bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized Placebo-controlled Trial of a 42-Day Tapering Course of Dexamethasone to Reduce the Duration of Ventilator Dependency in Very Low Birth Weight Infants: Outcome of Study Participants at 1-Year Adjusted Age
Authors: O'Shea T. Michael , Kothadia Jamanadas M. , Klinepeter Kurt L. , Goldstein Donald J. , Jackson Barbara G. , Weaver R. Grey , Dillard III‡; and Robert G. 
Published: August 2004

Objective.Ventilator-dependent preterm infants are often treated with a prolonged tapering course of dexamethasone to decrease the risk and severity of chronic lung disease. The objective of this study was to assess the effect of this therapy on developmental outcome at 1 year of age.Methods.Study participants were 118 very low birth weight infants who, at 15 to 25 days of life, were not weaning from assisted ventilation and were then enrolled in a randomized, placebo-controlled, double-blind trial of a 42-day tapering course of dexamethasone. Infants were examined at 1 year of age, adjusted for prematurity, by a pediatrician and a child psychologist. A physical and neurologic examination was performed, and the Bayley Scales of Infant Development were administered. All examiners were blind to treatment group.Results.Groups were similar in terms of birth weight, gestational age, gender, and race. A higher percentage of dexamethasone recipients had major intracranial abnormalities diagnosed by ultrasonography (21% vs 11%). Group differences were not found for Bayley Mental Development Index (median [range] for dexamethasone-treated group, 94 [50–123]; for placebo group, 90 [28–117]) or Psychomotor Development Index Index (median [range]) for dexamethasone-treated group, 78 (50–109); for placebo-treated group, 81 [28–117]). More dexamethasone-treated infants had cerebral palsy (25% vs 7%) and abnormal neurologic examination findings (45% vs 16%). In stratified analyses, adjusted for major cranial ultrasound abnormalities, these associations persisted (OR values for cerebral palsy, 5.3; 95% CI: 1.3–21.4; OR values for neurologic abnormality 3.6; 95% CI: 1.2–11.0).Conclusions.A 42-day tapering course of dexamethasone was associated with an increased risk of cerebral palsy. Possible explanations include an adverse effect of this therapy on brain development and/or improved survival of infants who either already have neurologic injury or who are at increased risk for such injury.
Adapting the Gang Model: Peer Mentoring for Violence Prevention
Authors: Sheehan Karen , DiCara Joseph A. , LeBailly Susan , Christoffel Katherine Kaufer 
Published: August 2004

Objectives.
This study assessed the effectiveness of an inner-city peer-mentoring program in modifying the attitudes and behaviors involving violence of preadolescent mentees.

Methods.
In a case-matched cohort study involving 7- to 13-year-old children, 50 children enrolled in peer mentoring (case subjects) were compared with 75 control subjects. Case subjects were involved before enrollment in the community program in which the intervention occurred; control subjects lived in the same housing project and were matched with case subjects on age, sex, and census tract. A total of 19 community adolescents mentored the case subjects by designing and presenting violence prevention lessons. Two reliable self-report scales, Determining our Viewpoints of Violent Events and Normative Beliefs About Aggression Scale, were used to measure attitudinal change. Teachers completed the Revised Behavior Problem Checklist to assess changes in behavior.

Results.
At baseline, the survey scores of the case and control subjects were not different. After the intervention period, the case scores indicated less support for violence than the control scores. Case behavior scores did not change, but control behavior scores worsened.

Conclusions.
The data suggest that peer mentoring for younger children may be an important component of efforts to reduce youth violence. A larger multisite trial is warranted. violence prevention, peer mentoring, community-based.
Comparative Analysis of Serologic Screening Tests for the Initial Diagnosis of Celiac Disease
Authors: Russo Pierre A. , Chartrand Lucie J. , Seidman Ernest 
Published: August 2004

Objective.
To prospectively evaluate and compare the sensitivity, specificity, and positive and negative predictive values of serum antigliadin (AGA) and antiendomysium antibodies (EMA) in predicting the initial diagnosis of celiac disease.

Design.
Sera were tested prospectively for IgA and IgG AGA by enzymed-linked immunosorbent assay and IgA EMA by immunofluorescence techniques on monkey esophagus and human umbilical cord sections in 95 pediatric patients referred for duodenal biopsies.

Patients.
Ninety-five pediatric patients were referred for duodenal biopsies, with a clinical suspicion of celiac disease; 24 of those patients had celiac disease by criteria of the European Society for Pediatric Gastroenterology and Nutrition.

