bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of a Single Remote Course Versus Weekly Courses of Antenatal Corticosteroids on Functional Residual Capacity in Preterm Infants: A Randomized Trial
Authors: McEvoy Cindy , Bowling Susan , Williamson Kathleen , Lozano David , Tolaymat Lama , Izquierdo Luis , Maher James , Helfgott Andrew 
Published: August 2004

Objective. There are no randomized data on the effect of repeat courses of corticosteroids during pregnancy on newborn pulmonary function. Our objective was to compare the effect of a single remote course of antenatal steroids (AS) with weekly courses of AS on functional residual capacity (FRC) and respiratory compliance in preterm infants.Study Design/Methods. Pregnant women 25 to 33 weeks’ gestation, who remained undelivered 1 week after their first course of antenatal corticosteroids (two 12-mg doses of betamethasone) were randomized to weekly courses of corticosteroids versus weekly placebo until delivery or 34 weeks’ gestation. FRC was measured with the nitrogen washout technique and respiratory compliance with the single breath occlusion technique within 48 hours of life.Results. Thirty-seven infants (mean gestational age at delivery ∼32.5 weeks) were studied. Maternal and infant demographics were similar. There was no significant difference in FRC (28.5 vs 27.5 mL/kg) or respiratory compliance between the infants who received a single remote course of antenatal corticosteroids and those who received weekly courses of corticosteroids until delivery. There was no significant difference in admission head circumference or birth weights between the groups.Conclusions. Our results demonstrate that weekly repetitive courses of AS do not significantly increase FRC or respiratory compliance in preterm infants when compared with a single remote course of steroids given at a mean gestational age of 29 weeks.
Clinical Management of Infants With Hypoplastic Left Heart Syndrome in the United States, 1988–1997
Authors: Chang Ruey-Kang R. , Chen Alex Y. , Klitzner Thomas S. 
Published: August 2004

Objectives. To evaluate changes in the clinical management of infants with hypoplastic left heart syndrome (HLHS) over a 10-year period.
Background. Orthotopic heart transplantation (OHT) and the Norwood procedure have emerged as the treatment options for HLHS over the last 2 decades.
Methods. We used 1988–1997 hospital discharge data from the National Inpatient Sample dataset. Patients ≤30 days of age with a principal diagnosis of HLHS were identified. Clinical management included the Norwood procedure, OHT, in-hospital death without surgery, discharge home without surgery, and transfer to another hospital. Multivariate logistic regression was used to evaluate variables associated with the choice of management.
Results. There were 1986 cases of HLHS with 812 in-hospital deaths, yielding a mortality rate 40.9%. The in-hospital mortality rate decreased from 54.4% in 1988 to 38.1% in 1997. The proportion of patients treated with the Norwood procedure increased from 8% in 1988 to 34% in 1997. The proportion of patients who died in the hospital without surgery decreased over time while the percentage discharged from the hospital without surgery or transferred to another hospital remained relatively unchanged. The in-hospital mortality rate was significantly lower in the OHT group compared with the Norwood group (26.2% vs 46.0%). We found no differences in gender, race, type of insurance, or home income between patients treated with the Norwood procedure compared with those who received comfort care. Patients from a later era, in the South, and in teaching hospitals were more likely to undergo the Norwood procedure.
Conclusions. Between 1988 and 1997, the proportion of infants with HLHS treated with the Norwood procedure increased while the use of comfort care decreased. Gender, race/ethnicity, type of medical insurance, and home income did not correlate with treatment choices.
When Children Die: A Seminar Series for Pediatric Residents
Authors: Bagatell Rochelle , Meyer Robyn , Herron Sandra , Berger Alice , Villar Rodrigo 
Published: August 2004

