the effectiveness of screening protocols in the early identification of diabetes and the effects of screening protocols on long-term morbidity is needed.
Effect of Parental R-Rated Movie Restriction on Adolescent Smoking Initiation
Authors: Sargent James D. , Beach Michael L. , Dalton Madeline A. , Ernstoff Linda Titus , Gibson Jennifer J. , Tickle Jennifer J. , Heatherton Todd F. 
Published: August 2004

Objective. To determine if young adolescents who report that their parents restrict viewing R-rated movies have a lower risk of trying smoking in the future.
Design. Prospective observational study. Students from 15 schools in New Hampshire and Vermont, randomly selected from all middle schools with &gt;150 students, were surveyed in 1999. Baseline never-smokers were surveyed again by telephone 13 to 26 months later to determine smoking status.
Outcome Measure. Trying smoking during the follow-up period.
Results. The majority of the 2596 students were white, with ages ranging from 10 to 14 years. Nineteen percent reported that their parents never allowed them to view R-rated movies, 29% were allowed once in a while, and 52% were allowed sometimes or all the time. Ten percent of students tried smoking during the follow-up period. Smoking-initiation rates increased as parental restriction of R-rated movies decreased (2.9% for adolescents reporting that their parents never allowed them to view R-rated movies, 7.0% for those allowed to view them once in a while, and 14.3% for those allowed to view them sometimes or all the time). There was a strong and statistically significant effect of parental R-rated movie restriction on adolescent smoking even after controlling for sociodemographics, social influences (friend smoking, receptivity to tobacco promotions), parenting style (maternal support and control, parental disapproval of smoking), and characteristics of the adolescent (school performance, sensation seeking, rebelliousness, self-esteem). Compared with adolescents whose parents never allowed them to view R-rated movies, the adjusted relative risk for trying smoking was 1.8 (95% confidence interval [CI]: 1.1, 3.1) for those allowed to watch them once in a while and 2.8 (95% CI: 1.6, 4.7) for those allowed to watch them sometimes or all the time. The effect was especially strong among adolescents not exposed to family (parent or sibling) smoking, among whom the adjusted relative risk for smoking was 4.3 (95% CI: 1.4, 13) for those allowed to view R-rated movies once in a while and 10.0 (95% CI: 3.6, 31) for those allowed to view them sometimes or all the time.
Conclusions. Parental restriction from watching R-rated movies strongly predicts a lower risk of trying smoking in the future. The effect is largest among adolescents not exposed to family smoking. By exerting control over media choices and by not smoking themselves, parents may be able to prevent or delay smoking in their children.
A Prospective, Population-Based Study of the Epidemiology and Outcome of Out-of-Hospital Pediatric Cardiopulmonary Arrest
Authors: Young Kelly D. , Gausche-Hill Marianne , McClung Christian D. , Lewis Roger J. 
Published: August 2004

Background. This study reports the epidemiologic features, survival rates, and neurologic outcomes of the largest population-based series of pediatric out-of-hospital cardiopulmonary arrest patients with prospectively collected data.Methods. Secondary analysis of data from a prospective, interventional trial of out-of-hospital pediatric airway management conducted from 1994 to 1997 (Gausche M, Lewis RJ, Stratton SJ, et al. JAMA. 2000;283:783-790). Consecutive out-of-hospital patients from 2 large urban counties in California &lt;12 years old or 40 kg in bodyweight who were determined by paramedics to be pulseless and apneic were included. Main outcome measures included survival to hospital discharge, patient demographics, arrest etiology, arrest rhythm, event intervals, and neurologic outcomes.Results. In 599 patients, 601 events were studied (54% were &lt;1 year old, 58% were male). Return of spontaneous circulation was achieved in 29%; 25% were admitted to the hospital, and 8.6% (51) survived to hospital discharge. The most prevalent etiologies were sudden infant death syndrome and trauma; these resulted in relatively higher mortality. Respiratory etiologies and submersions followed; these resulted in relatively lower mortality. Twenty-six percent of the arrests were witnessed by citizens, and an additional 8% were witnessed by rescue personnel. Witnessed arrests had a higher survival rate (16%). Thirty-one percent of patients received bystander cardiopulmonary resuscitation, which was not demonstrated to result in improved survival rates. Arrest rhythms were asystole (67%), pulseless electrical activity (24%), and ventricular fibrillation (9%); children with the latter 2 rhythms had better survival rates. One third of the survivors (16 of 51) had good neurologic outcome, none of whom received &gt;3 doses of epinephrine or were resuscitated for &gt;31 minutes in the emergency department.Conclusions. The 8.6% survival rate after out-of-hospital pediatric cardiopulmonary arrest is poor. Administration of &gt;3 doses of epinephrine or prolonged resuscitation is futile.
Characteristics That Distinguish Accidental From Abusive Injury in Hospitalized Young Children With Head Trauma
Authors: Bechtel Kirsten , Stoessel Kathleen , Leventhal John M. , Ogle Eileen , Teague Barbara , Lavietes Sylvia , Banyas Bruna , Allen Karin , Dziura James , Duncan Charles 
Published: August 2004

