bluuebunny/crossref_metadata_2025_split huggingface dataset:
Infants With a Thumb-in-Fist Posture
Authors: Jaffe Michael , Tal Yoram , Dabbah Husein , Ganelis Leonid , Cohen Ayala , Even Lea , Tirosh Emanuel 
Published: August 2004

Objective.
In early infancy the infant's thumb is not infrequently enclosed within the palm, ie, thumb-in-fist (TIF). This posture has received scant attention in the neurodevelopmental literature. Its prevalence, resolution, and clinical associations were investigated in this study.

Methodology.
Two hundred sequentially born, apparently healthy full-term newborn infants comprised the cohort. The whole study group was followed up until the disappearance of the TIF occurred. In the first 150 of the cohort, additional data on development and the neurological status were obtained at 12 months of life.

Results.
In 125 infants (62.5%) of the total cohort, a TIF was noted. The mean age of disappearance was 1.5 months, and no TIF persisted after 7 months old. No relationship was noted between the TIF resolution and abnormal neurological signs or gross or fine motor development. The only association noted between age of resolution of the TIF and the neurodevelopmental status was a delay in language attainment at the 12-month screening.

Conclusions.
The TIF posture in infancy was noted in 65% of our cohort, and it had resolved in all infants by 7 months old. Therefore, a TIF posture after this age should alert the clinician to the possibility of possible neurological dysfunction. An unanticipated association of a delay in the 12-month language milestone attainment was noted in those infants with later resolution of the TIF posture. No data on language development in this group were obtained after 12 months old; therefore, the clinical significance of this finding is not yet elucidated.
A Guideline Implementation System Using Handheld Computers for Office Management of Asthma: Effects on Adherence and Patient Outcomes
Authors: Shiffman Richard N. , Freudigman MCIS*‡; Kimberly A. , Brandt Cynthia A. , Liaw Yischon , Navedo Deborah D. 
Published: August 2004

Objective.
To evaluate effects on the process and outcomes of care brought about by use of a handheld, computer-based system that implements the American Academy of Pediatrics guideline on office management of asthma exacerbations.

Design.
A before–after trial with randomly selected, office-based Connecticut pediatricians. In both the control and intervention phases, physicians collected data from 10 patient encounters for acute asthma exacerbations. During the intervention phase, the computer provided for structured encounter documentation and offered recommendations based on the guideline of the American Academy of Pediatrics. Patients were contacted by telephone 7 to 14 days after the visit to assess outcomes.

Results.
Nine study-physicians enrolled 91 patients in the control phase and 74 in the intervention phase. Follow-up information was available for 93% of encounters. Use of the intervention was associated with increased mean frequency/visit of: 1) measurements of peak expiratory flow rate (2.18 vs 1.57) and oxygen saturation (1.12 vs .42), and 2) administration of nebulized β2-agonists (1.25 vs .71). Visits in the intervention phase lasted longer and fees were higher ($145.61 vs $103.11). There were no significant differences in immediate disposition or subsequent emergency department visits, hospitalizations, missed school, or caretaker's missed work during the 7 days post visit.

Conclusion.
Use of handheld computers that provide guideline-based decision support was associated with increased physician adherence to guideline recommendations; however, visits were prolonged, fees were higher, and no improvement could be demonstrated with regard to the observed intermediate-term patient outcomes. Guideline implementers (and users) should be cautious about putting unvalidated recommendations into practice.
Echocardiographic Diagnosis of Heart Disease in Apparently Healthy Adolescents
Authors: Steinberger Julia , Moller James H. , Berry James M. , Sinaiko Alan R. 
Published: August 2004

Objective.
Comprehensive data are currently unavailable on the prevalence of cardiac abnormalities in children after the newborn/infant period. The present report describes the prevalence of echocardiographically detected cardiac disease in a cohort of randomly selected healthy junior high school children.

Methods.
The cohort for this report consists of 357 children (mean age: 13 years) randomly selected after blood pressure screening of 12 043 fifth through eighth grade students and having an echocardiographic examination as part of a study of insulin resistance in childhood.