Objective. Our goals were to assist residents in acquiring skills needed to care for children at the end of life and to increase their comfort level regarding critical aspects of caring for dying children.
Methods. We designed and implemented a 6-part seminar series for pediatric residents in their postgraduate year-2 at the University of Arizona Pediatric Residency Program. The series consisted of small group sessions regarding medical and legal issues facing physicians at the time of a pediatric patient’s death, symptom management in dying children, approaches to limitation of care and discussion of impending death of a child, cultural and developmental factors impacting on the care of children at the end of life, parent and sibling bereavement after the death of a child, and physician’s personal responses to the death of pediatric patients. The sessions were conducted on weekday evenings away from patient care settings and included input from community-based individuals as well as academic pediatric subspecialists. To promote active discussion, size was limited to 12 participants. Pretests and posttests were used to evaluate the success of this program. Residents’ level of comfort with important issues in end-of-life care was measured using a 5-point Likert scale.
Results. Although most of the residents taking part in the seminar series had previously participated in discussions of limitation of care of a child and/or had performed advanced life support measures on a child, few had any previous training in end-of-life care. Responses of the 8 participants who completed both the pretests and posttests were evaluated for assessment of changes in comfort level in areas pertinent to end-of-life care. We found that on completion of this program, residents were significantly more comfortable with logistic issues and symptom management, discussing death and limitation of medical care with families, discussing end-of-life care with colleagues and families, handling conflicts within the health care team, working with families of varying ethnic backgrounds, guiding developmentally appropriate discussions of death, identifying and seeking out advice from a role model regarding end-of-life care, and coping with their own responses to a child’s death. Costs of this seminar series were minimal.
Conclusions. An inexpensive, discussion-based seminar series successfully provided pediatric residents with basic information regarding end-of-life care and significantly increased their confidence as clinicians caring for seriously ill and dying children.
Small Thymus at Birth: A Predictive Radiographic Sign of Bronchopulmonary Dysplasia
Authors: De Felice Claudio , Latini Giuseppe , Del Vecchio Antonio , Toti Paolo , Bagnoli Franco , Petraglia Felice 
Published: August 2004

Objective. Emerging evidence indicates a relationship between bronchopulmonary dysplasia (BPD) and chorioamnionitis. Recent data provide evidence of an acute thymic involution in very low birth weight (VLBW) preterm infants and fetuses with histologic chorioamnionitis. We tested the hypothesis that a small thymus detected at birth on the routine chest radiograph is a predictor of BPD in VLBW infants.Methods. A prospective study was conducted on 400 VLBW preterm infants who survived &gt;4 weeks (mean gestational age: 27.5 weeks [range: 24–30]; mean birth weight: 1010 g [range: 450-1450]). Thymic size was measured on routine chest radiographs taken in the first 6 hours after birth and expressed as the ratio between the transverse diameter of the cardiothymic image at the level of the carina and that of the thorax (CT/T). The accuracy of CT/T for identifying infants with BPD was tested using receiver operating characteristic curve analyses and multivariate logistic regression.Results. Fifty-one VLBW infants (12.7%) subsequently developed BPD. A small thymus (CT/T &lt;0.28) was observed in 94.1% of the infants with BPD versus 2.9% of the infants without BPD. A small thymus at birth identified infants with BPD with 94.1% sensitivity and 98.3% specificity (odds ratio: 17.8; 95% confidence interval: 5.7–55.4).Conclusions. A small thymus at birth on the standard chest radiograph can accurately identify VLBW infants who subsequently develop BPD.
Vaccination Coverage of Foreign-Born Children 19 to 35 Months of Age: Findings From the National Immunization Survey, 1999–2000
Authors: Strine Tara W. , Barker Lawrence E. , Mokdad Ali H. , Luman Elizabeth T. , Sutter Roland W. , Chu Susan Y. 
Published: August 2004