Setting.
A pediatric gastroenterology clinic of a tertiary care pediatric university hospital.

Results.
EMA testing on human umbilical cords was the most specific but was also the least sensitive. All the patients with biopsy-proven celiac disease were identified by either one or both serologic tests (100% combined sensitivity). The combination of AGA and EMA on monkey esophagus resulted in a negative predictive value of 100% accuracy.

Conclusions.
A combination of AGA and EMA tests resulted in 100% sensitivity and 100% negative predictive value, useful in selecting patients for duodenal biopsy.
Oral Versus Initial Intravenous Therapy for Urinary Tract Infections in Young Febrile Children
Authors: Hoberman Alejandro , Wald Ellen R. , Hickey Robert W. , Baskin Marc , Charron Martin , Majd Massoud , Kearney Diana H. , Reynolds Ellen A. , Ruley Jerry , Janosky Janine E. 
Published: August 2004

Background.
The standard recommendation for treatment of young, febrile children with urinary tract infection has been hospitalization for intravenous antimicrobials. The availability of potent, oral, third-generation cephalosporins as well as interest in cost containment and avoidance of nosocomial risks prompted evaluation of the safety and efficacy of outpatient therapy.

Methods.
In a multicenter, randomized clinical trial, we evaluated the efficacy of oral versus initial intravenous therapy in 306 children 1 to 24 months old with fever and urinary tract infection, in terms of short-term clinical outcomes (sterilization of the urine and defervescence) and long-term morbidity (incidence of reinfection and incidence and extent of renal scarring documented at 6 months by99mTc-dimercaptosuccinic acid renal scans). Children received either oral cefixime for 14 days (double dose on day 1) or initial intravenous cefotaxime for 3 days followed by oral cefixime for 11 days.

Results.
Treatment groups were comparable regarding demographic, clinical, and laboratory characteristics. Bacteremia was present in 3.4% of children treated orally and 5.3% of children treated intravenously. Of the short-term outcomes, 1) repeat urine cultures were sterile within 24 hours in all children, and 2) mean time to defervescence was 25 and 24 hours for children treated orally and intravenously, respectively. Of the long-term outcomes, 1) symptomatic reinfections occurred in 4.6% of children treated orally and 7.2% of children treated intravenously, 2) renal scarring at 6 months was noted in 9.8% children treated orally versus 7.2% of children treated intravenously, and 3) mean extent of scarring was ∼8% in both treatment groups. Mean costs were at least twofold higher for children treated intravenously ($3577 vs $1473) compared with those treated orally.

Conclusions.
Oral cefixime can be recommended as a safe and effective treatment for children with fever and urinary tract infection. Use of cefixime will result in substantial reductions of health care expenditures.
Prevalence and Parental Origin in Tetralogy of Fallot Associated With Chromosome 22q11 Microdeletion
Authors: Lu Jen-Her , Chung Ming-Yi , Hwang Betau , Chien Hsieh-Ping 
Published: August 2004

Objective.
Tetralogy of Fallot is a common cardiac anomaly that is associated with chromosome 22q11 microdeletion. In this study we examined the mode of transmission as well as the parental origin of microdeletion in patients with tetralogy of Fallot.

Methods.
Eighty-four children with sporadic tetralogy of Fallot (40 boys and 44 girls; mean age, 34 months) were analyzed for microdeletion at chromosome 22q11 by genotype analysis, using five microsatellite markers, D22S427, D22S941, D22S944, D22S264 and D22S311, and confirmed by quantitative polymerase chain reaction, using TUPLE1 and D22S264. All parents of these subjects consented to their own participation and their child's participation in the clinical evaluation and molecular study. To provide a molecular characterization of microdeletion, we isolated DNA from the parents and typed their DNA with each of the five polymorphic markers.

Results.
Sixty-six patients were associated with pulmonary stenosis; and 8 of these cases (12%) had microdeletion. Eighteen patients were associated with pulmonary atresia, and 6 (33%) of these cases had microdeletion. The parental origins of the 14 patients with microdeletion were paternal in 3 cases and maternal in 11 cases. The most common mode of transmission was de novo without parental hemizygosity (93%). Transmission by autosomal dominant heredity was uncommon (7%).