Results.
A physical examination performed by a board-certified pediatrician reported no cardiac abnormalities. However, echocardiography and Doppler studies identified 13 (3.6%) children (7 males and 6 females), with previously unknown cardiac abnormalities, as follows: abnormal mitral valve with mitral regurgitation (4), bicuspid aortic valve (2), atrial septal defect (2), coronary artery to pulmonary artery fistula (1), patent ductus arteriosus (1), pulmonary hypertension (1), cardiomyopathy (1), and pulmonary artery stenosis (1). Physical examination performed by a pediatric cardiologist detected abnormal cardiac findings in 7 (54%) of the children. Cardiac catheterization was required in 3 for additional diagnostic evaluation and in 2 for therapeutic intervention; 1 patient underwent open-heart surgery. Bacterial endocarditis prophylaxis was recommended in 8 (62%) of the 13 children.

Conclusions.
The results suggest that: 1) clinically significant cardiac disease in childhood is more prevalent than previously reported; and 2) improved screening methods should be considered to detect asymptomatic but significant cardiac abnormalities that may result in long-term complications. echocardiography, prevalence, incidence, heart disease, children.
Systemic Corticosteroids in Infant Bronchiolitis: A Meta-analysis
Authors: Garrison Michelle M. , Christakis Dimitri A. , Harvey Eric , Cummings Peter , Davis Robert L. 
Published: August 2004

Objective.
To determine whether corticosteroids are efficacious in treating bronchiolitis in hospitalized infants.

Methods.
Online bibliographic databases (Medline, Embase, and Cochrane Clinical Trials Registry) were searched for: 1) bronchiolitis or respiratory syncytial virus, and 2) corticosteroid or glucocorticoid or steroidal antiinflammatory agents or adrenal cortex hormones. Reference lists from all selected articles were also examined. Randomized, placebo-controlled trials of systemic corticosteroids in treatment of infants hospitalized with bronchiolitis were selected by 2 investigators. Of 12 relevant publications identified in the literature search, 6 met the selection criteria and had relevant data available. Investigators independently extracted data for 3 outcomes: length of stay (LOS), duration of symptoms (DOS), and clinical scores.

Results.
In the pooled analysis, infants who received corticosteroids had a mean LOS or DOS that was .43 days less than those who received the placebo treatment (95% confidence interval: −.81 to −.05 days). The effect size for mean clinical score was −1.60 (95% confidence interval: −1.92 to −1.28), favoring treatment. Secondary analyses of mean LOS or DOS were performed on 5 trials that had clearly identified methods of randomization, 5 trials that measured LOS, and 4 trials that clearly excluded infants with previous wheezing. The estimates of effect were similar to the primary analysis but were not statistically significant.

Conclusions.
Combined, published reports of the effect of systemic corticosteroids on the course of bronchiolitis suggest a statistically significant improvement in clinical symptoms, LOS, and DOS.
Ketogenic Diet for the Treatment of Refractory Epilepsy in Children: A Systematic Review of Efficacy
Authors: Lefevre Frank , Aronson Naomi 
Published: August 2004

Objectives.
To systematically review and synthesize the available evidence on the efficacy of the ketogenic diet in reducing seizure frequency for children with refractory epilepsy.

Data Sources.
Medline searches were performed using the keywords epilepsy/therapy, dietary therapy, and epilepsy, and the text word ketogenic diet. The Cochrane Library of clinical trials was searched using the term ketogenic diet. Bibliographies of recent review articles and relevant primary research reports, as well asCurrent Contents were reviewed for additional relevant citations.

Study Selection.
Studies were selected for inclusion in the review that reported the reduction of seizure frequency following treatment with the ketogenic diet in children with refractory epilepsy. The outcome measures used were the percentage of patients with: 1) complete elimination of seizures, 2) &gt;90% reduction in seizures, and 3) &gt;50% reduction in seizures.