Objective. To compare coverage estimates of foreign-born children 19 to 35 months old with those of US-born children of the same age group.
Methods. The National Immunization Survey is a multistage, random-digit dialing survey designed to measure vaccination coverage estimates of US children 19 to 35 months old. Data from 1999–2000 were combined to permit comparison of vaccination coverage among foreign- and US-born children.
Results. Foreign-born and US-born children 19 to 35 months of age had comparable 3:3:1 series coverage (3 or more doses of diphtheria and tetanus toxoids and pertussis vaccine [DTP/DTaP/DT], 3 or more doses of poliovirus vaccine, and 1 or more doses of measles-containing vaccine), the standard in most countries. However, coverage for a US standard, 4:3:1:3 series (4 or more doses of DTP/DTaP/DT, 3 or more doses of poliovirus vaccine, 1 or more doses of measles-containing vaccine, and an adequate number of Haemophlius influenzae type b [Hib] doses based on age at first dose) was lower among foreign-born children because of markedly lower Hib cover and marginally lower DTP/DTaP/DT coverage. In addition, hepatitis B coverage was markedly lower in foreign-born children.
Conclusion. Lower vaccination coverage among foreign-born children, especially against Hib and hepatitis B, is of concern because foreign-born children often live in households and communities characterized by more intense exposure to these diseases, and many originate from countries with much higher prevalence rates of these diseases than the United States. The differences in Hib and hepatitis B coverage suggest a need for increased culturally competent public health immunization interventions to increase coverage among foreign-born children.
Underascertainment of Child Maltreatment Fatalities by Death Certificates, 1990–1998
Authors: Crume Tessa L. , DiGuiseppi Carolyn , Byers Tim , Sirotnak Andrew P. , Garrett Carol J. 
Published: August 2004

Objective. Child fatality review teams have emerged across the United States in the past decade to address the concern that systems of child protection, law enforcement, criminal justice, and medicine do not adequately assess the circumstances surrounding child fatality as a result of maltreatment.Methods. We compared data collected by a multidisciplinary child fatality review team with vital records for all children who were aged birth to 16 years and died in Colorado between January 1, 1990, and December 1, 1998. Odds ratios and 95% confidence intervals for ascertainment by the death certificate were estimated using logistic regression.Results. Only half of the children who died as a result of maltreatment had death certificates that were coded consistently with maltreatment. Black race and female gender were associated with higher ascertainment, whereas death in a rural county was associated with lower ascertainment. Deaths resulting from violent causes (eg, shaking, blunt force trauma, striking) were more likely to be ascertained than those that involved acts of omission (eg, neglect and abandonment, drowning, fire). The most common perpetrators of maltreatment were parents. However, maltreatment by an unrelated perpetrator was 8.71 times (95% confidence interval: 3.52–21.55) more likely to be ascertained than maltreatment by a parent.Conclusions. The degree of underascertainment found in this study is of concern because most national estimates of child maltreatment fatality in the United States are derived from coding on death certificates. In addition, the patterns recognized in this study raise concern about systematic underascertainment that may affect children of specific sociodemographic groups.
Persistent Sterile Leukocyturia Is Associated With Impaired Renal Function in Human Immunodeficiency Virus Type 1-Infected Children Treated With Indinavir
Authors: van Rossum Annemarie M. C. , Dieleman Jeanne P. , Fraaij Pieter L. A. , Cransberg Karlien , Hartwig Nico G. , Burger David M. , Gyssens Inge C. , de Groot Ronald 
Published: August 2004

Background. Prolonged administration of indinavir is associated with the occurrence of a variety of renal complications in adults. These well-documented side effects have restricted the use of this potent protease inhibitor in children.Design. A prospective study to monitor indinavir-related nephrotoxicity in a cohort of 30 human immunodeficiency virus type 1-infected children treated with indinavir.Methods. Urinary pH, albumin, creatinine, the presence of erythrocytes, leukocytes, bacteria and crystals, and culture were analyzed every 3 months for 96 weeks. Serum creatinine levels were routinely determined at the same time points. Steady-state pharmacokinetics of indinavir were done at week 4 after the initiation of indinavir.Results. The cumulative incidence of persistent sterile leukocyturia (≥75 cells/μL in at least 2 consecutive visits) after 96 weeks was 53%. Persistent sterile leukocyturia was frequently associated with a mild increase in the urine albumin/creatinine ratio and by microscopic hematuria. The cumulative incidence of serum creatinine levels &gt;50% above normal was 33% after 96 weeks. Children with persistent sterile leukocyturia more frequently had serum creatinine levels of 50% above normal than those children without persistent sterile leukocyturia. In children younger than 5.6 years, persistent sterile leukocyturia was significantly more frequent than in older children. A higher cumulative incidence of persistent leukocyturia was found in children with an area under the curve &gt;19 mg/L*h or a peak serum level of indinavir &gt;12 mg/L. In 4 children, indinavir was discontinued because of nephrotoxicity. Subsequently, the serum creatinine levels decreased, the urine albumin/creatinine ratios returned to zero, and the leukocyturia disappeared within 3 months.Conclusions. Children treated with indinavir have a high cumulative incidence of persistent sterile leukocyturia. Children with persistent sterile leukocyturia more frequently had an increase in serum creatinine levels of &gt;50% above normal. Younger children have an additional risk for renal complications. The impairment of the renal function in these children occurred in the absence of clinical symptoms of nephrolithiasis. Indinavir-associated nephrotoxicity must be monitored closely, especially in children with risk factors such as persistent sterile leukocyturia, age &lt;5.6 years, an area under the curve of indinavir &gt;19 mg/L*h, and a Cmax &gt;12 mg/L.
Respiratory Syncytial Virus Infection in Navajo and White Mountain Apache Children
Authors: Bockova Jana , O’Brien Katherine L. , Oski Jane , Croll Janne’ , Reid Raymond , Weatherholtz Robert C. , Santosham Mathuram , Karron Ruth A. 
Published: August 2004