Objective. To describe the clinical features that distinguish accidental from abusive head injury in hospitalized children &lt;24 months of age.Methods. Prospective study of children &lt;24 months of age hospitalized for head injury between August 1, 2000, and October 31, 2002. During hospitalization, children had computed tomographic scans of the brain, serial neurologic examinations, dilated ophthalmoscopic eye examinations, evaluation by a social worker, and, in some cases, a child abuse specialist.Outcome Measures. The main outcome measure was the proportion of children in each group with retinal hemorrhages (RHs). Secondary outcome measures were the proportion of children in each group who had vitreous hemorrhage; abnormal mental status on presentation; seizures; scalp hematomas; need for anticonvulsants; and operative procedures such as subdural tap, craniotomy, ventriculostomy, tracheostomy, and gastrostomy.Results. Eighty-seven children were prospectively enrolled. Fifteen children were classified as having abusive head injury, and 72 were classified as having accidental head injury. Five children, all in the accidental head injury group, were excluded from statistical analysis, because they did not have a dilated ophthalmoscopic examination during their hospitalization. Thus 82 children were included in the statistical analysis. There were no significant differences between the 2 groups with respect to mean age, gender, or ethnicity. RHs were more likely to be seen in children with abusive head injury (60% vs 10%) and were more likely to be bilateral (40% vs 1.5%). Pre-RHs were more likely to be seen in children with abusive head injury (30% vs 0%). Premacular RHs and RHs that extended to the periphery of the retina were also more likely to be seen in children with abusive head injury (20% vs 0% and 27% vs 0%, respectively). Of the 7 children with accidental head injury who had RHs, 6 had unilateral RHs. Children with abusive head injury were more likely to have seizures (53% vs 6%) and an abnormal mental status on initial presentation (53% vs 1%). Children with accidental head injury were more likely to have scalp hematomas (6.7% vs 49%).Conclusions. RHs are seen more often in abusive head injury and often are bilateral and involve the preretinal layer. Children with abusive head injury were more likely to have RHs that cover the macula and extend to the periphery of the retina. Unilateral RHs can be seen in children with accidental head injury. Children with abusive head injury were more likely to present with abnormal mental status and seizures, whereas children with accidental head injury were more likely to have scalp hematomas. Such characteristics may be useful to distinguish accidental from abusive head trauma in children &lt;24 months of age.
A Randomized Clinical Trial to Assess the Effects of Tympanometry on the Diagnosis and Treatment of Acute Otitis Media
Authors: Spiro David M. , King William D. , Arnold Donald H. , Johnston Carden , Baldwin Steven 
Published: August 2004

Objectives. Acute otitis media (OM) is the most common indication for the use of antibiotics among children. Otoscopy alone is an imprecise method for the diagnosis of OM, which may lead to inappropriate antibiotic use. We sought to determine whether tympanometry, as an adjunct to otoscopy, would significantly change physician prescribing behavior and whether physicians overprescribe antibiotics for OM, using independently graded tympanometry results as a standard.
Methods. A randomized, clinical trial was conducted among children 6 to 35 months of age who presented to a pediatric emergency department with either fever or upper respiratory infection symptoms. Children were randomized into 2 groups, in which the attending physician evaluated tympanometry results (Tymp Aware) or the attending physician was blinded to the tympanometry findings (Tymp Unaware). Tympanometry curves were graded independently by using a modified version of the Jerger scale.
Results. Of the 698 patients enrolled, tympanometry was performed successfully for 99.3%. Antibiotics were prescribed for OM for 27.9% of all patients. No statistically significant difference in antibiotic prescription rates for OM between the Tymp Aware group (28.8%) and the Tymp Unaware group (26.8%) was found. Of all patients for whom antibiotics were prescribed for OM, 14% had normal curves for both ears and 40% had some tympanographic movement bilaterally.
Conclusions. Tympanometry did not seem to change diagnoses or prescribing behavior in the group of physicians studied. Antibiotics were commonly prescribed for presumed OM in the absence of effusions documented with tympanometry.