bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maternal Receipt of Magnesium Sulfate Does Not Seem to Reduce the Risk of Neonatal White Matter Damage
Authors: Leviton Alan , Paneth Nigel , Susser Mervyn , Reuss M. Lynn , Allred Elizabeth N. , Kuban Karl , Sanocka Ulana , Hegyi Thomas , Hiatt Mark , Shahrivar Farrokh , Van Marter Linda J. 
Published: August 2004

Objective. To investigate whether in utero exposure to magnesium sulfate is associated with a lower incidence of cranial ultrasonographic abnormalities that predict cerebral palsy in infants who weigh less than 1501 g at birth.Design. For a prospective study of the antecedents of cranial ultrasonographic abnormalities, we enrolled infants who weighed 500 to 1500 g when born at five institutions. Data were collected by interview of the mothers and review of medical records. Protocol cranial ultrasonograms were obtained as close as possible to postnatal days 1, 7, and 21. Abnormality on cranial ultrasound scans was determined by a consensus committee of three sonologists.Results. Of the 1518 infants for whom we knew whether the mothers received magnesium sulfate, the first protocol cranial ultrasound scan was available for 1409 infants, the second for 1274 infants, and the third for 1050 infants. Forty-five percent of infants were exposed to magnesium sulfate before delivery. The major correlates of magnesium sulfate exposure were receipt of antenatal corticosteriods and a diagnosis of preeclampsia and/or pregnancy-induced hypertension. Maternal magnesium receipt was not associated with a reduced incidence of hypoechoic or hyperechoic images of white matter parenchyma, intraventricular hemorrhage, or ventriculomegaly, even when the sample was stratified by each of six potential confounders. When adjustment was made for gestational age, a measure of birth weight for gestational age, antenatal corticosteroid exposure, preeclampsia and pregnancy-induced hypertension, route of delivery, and the occurrence of any labor, the risk ratios for each cranial ultrasonographic abnormality associated with magnesium sulfate exposure hovered close to 1.Conclusion. Maternal receipt of magnesium sulfate does not seem to be associated with an appreciably reduced risk of cranial ultrasonographically defined neonatal white matter damage, intraventricular hemorrhage, or ventriculomegaly. low birth weight, magnesium sulfate, periventricular leukomalacia, antenatal corticosteriods, intraventricular hemorrhage, pregnancy-induced hypertension.
Collaborative Office Rounds: Continuing Education in the Psychosocial/Developmental Aspects of Child Health
Authors: Fishman Michael E. , Kessel Woodie , Heppel David E. , Brannon M. Elizabeth , Papai James J. , Bryn Stephanie D. , Nora Audrey H. , Hutchins Vince L. 
Published: August 2004

Objectives. In recent years there has been increasing emphasis on the mental health aspects of primary health care for children and adolescents. The Health Resources and Services Administration’s Maternal and Child Health Bureau has contributed to efforts aimed at strengthening primary care not only in early identification and beginning intervention with mental disorders, but also in prevention of emotional and behavioral problems and in promotion of positive psychosocial development. The Collaborative Office Rounds (COR) Program is a noteworthy part of these efforts.
Methods. The COR program supports small discussion groups that meet at regular intervals over sustained periods of time to address the mental health aspects of pediatric care. The groups are jointly led by pediatricians and child psychiatrists. Although they vary in a number of ways, all are concerned with the day-to-day psychosocial issues that confront primary care providers serving children, adolescents, and their families.
Results. COR groups have addressed a wide range of areas including numerous problems and disorders, health supervision issues, family and community topics, personal challenges and practical complexities, and clinical management issues. Evaluation information indicates a positive response on the part of participants and moderators. This is reflected in group stability, high attendance rates, universal readiness to recommend the COR experience, and a variety of collateral accomplishments.
Conclusions. Experience to date points to the COR group as a useful tool for addressing psychosocial issues in primary care. Its potential may be more fully realized by applying this approach more widely, even as further assessment is pursued. continuing education, discussion groups, psychosocial.
Racial Differences in Choice of Dialysis Modality for Children With End-stage Renal Disease
Authors: Furth Susan L. , Powe Neil R. , Hwang Wenke , Neu Alicia M. , Fivush Barbara A. 
Published: August 2004