Conclusions.
Biased parental origin was consistently found in tetralogy of Fallot patients with chromosomal 22q11 microdeletion. Our results indicated a higher prevalence of microdeletion because of inheritance of maternal microdeletion (78%).
Serum Concentrations of Antidepressants and Benzodiazepines in Nursing Infants: A Case Series
Authors: Birnbaum Carol S. , Cohen Lee S. , Bailey Jennie W. , Grush Lynn R. , Robertson Laura M. , Stowe Zachary N. 
Published: August 2004

Objective.The relative risk of psychotropic medication use in women with puerperal psychiatric illness who are breastfeeding has yet to be quantified adequately. Although the emotional and medical benefits of breastfeeding and adverse effects of maternal depression on infant development are well described, how these absolute benefits weigh against the potential effects of psychotropic drug use during lactation to ultimately guide clinical decisions is still unclear. The objective of this report was to evaluate the extent that psychotropic medications were present in the serum of infants breastfed by mothers treated with antidepressants and benzodiazepines.Design.Serum samples were obtained from 35 nursing infants whose mothers were treated with psychotropic medications while breastfeeding. When a detectable concentration of medication was reported, information regarding infant behavior was obtained by maternal report.Setting.The Perinatal and Reproductive Psychiatry Program at Massachusetts General Hospital serves as a regional consultation center for the treatment of psychiatric disorders during pregnancy and the postpartum period.Patients.Subjects were mothers referred to the Perinatal Psychiatry Program for consultation regarding the relative safety of psychotropic medication use while breastfeeding.Primary Outcome Measures.Presence of detectable levels of medication in infants whose mothers breastfed while taking psychotropic medications during pregnancy and/or during the puerperium and the well-being (based on maternal report) of infants who had detectable serum concentrations of medication.Results.Seventy-four percent (n = 26) of infants had serum medication concentrations below the laboratory limit of detection (assay sensitivity 5–50 ng/mL). In the remaining 26% of the sample (n = 9), serum concentrations of psychotropic medications and/or active metabolites were detected. In each of these cases, infants had been exposed to the medication during pregnancy. Medications were not detected in infant serum when mothers had taken these agents solely during the postpartum period. No readily apparent difficulties with the infants were reported by mothers.Conclusions.These data support the low incidence of infant toxicity and adverse effects associated with antidepressant and benzodiazepine use during breastfeeding. These data also suggest that infant serum monitoring is helpful in the assessment of medication exposure in children of mothers who breastfeed while using psychotropic medications. Given the limited accumulated data regarding serum concentrations of psychotropic medications in breastfeeding infants, no single agent seems to be safer than another. Therefore, choice of pharmacologic treatment should be guided by the likelihood that it will result in restoration of maternal psychiatric well-being.
Previous Exposure to Measles, Mumps, and Rubella—but Not Vaccination During Adolescence—Correlates to the Prevalence of Pancreatic and Thyroid Autoantibodies
Authors: Lindberg Bengt , Ahlfors Karin , Carlsson Annelie , Ericsson Ulla-Britt , Landin-Olsson Mona , Lernmark Åke , Ludvigsson Johnny , Sundkvist Göran , Ivarsson Sten-Anders 
Published: August 2004

Objective.This study was designed to determine whether a relationship exists between previous exposure to measles, mumps, and rubella (MMR) by natural infection or vaccination or by new immunization with MMR vaccine, and either the presence or levels of autoantibodies against thyroid cell and pancreatic β-cell antigens.Methods.Antibodies against MMR and autoantibodies against thyroglobulin, thyroid peroxidase, pancreas islet cells (ICA), islet cell surface, glutamic acid decarboxylase 65k autoantibodies, and insulin were studied before, and 3 months after, vaccination with combined MMR vaccine in 386 school children between 11 and 13 years of age.Results.The vaccination changed neither the prevalence nor the level of autoantibodies. Children with rubella antibodies before vaccination had higher levels of ICA than did the rubella seronegative children. In contrast, thyroid autoantibody levels and prevalence were lower in children with antibodies against measles, mumps, or both before vaccination than in children without those antibodies.Conclusions.Previous natural infection or vaccination against measles, mumps, or both seemed to have an inhibitory effect on the development of thyroid autoantibodies. In contrast, children with previous exposure to rubella had higher levels of ICA. No evidence was found that MMR vaccination during adolescence may trigger autoimmunity.
Rehospitalization in the First Two Weeks After Discharge From the Neonatal Intensive Care Unit
Authors: Escobar Gabriel J. , Joffe Steven , Gardner Marla N. , Armstrong Mary Anne , Folck Bruce F. , Carpenter Diane M. 
Published: August 2004