Results.
The evidence consists entirely of uncontrolled studies. Of 11 studies identified for this review, 9 are retrospective series of patients from a single institution. Two studies are prospective, 1 of which is a multicenter trial. The results of these studies are consistent in showing that some children benefit from the ketogenic diet, demonstrated by a significant reduction in seizure frequency. Estimates of the rates of improvement by combined analysis (confidence profile method) are complete cessation of all seizures in 16% of children (95% confidence interval [CI]: 11.0–21.7); a greater than 90% reduction in seizures in 32% (95% CI: 25.3–39.8); and a greater than 50% reduction in seizures in 56% (95% CI: 41.2–69.7). It is unlikely that this degree of benefit can result from a placebo response and/or spontaneous remission.

Conclusions.
Although controlled trials are lacking, the evidence is sufficient to determine that the ketogenic diet is efficacious in reducing seizure frequency in children with refractory epilepsy.
Voiding Cystourethrograms and Urinary Tract Infections: How Long to Wait?
Authors: McDonald Anu , Scranton Maria , Gillespie Robert , Mahajan Vandana , Edwards George A. 
Published: August 2004

Objectives.
Many authorities recommend an interval of at least 3 to 6 weeks after a urinary tract infection (UTI) before performing a voiding cystourethrogram (VCUG). However, such an interval may reduce the likelihood of completing the procedure. This study was performed to investigate whether the length of the interval between a UTI and the performance of the VCUG influences the presence or severity of reflux, and whether it influences the likelihood of actually having the study performed.

Design.
We reviewed 352 admissions of children under 10 years old whose discharge diagnoses indicated UTIs. These admissions occurred over a 27-month period between October 1994 and December 1996 at the Children's Hospital of Austin, Texas. We identified 213 patients with confirmed UTIs and no other previously defined urinary tract pathology. These patients were divided into 2 groups according to whether they had a VCUG scheduled to be performed either within 1 week after the diagnosis of a UTI (the early group), or later than 1 week after the diagnosis (the late group). We compared the presence and severity of reflux in the 2 groups as well as the proportion of scheduled VCUGs that were actually performed.

Results.
Reflux was present in 19% of the patients studied within 1 week after UTI (95% confidence interval [CI]: 12.9–26.4) and in 18% of those studied after 1 week (95% CI: 6.7–34.5). This difference was not statistically significant (χ2 = .034; DF = 1). However there was a substantial difference between the 2 groups with regard to the number of scheduled VCUGs actually performed. Whereas 100% of the scheduled VCUGs in the early group were performed, only 48% (95% CI: 35.9–60.1) of those scheduled in the late group were performed. This difference is statistically significant (χ2 = 89.6; DF = 1).

Conclusions.
In the hospitalized children who underwent VCUGs within a week after diagnosis of UTI, the presence of reflux is not significantly different from those studied later. Furthermore, late scheduling of VCUGs resulted in failure to perform the procedure in more than half of the patients. Some of the patients who were not evaluated would be expected to have vesicoureteral reflux and thus be at risk for chronic renal disease. Therefore, the traditional recommendation to perform the VCUG at 3 to 6 weeks after the diagnosis of UTI should be reconsidered, especially for hospitalized children.
Preventable Childhood Tuberculosis in Alabama: Implications and Opportunity
Authors: Kimerling Michael E. , Barker Jill T. , Bruce Frank , Brook Nancy L. , Dunlap Nancy E. 
Published: August 2004

Childhood tuberculosis (TB) cases indicate recent community transmission and thus reflect the effectiveness of TB control efforts, particularly the contact investigation.
Objective. To evaluate all preventable childhood TB cases and implications in the context of TB morbidity trends.
Design. Statewide morbidity trends are presented from 1983 to 1997. Since 1992, each child TB case is classified as either preventable or not preventable, based on a standard definition.
Main Outcome Measures. Case characteristics (preventable and not preventable), TB disease rates over time, and reasons for preventable case classification.
Setting. Alabama TB control program, from January 1, 1983 through December 31, 1997.
Results. For the period 1983–1997, nonwhite children had a higher disease rate (rate ratio: 5.7; 95% confidence interval: 4.3,7.6) than white children. Since 1990, the overall child rate has increased significantly despite a decline in the adult rate. Among 120 child cases diagnosed from 1992 to 1997, 25 (21%) were classified as preventable. The causes were contact investigation interview failure (12/25 = 48%), delay to evaluation (16%), source case noncompliance with previously prescribed preventive therapy (16%), and source case diagnosed out of state (16%) with no initial investigation performed in Alabama. All preventable cases identified were black children; the proportion of preventable cases did not vary by age group or sex. During 1996, the case rate for nonwhite children exceeded that of adult whites.
Conclusions. Childhood TB in Alabama for nonwhites is rising despite a national downward trend. TB is clearly a disproportionate disease burden for the state's African American population, and the median case age is falling. Additional research and improved training in contact investigation are required to assess this situation and effectively intervene.
Diminished Inducible Nitric Oxide Synthase Expression in Fulminant Early-Onset Neonatal Pneumonia
Authors: Aikio Outi , Vuopala Katri , Pokela Marja-Leena , Hallman Mikko 
Published: August 2004