Objective. Black-white disparities in the use of specific medical and surgical services have been reported in adult populations. Such disparities are not well documented in children. We sought to determine whether racial disparities in the use of medical services exist among children with chronic illness who have similar health insurance, specifically the choice of dialysis modality for individuals with end-stage renal disease.
Design. National cross-sectional study.
Setting. Outpatient dialysis facilities throughout the United States.
Patients and Participants. All Medicare-eligible children (age, ≤19 years) undergoing renal replacement therapy in 1990 in the United States, using data from the Medicare ESRD registry.
Outcome Measures. The odds of receiving hemodialysis versus peritoneal dialysis according to race. Adjustment was made for differences in age, gender, cause, and duration of end-stage renal disease, income, education, and facility chracteristics using multiple logistic regression.
Results. In 1990, 870 white and 368 black children received chronic (&gt;1 year) renal replacement therapy in the United States. In bivariate analysis, blacks were two times (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.7, 2.8) more likely than whites to receive hemodialysis versus peritoneal dialysis. After controlling for other patient and facility characteristics in multivariate analysis, black children were still significantly more likely than white children to receive hemodialysis (OR, 2.4; 95% CI, 1.7, 3.5).
Conclusions. Black race is strongly associated with the use of hemodialysis in children. Family, patient, or provider preferences could account for the difference in choice of therapy by race. chronic renal failure, children; racial disparities, peritoneal dialysis, health insurance.
Tolerance to the Bronchoprotective Effect of Salmeterol in Adolescents With Exercise-induced Asthma Using Concurrent Inhaled Glucocorticoid Treatment
Authors: Simons F. Estelle R. , Gerstner Thomas V. , Cheang Mary S. 
Published: August 2004

Objectives. The long-acting β2-adrenergic agonist salmeterol prevents exercise-induced asthma, but tolerance may develop to its bronchoprotective effect. We wanted to ascertain if the development of tolerance could be prevented by using a low-dose treatment regimen of 50 μg once daily, instead of the usual dose of 50 μg twice daily, in adolescents receiving regular glucocorticoid inhalations.Methods. In a randomized, double-blind, 2x28-day crossover study, we administered salmeterol (50 μg) or placebo once daily via a metered-dose inhaler and Nebulizer Chronolog device to monitor compliance. Exercise challenge tests were performed 1 and 9 hours after salmeterol or placebo inhalation on the 1st and 28th day of each treatment period. The primary outcome variable was the maximum decrease in percent predicted FEV1 postexercise.Results. Fourteen subjects with a mean age of 13.1 years completed the study. The first dose of salmeterol had an excellent bronchoprotective effect against exercise-induced asthma at 1 and 9 hours. After the 28th consecutive daily dose of salmeterol, the bronchoprotective effect was significantly greater than that of placebo at 1 hour, but not at 9 hours.Conclusions. We conclude that a single 50-μg dose of salmeterol has an excellent protective effect against exercise-induced asthma for at least 9 hours, but that this effect may wane during regular once-daily salmeterol treatment, despite the reduced frequency of dosing and despite concomitant use of inhaled glucocorticoids.
Pulse Oximetry as a Fifth Pediatric Vital Sign
Authors: Mower William R. , Sachs Carolyn , Nicklin Emily L. , Baraff Larry J. 
Published: August 2004

Purpose. To determine the utility of pulse oximetry as a routine fifth vital sign in acute pediatric assessment.Design. Prospective study using pulse oximetry to measure oxygen saturation in children presenting to emergency department triage. Saturation values were disclosed to clinicians only after they had completed medical evaluations and were ready to discharge or admit each child. We measured changes in medical treatment and diagnoses initiated after the disclosure of pulse oximetry values.Setting and Participants. The study included 2127 consecutive children presenting to triage at a university emergency department.Measurements. Changes in select diagnostic tests: chest radiography, complete blood count, spirometry, arterial blood gases, pulse oximetry, and ventilation-perfusion scans; treatments: antibiotics, β-agonists, supplemental oxygen; and hospital admission and final diagnoses that occurred after disclosure of triage pulse oximetry values.Results. Of 305 children having triage pulse oximetry values less than 95%, physicians ordered second oximetry for 49, additional chest radiography for 16, complete blood counts for 7, arterial blood gas measurements for 4, spirometry for 2, and ventilation-perfusion scans for 2. Physicians ordered 39 new therapies for 33 patients, including antibiotics for 15, supplemental oxygen for 11, and β-agonists for 8. Five patients initially scheduled for hospital discharge were subsequently admitted. Physicians changed or added diagnoses in 25 patients.Conclusions. Using pulse oximetry as a routine fifth vital sign resulted in important changes in the treatment of a small proportion of pediatric patients.
Magnesium Sulfate in Labor and Risk of Neonatal Brain Lesions and Cerebral Palsy in Low Birth Weight Infants
Authors: Paneth Nigel , Jetton James , Pinto-Martin Jennifer , Susser Mervyn ,   the Neonatal Brain Hemorrhage Study Analysis Group
Published: August 2004