Background.High-risk newborns are known to have higher than average utilization of services after discharge from the neonatal intensive care unit (NICU). Most studies on this subject report aggregate data over periods ranging from 1 to 3 years postdischarge. Little is known about events that are temporally close to NICU discharge.Objectives.To characterize rehospitalizations within the first 2 weeks after discharge from six community NICUs.Methods.We scanned electronic databases and reviewed the charts of rehospitalized infants from six NICUs in the Kaiser Permanente Medical Care Program. We subdivided infants into five groups based on gestational age (GA) and birth hospitalization length of stay (LOS): 1) ≥37 weeks' GA with &lt;4 days LOS (n = 2593); 2) ≥37 weeks' GA with ≥4 days' LOS (n = 1133); 3) from 33 to 36 weeks' GA with &lt;4 days' LOS (n = 545); 4) from 33 to 36 weeks' GA with ≥4 days' LOS (n = 1196); and 5) &lt;33 weeks' GA (n = 587). We performed bivariate and multivariate analyses to identify predictors that might be useful for practitioners.Results.There were 6054 newborns discharged alive from the six study NICUs between August 1, 1992 and December 31, 1995, and 99.5% of these infants remained in the health plan during the 2 weeks after NICU discharge. The overall rehospitalization rate was 2.72%, which is 20% higher than the rate among healthy term newborns in the Kaiser Permanente Medical Care Program (2.26%). The two most common reasons for rehospitalization were jaundice (62/165, 37.6%) and feeding difficulties (25/165, 15.2%). Infants with 33 to 36 weeks' GA and &lt;4 days' LOS were rehospitalized at a significantly higher rate than were all other infants (5.69%); 71% of infants in this group were rehospitalized for jaundice. The following variables predicted rehospitalization in multivariate models: &lt;33 weeks' GA (adjusted OR [AOR]: 1.88; 95% CI: 1.10–3.21), from 33 to 36 weeks' GA with &lt;96 hours' LOS (AOR: 2.94; 95% CI: 1.87–4.62), and birth at facility B, which had the highest rehospitalization rate of the six facilities (AOR: 1.92; 95% CI: 1.39–2.65).Conclusions.The rate of rehospitalization among NICU graduates is higher than among healthy term infants. Most of the rehospitalizations among infants with from 33 to 36 weeks' GA and &lt;4 days' LOS are for illnesses that are not life-threatening. Collaborative studies and new process and outcomes measures are needed to assess the effectiveness of follow-up strategies in high-risk newborns.
The Effects of Different Resistance Training Protocols on Muscular Strength and Endurance Development in Children
Authors: Faigenbaum Avery D. , Westcott Wayne L. , Loud Rita LaRosa , Long Cindy 
Published: August 2004

Background.Previous research has shown that children can increase their muscular strength and muscular endurance as a result of regular participation in a progressive resistance training program. However, the most effective exercise prescription regarding the number of repetitions remains questionable.Objective.To compare the effects of a low repetition–heavy load resistance training program and a high repetition–moderate load resistance training program on the development of muscular strength and muscular endurance in children.Design.Prospective, controlled trial.Setting.Community-based youth fitness center.Subjects.Eleven girls and 32 boys between the ages of 5.2 and 11.8 years.Intervention.In twice-weekly sessions of resistance training for 8 weeks, children performed 1 set of 6 to 8 repetitions with a heavy load (n = 15) or 1 set of 13 to 15 repetitions with a moderate load (n = 16) on child-size exercise machines. Children in the control group (n = 12) did not resistance train. One repetition maximum (RM) strength and muscular endurance (repetitions performed posttraining with the pretraining 1-RM load) were determined on the leg extension and chest press exercises.Results.One RM leg extension strength significantly increased in both exercise groups compared with that in the control subjects. Increases of 31.0% and 40.9%, respectively, for the low repetition–heavy load and high repetition–moderate load groups were observed. Leg extension muscular endurance significantly increased in both exercise groups compared with that in the control subjects, although gains resulting from high repetition–moderate load training (13.1 ± 6.2 repetitions) were significantly greater than those resulting from low repetition–heavy load training (8.7 ± 2.9 repetitions). On the chest press exercise, only the high repetition–moderate load exercise group made gains in 1-RM strength (16.3%) and muscular endurance (5.2 ± 3.6 repetitions) that were significantly greater than gains in the control subjects.Conclusion.These findings support the concept that muscular strength and muscular endurance can be improved during the childhood years and favor the prescription of higher repetition–moderate load resistance training programs during the initial adaptation period.
Minimum Incidence and Diagnostic Rate of First Urinary Tract Infection
Authors: Jakobsson Birgir , Esbjörner Elisabeth , Hansson Sverker ,   on behalf of the Swedish Pediatric Nephrology Association
Published: August 2004

Objective.
To study awareness of urinary tract infections (UTIs) by determining the diagnostic rate of first UTI in children &lt;2 years of age and to estimate the minimum incidence.