Objective.Fulminant early-onset neonatal pneumonia is associated with ascending intrauterine infection (IUI), prematurity, persistent pulmonary hypertension (PPHN), and septicemia. Nitric oxide (NO) as an inflammatory mediator is included in antimicrobial defense and has a role in pathogenesis of septic shock. The aim was to study the role of inflammatory NO in neonatal pneumonia.Methods.Lungs from 36 autopsies were studied: 12 had fulminant early-onset neonatal pneumonia, 5 pneumonia of later onset, and 19 controls had similar gestational and postnatal age. In addition, airway specimens from 21 intubated newborns were analyzed: 7 with fulminant early-onset pneumonia, 7 apparently noninfected infants born prematurely attributable to IUI, and 7 premature infants of similar gestation. Specimens were analyzed for inducible NO synthase (NOS2) and nitrotyrosine, an indicator of NO toxicity. The degree of staining was analyzed.Results.In fulminant pneumonia, alveolar macrophages (AM) showed significantly less NOS2 immunoactivity than the controls. In the airway specimens, the infants with fulminant pneumonia 0 to 2 days after birth had significantly lower intracellular NOS2 and nitrotyrosine and significantly lower interleukin-1β and surfactant protein-A than apparently noninfected IUI infants. NOS2 and the other indices increased significantly during the recovery.Conclusions.For the first time, we report NOS2 expression by macrophages from human neonates. In fulminant early-onset neonatal pneumonia, delayed production rather than excess of pulmonary inflammatory NO is associated with severe symptoms.
A Comparison of Neonatal Mortality Risk Prediction Models in Very Low Birth Weight Infants
Authors: Pollack Murray M. , Koch Matthew A. , Bartel Doris A. , Rapoport Irina , Dhanireddy Ramasubbareddy , El-Mohandes Ayman A. E. , Harkavy Kenneth , Subramanian K. N. Siva ,   the District of Columbia Neonatal Network
Published: August 2004

Background.Risk-adjusted severity of illness is frequently used in clinical research and quality assessments. Although there are multiple methods designed for neonates, they have been infrequently compared and some have not been assessed in large samples of very low birth weight (VLBW; &lt;1500 g) infants.Objectives.To test and compare published neonatal mortality prediction models, including Clinical Risk Index for Babies (CRIB), Score for Neonatal Acute Physiology (SNAP), SNAP-Perinatal Extension (SNAP-PE), Neonatal Therapeutic Interventions Scoring System, the National Institute of Child Health and Human Development (NICHD) network model, and other individual admission factors such as birth weight, low Apgar score (&lt;7 at 5 minutes), and small for gestational age status in a cohort of VLBW infants from the Washington, DC area.Methods.Data were collected on 476 VLBW infants admitted to 8 neonatal intensive care units between October 1994 and February 1997. The calibration (closeness of total observed deaths to the predicted total) of models with published coefficients (SNAP-PE, CRIB, and NICHD) was assessed using the standardized mortality ratio. Discrimination was quantified as the area under the curve (AUC) for the receiver operating characteristic curves. Calibrated models were derived for the current database using logistic regression techniques. Goodness-of-fit of predicted to observed probabilities of death was assessed with the Hosmer-Lemeshow goodness-of-fit test.Results.The calibration of published algorithms applied to our data was poor. The standardized mortality ratios for the NICHD, CRIB, and SNAP-PE models were .65, .56, and .82, respectively. Discrimination of all the models was excellent (range: .863–.930). Surprisingly, birth weight performed much better than in previous analyses, with an AUC of .869. The best models using both 12- and 24-hour postadmission data, significantly outperformed the best model based on birth data only but were not significantly different from each other. The variables in the best model were birth weight, birth weight squared, low 5-minute Apgar score, and SNAP (AUC = .930).Conclusion.Published models for severity of illness overpredicted hospital mortality in this set of VLBW infants, indicating a need for frequent recalibration. Discrimination for these severity of illness scores remains excellent. Birth variables should be reevaluated as a method to control for severity of illness in predicting mortality.
Parental Prevention Practices for Young Children in the Context of Maternal Depression
Authors: McLennan John D. , Kotelchuck Milton 
Published: August 2004