Objectives. We tested the hypothesis that administration of magnesium sulfate in labor protects against the development of neonatal brain lesions and cerebral palsy (CP) in low birth weight infants.Methods. Magnesium exposure was ascertained in a population-based cohort of 1105 infants weighing 2000 g or less through review of medical records of maternal magnesium sulfate administration and, where available, elevated maternal serum magnesium levels. Neonatal germinal matrix/intraventricular hemorrhage and parenchymal brain lesions were ascertained by a prospective, timed ultrasound scanning protocol in the first week of life. CP was ascertained at 2 years of age by clinical examination in 80% of survivors and by interview and medical record review in another 6% and was classified as disabling or nondisabling.Results. No significant reduction in risk of nondisabling CP (adjusted odds ratio [OR], 1.00; 95% confidence interval [CI], 0.53 to 1.88) or disabling CP [DCP] (adjusted OR, 0.63; 95% CI, 0.32 to 1.24) CP with magnesium exposure was found in a logistic regression model that controlled for gestational age, fetal growth, gender, multiple birth status, mode of delivery, amnionitis, and hypertensive disorders. In a small subset of infants, those with onset of parenchymal lesions at 7 days of age or later (n = 29), magnesium exposure was associated with a significantly reduced risk of DCP (OR, 0.10; 95% CI, 0.02 to 0.65). Magnesium sulfate exposure was not associated with germinal matrix/intraventricular hemorrhage (adjusted OR, 0.89; 95% CI, 0.64 to 1.25) or with parenchymal brain lesions (adjusted OR, 0.83; 95% CI, 0.53 to 1.30).Conclusions. The hypothesis that magnesium sulfate use reduces the risk of neonatal brain lesions or CP in low birth weight infants was not statistically supported in this study, although a modest reduction in risk of DCP cannot be excluded. The data further suggest that magnesium exposure may be associated with reduction in risk of CP in low birth weight infants who have late-onset brain lesions, but this unpredicted observation requires confirmation in another data set. cerebral palsy; magnesium sulfate; infant, low birth weight; preeclampsia; cerebral hemorrhage, infant.
Errors and Correlates in Parental Recall of Child Immunizations: Effects on Vaccination Coverage Estimates
Authors: Suarez Lucina , Simpson Diane M. , Smith David R. 
Published: August 2004

Objective. We evaluated the accuracy of parental recall of children’s immunization histories as compared with provider records and examined how errors in parental recall correlate with sociodemographic characteristics.
Design. The validation study was part of a population-based household survey designed to assess immunization levels among Texas children under age 2 years. For 72% (n = 3278), interviewers used vaccination records from the parent to copy dates for the diphtheria and tetanus toxoids and pertussis vaccine (DTP), oral polio vaccine (OPV), and measles, mumps, and rubella (MMR) shots. For parents without shot records (n = 1216), interviewers asked about each vaccine, whether the child had received the shot, how many, and at what age. Of these, 85% (n = 1029) were validated with health provider records.
Results. Measured against provider records, only 34% of parents accurately recalled the number of DTP shots a child had. More often (42%) parents underestimated the number of DTP shots than overestimated (24%). Agreement between parental recall and provider records was high (83%) for the single dose of MMR. Accuracy of parents’ recall did not differ by race/ethnicity, education level, or type of health insurance coverage, but decreased as child’s age increased. Having a vaccination record at home was associated with a higher immunization status. Hispanic, lower educated, and uninsured parents were more likely to have a vaccination record than non-Hispanic, higher educated, and privately insured parents.
Discussion. Validity of parental recall of children’s immunization histories depends on the vaccine and the age of the child, which is highly correlated with the number of shots parents must recollect. Results suggest that inclusion of parent recall information from vaccination surveys underestimates DTP:OPV:MMR coverage. This underestimation is consistent across economic and race/ethnic groups. Thus, community surveys based on cards and recall should provide reliable conclusions about which groups need intensive program efforts. For the routine monitoring of vaccination coverage, reasonable estimates can be obtained by combining parent-held record and parent recall data. Caution is required when comparing coverage estimates from different surveys since the source of information and method of derivation will produce widely varying coverage rates. vaccinations, immunization, validity, recall bias, infant.
Socioeconomic Variation in Discretionary and Mandatory Hospitalization of Infants: An Ecologic Analysis
Authors: McConnochie Kenneth M. , Roghmann Klaus J. , Liptak Gregory S. 
Published: August 2004