Methods.
Twenty-six of a total of 43 pediatric centers participated in the study. Sixty-four percent of the total childhood population &lt;2 years of age was covered. The number of all children included in the study was used to calculate the diagnostic rate. Only UTI confirmed by either suprapubic aspiration (any growth) or midstream or bag samples with ≥100 000 bacteria/mL, together with a positive nitrite reaction, was used to estimate the minimum incidence.

Results.
The mean diagnostic rate was 1.5% for boys (range, 0.7%–3.0%) and 1.7% for girls (range, 0.7%–2.9%). The diagnostic rate was significantly higher in June than in December. The mean incidence was 1.0% for both boys and girls (range, 0.3%–3.0% and 0.4%–2.9%, respectively). The minimum cumulative incidence at 2 years of age was estimated to be 2.2% for boys and 2.1% for girls.

Conclusion.
This study suggests a high UTI awareness in Sweden as indicated by a higher diagnostic rate and, despite stricter diagnostic criteria, a higher incidence of UTI in children &lt;2 years of age than previously reported. It is suggested that a high UTI awareness may reduce chronic renal failure because of pyelonephritic renal scarring.
Safety of Withdrawing Inhaled Nitric Oxide Therapy in Persistent Pulmonary Hypertension of the Newborn
Authors: Davidson Dennis , Barefield Elaine S. , Kattwinkel John , Dudell Golde , Damask Michael , Straube Richard , Rhines Jared , Chang Cheng-Tao ,   the I-NO/PPHN Study Group
Published: August 2004

Objective.Because of case reports describing hypoxemia on withdrawal of inhaled nitric oxide (I-NO), we prospectively examined this safety issue in newborns with persistent pulmonary hypertension who were classified as treatment successes or failures during a course of I-NO therapy.Methods.Randomized, placebo-controlled, double-masked, dose-response clinical trial at 25 tertiary centers from April 1994 to June 1996. Change in oxygenation and outcome (death and/or extracorporeal membrane oxygenation) during or immediately after withdrawing I-NO were the principal endpoints. Patients (n = 155) were term infants, &lt;3 days old at study entry with echocardiographic evidence of persistent pulmonary hypertension of the newborn. Exclusion criteria included previous surfactant treatment, high-frequency ventilation, or lung hypoplasia. Withdrawal from treatment gas (0, 5, 20, or 80 ppm) started once treatment success or failure criteria were met. Withdrawal of treatment gas occurred at 20% decrements at &lt;4 hours between steps.Results.The patient profile was similar for placebo and I-NO groups. Treatment started at an oxygenation index (OI) of 25 ± 10 (mean ± SD) at 26 ± 18 hours after birth. For infants classified as treatment successes (mean duration of therapy = 88 hours, OI &lt;10), decreases in the arterial partial pressure of oxygen (Pao2) were observed only at the final step of withdrawal. On cessation from 1, 4, and 16 ppm, patients receiving I-NO demonstrated a dose-related reduction in Pao2 (−11 ± 23, −28 ± 24, and −50 ± 48 mm Hg, respectively). For infants classified as treatment failures (mean duration of therapy = 10 hours), no change in OI occurred for the placebo group (−13 ± 36%, OI of 31 ± 11 after the withdrawal process); however a 42 ± 101% increase in OI to 46 ± 21 occurred for the pooled nitric oxide doses. One death was possibly related to withdrawal of I-NO.Conclusion.For infants classified as treatment successes, a dose response between the I-NO dose and decrease in Pao2 after discontinuing I-NO was found. A reduction in I-NO to 1 ppm before discontinuation of the drug seems to minimize the decrease in Pao2 seen. For infants failing treatment, discontinuation of I-NO could pose a life-threatening reduction in oxygenation should extracorporeal membrane oxygenation not be readily available or I-NO cannot be continued on transport.