Objective.To assess the relationship between maternal depression and 4 parent-based prevention practices (use of car seats and electrical plug covers, presence of syrup of ipecac in the home, and reading to their child), using a large nationally representative follow-back sample.Methods.The maternal self-report components of 2 databases were used for this study, the 1988 National Maternal and Infant Health Survey and the linked companion 1991 Longitudinal Follow-Up Survey. A total of 7537 mothers with newborns in 1988 served as the subjects. Measures of the 4 prevention practices were extracted from the 1991 survey. Depressive symptom measures were derived from both surveys using the Center for Epidemiologic Studies-Depression Scale. Weighted bivariate and multivariate logistic analyses were used to assess the relationship between maternal depressive symptoms (trichotomized to depression at both time points, at 1 time point, and at neither time point) and parental prevention practices, while controlling for a wide variety of sociodemographic variables.Results.Mothers reporting a high level of depressive symptoms (Center for Epidemiologic Studies-Depression Scale score ≥16) reported significantly poorer prevention practices for car seat use, covering electrical plugs, and having syrup of ipecac in the home. High depressive symptoms were also related to a lower likelihood of daily reading, but only for those mothers presently living with a male partner. Engagement in all prevention practices, except having syrup of ipecac in the home, were less likely if the mother reported high levels of depressive symptoms at both time points versus a single time point.Conclusion.Maternal depression may significantly impede parental prevention practices. As maternal depression is a treatable condition, screening and treating this disorder may contribute to improvement in childhood prevention practices and ultimately child health.
Rectal Methohexital Sedation for Computed Tomography Imaging of Stable Pediatric Emergency Department Patients
Authors: Pomeranz Elaine S. , Chudnofsky Carl R. , Deegan Thomas J. , Lozon Marie M. , Mitchiner James C. , Weber James E. 
Published: August 2004

Objective.
Rapid onset of sleep, brief duration of action, and ease of administration are properties that make rectal methohexital (MXT) an attractive choice for sedating stable pediatric emergency department (ED) patients for computed tomography (CT) imaging.

Methodology.
One hundred stable patients between 3 and 60 months of age who presented to any of 3 participating EDs and required sedation to undergo CT scanning were given 25 mg/kg of rectal MXT ∼15 minutes before their imaging. Vital signs and oxygen saturation were recorded at regular intervals. Data collected included indication for CT imaging, time to achieve sleep, time to reach discharge criteria, adequacy of sedation, adverse effects, and parental satisfaction.

Results.
Ninety-five percent of the patients were adequately sedated with rectal MXT. It took an average of 8 minutes to achieve full sedation and the duration of action averaged 79.3 minutes. Ten percent had transient side effects, but all recovered completely. None required intubation. Parental satisfaction was 90%.

Conclusion.
Rectal MXT compares favorably to other methods of nonintravenous sedation for CT scanning of stable pediatric ED patients in terms of rapidity of onset and reliability but does cause a significant amount of transient respiratory depression. Its use requires careful monitoring of oxygen saturation and should be used only in a setting where physicians skilled in airway management are present. If these requirements are met, it may be a good choice for the relatively noninvasive sedation of pediatric ED patients undergoing painless but anxiety-provoking procedures. methohexital, pediatric procedure sedation, rectal administration, computerized tomography imaging.