Objectives. To examine geographic variation in rates of infant hospitalization for diagnoses classified by type of hospitalization decision in Monroe County (Rochester), New York.Methods. Study design was cross-sectional and ecologic.International Classification of Diseases (ICD) codes were used to categorize all 7883 hospitalizations for infants (age, &lt;24 months) beyond the newborn period between 1985 and 1991. Postal zip codes defined socioeconomic areas as inner-city, other urban, and suburban for the population at risk. In 1990, inner-city infants included 62% black and 65% Medicaid-covered infants, whereas suburban infants included 3% black and 6% covered by Medicaid. Hospitalization rates were compared among the three socioeconomic areas.Results. Overall hospitalization rate was 50.3 per 1000 child years. Admissions classified as discretionary accounted for 59% of these, followed by those classified as mandatory, 18%; sometime (congenital heart disease, cleft palate), 15%; discretionary surgery (inguinal hernia, tonsillectomy/adenoidectomy), 6%; and unlikely to need admission, 2%. A stepwise, socioeconomic gradient in hospitalization was found, with rates of 38.1, 51.3, and 82.9 per 1000 child-years, respectively, for suburban, other urban, and inner-city areas. Rates for discretionary, unlikely, and mandatory admissions followed this gradient. Using the odds for hospitalization of suburban infants as the base odds, the odds ratio for discretionary hospitalization for inner-city infants was 2.88 (95% confidence interval [CI], 2.69 to 3.08) and that for mandatory hospitalization was 2.20 (95% CI, 1.94 to 2.49). In multiple regression analysis, low education level of mothers explained 81% of the variance in discretionary hospitalization rate. Although the per capita rate of hospital care of inner-city infants was more than twofold greater than that for suburban infants, potential for reducing this difference is suggested by the fact that discretionary admissions accounted for 78.9% of this difference, whereas mandatory admissions accounted for 17.7% of the difference.Conclusion. The hospitalization rate for inner-city infants is much greater than that for suburban infants. A substantial portion of the difference, namely that attributable to mandatory admissions, reflected higher rates of serious illness. Differences attributable to discretionary admissions may reflect higher rates of serious illness to some extent, but also appear to reflect less effective health services to a substantial degree.
Impact of Zinc Supplementation on Morbidity From Diarrhea and Respiratory Infections Among Rural Guatemalan Children
Authors: Ruel Marie T. , Rivera Juan A. , Santizo Maria-Claudia , Lönnerdal Bo , Brown Kenneth H. 
Published: August 2004

Objective. A community-based, randomized, double-blind intervention trial was conducted to measure the impact of zinc supplementation on young Guatemalan children's morbidity from diarrhea and respiratory infections.
Methods. Children aged 6 to 9 months were randomly assigned to receive 4 mL of a beverage containing 10 mg of zinc (as zinc sulfate) daily (7 d/wk) for 7 months (n = 45) or a placebo (n = 44). Morbidity data were collected daily. Diagnoses of diarrhea, fever, and anorexia were based on mothers' definitions. Respiratory infections were defined as the presence of at least two of the following symptoms: runny nose, cough, wheezing, difficulty breathing, or fever.
Results. High rates of diarrhea and respiratory infections were reported. Children from the placebo group had a 20% episodic prevalence of diarrhea, with 8 episodes/100 d, and a 7% episodic prevalence of respiratory infections, with 3 episodes/100 d. The median incidence of diarrhea among children who received zinc supplementation was reduced by 22% (Wilcoxon rank test), with larger reductions among boys and among children with weight-for-length at baseline lower than the median of the sample (39% reductions in both subgroups). Zinc supplementation also produced a 67% reduction in the percentage of children who had one or more episodes of persistent diarrhea (χ2 test). No significant effects were found on the episodic prevalence of diarrhea, the number of days per episode, or the episodic prevalence or incidence of respiratory infections.
Conclusions. The large impact of zinc supplementation on diarrhea incidence suggests that young, rural Guatemalan children may be zinc deficient and that zinc supplementation may be an effective intervention to improve their health and growth.
Effect of Diuretics on Urinary Oxalate, Calcium, and Sodium Excretion in Very Low Birth Weight Infants
Authors: Campfield Thomas , Braden Gregory , Flynn-Valone Patrecia , Powell Steven 
Published: August 2004

Objective. To study the effect of diuretic drugs on urinary oxalate excretion in premature infants, and to examine the relationship between urinary calcium and sodium excretion in premature infants.Methodology. We measured urinary oxalate, calcium, and sodium excretion in 32 premature infants at approximately 34 weeks gestational age. Seven infants were receiving furosemide, 5 infants were receiving thiazide, 8 infants were receiving furosemide plus thiazide, and 12 infants who were not receiving diuretics served as controls.Results. Urinary oxalate to creatinine ratios in infants receiving furosemide (0.48 ± .26), thiazide (0.54 ± .20), furosemide plus thiazide (0.44 ± .19), and control infants (0.51 ± .43) were similar by analysis of variance (ANOVA). Data expressed as oxalate concentration gave similar results. Urinary calcium to creatinine ratios in infants receiving furosemide (0.81 ± .30), thiazide (0.54 ± .25), furosemide plus thiazide (0.75 ± .49), and control infants (0.37 ± .25) were similar by ANOVA. The urinary calcium concentration in infants receiving furosemide plus thiazide (0.085 ± 0.042 mg/mL) was different from control infants (0.044 ± .023) by ANOVA and Student-Newman-Keuls test. Urinary calcium to creatinine ratio was correlated with sodium to creatinine ratio (r = .751).Conclusion. Urinary oxalate excretion in premature infants is not affected by diuretic drugs. Urinary sodium and calcium excretion are closely linked in sodium supplemented premature infants receiving diuretics. The calciuric effect of furosemide is not decreased by the addition of thiazide in premature infants receiving sodium supplements.
Simplified Treatment of Acute Staphylococcal Osteomyelitis of Childhood
Authors: Peltola Heikki , Unkila-Kallio Leila , Kallio Markku J.T. ,   the Finnish Study Group
Published: August 2004

Objective. Recommendations on treatment of acute staphylococcal osteomyelitis of children, based mostly on retrospective analyses, comprise surgical drainage, up to 6 weeks of antimicrobials guided by the erythrocyte sedimentation rate, and the possibility of switching to the oral route only if monitoring of serum bactericidal titer is guaranteed. A prospective study was conducted to test whether the treatment could be simplified.Design. Fifty pediatric cases of acuteStaphylococcus aureus osteomyelitis were randomized to receive 150 mg/kg/day of cephradine divided in four doses, or 40 mg/kg/day in four doses of clindamycin. The treatment was initiated intravenously, but switched to oral administration mostly within 4 days, using the same doses. The peak antimicrobial serum inhibitory titer or bactericidal titer was not measured. The course of illness was monitored by blood leukocytes, erythrocyte sedimentation rate, and serum C-reactive protein. The follow-up was extended to 1 year posthospitalization.Setting. Eight tertiary pediatric-orthopedic hospitals in Finland.Main Outcome Measure. Full recovery and remaining healthy at least 12 months from hospital discharge.Results. The lower and upper extremities were affected in 72% and 8% of patients, respectively. No surgery at all or needle aspiration only was performed in 62% and drilling in 38%. C-reactive protein and the sedimentation rate normalized within 9 days and 29 days, respectively. X-ray changes developed in 68% but had no prognostic significance. The mean hospitalization time was 11 days, and the total duration of antimicrobials was 23 days. No failure has occurred nor have long-term sequelae been observed in any patient.Conclusions. Treatment of pediatric acute staphylococcal osteomyelitis can be simplified and costs reduced by keeping surgery at a minimum, shortening hospitalization and the course of antimicrobials, switching quickly to the oral route, and not monitoring serum bactericidal activity.