Objective. The hospitalization rate for bronchiolitis of any cause among US children younger than 1 year is estimated at 31.2 per 1000. No data exist on respiratory syncytial virus (RSV)-specific hospitalization rates among high-risk Native Americans other than Alaska Natives, for whom the incidence of RSV hospitalization was estimated at 150 per 1000 among infants younger than 1 year. We aimed to estimate RSV hospitalization rates among Navajo and White Mountain Apache children younger than 2 years.
Methods. We conducted prospective population-level hospital-based surveillance to determine RSV hospitalization rates among Navajo and White Mountain Apache children younger than 2 years. From 1997 to 2000, all children who were admitted for acute lower respiratory tract infection between October 1 and March 31 had a nasopharyngeal aspirate obtained and tested for RSV by commercial enzyme immunoassay kits. We reviewed charts of children who tested positive for RSV antigen to determine disease severity.
Results. During 3 RSV seasons (1997–2000), 51.3% of 1837 admissions for acute lower respiratory tract infection among children younger than 2 years were attributed to RSV infection. The overall seasonal RSV hospitalization rate among children younger than 2 years was 63.6 per 1000 and 91.3 per 1000 among children younger than 1 year. In a univariate analysis, predictors of severity included age &lt;6 months (relative risk: 6.8; 95% confidence interval: 3.1–17.0).
Conclusions. Navajo and White Mountain Apache children are at high risk for RSV disease requiring hospitalization. A lower threshold for hospitalization or underlying chronic conditions that predispose to severe RSV disease do not seem to explain high RSV hospitalization rates in this population.
Urinary Incontinence in Female Adolescents With Cystic Fibrosis
Authors: Nixon Gillian M. , Glazner Judith A. , Martin Jennifer M. , Sawyer Susan M. 
Published: August 2004

Objectives. Urinary incontinence is common in healthy women and occurs with increased frequency in adult women with chronic lung disease, including cystic fibrosis (CF). This study aimed to determine the prevalence, severity, and impact on daily life of urinary incontinence in female adolescents with CF.
Methods. An interviewer-administered questionnaire was conducted with females who were aged 12 years and older and attend the CF Clinic at the Royal Children’s Hospital in Melbourne, Australia.
Results. Fifty-five (96%) of 57 eligible adolescents (age: 12–19 years) participated. Twenty-six (47%) reported ever having been incontinent of urine; 12 (22%) reported daytime incontinence twice a month or more. Median age of onset of incontinence was 13 years (range: 7–16 years). No relationship was seen with age, lung function, body mass index, or menarchal status. Coughing and laughing were the most commonly reported precipitants (affecting 84% and 68%, respectively). Of those with incontinence once a year or more, 42% reported that it sometimes prevented them from doing effective physiotherapy. Social life was affected by incontinence in approximately one third of respondents. Nearly half (42%) of affected adolescents had told no one, and only 2 had discussed the problem with their physician.
Conclusions. Urinary incontinence is common in female adolescents with CF and is not related to illness severity. Urinary incontinence has a negative impact on the performance of chest physiotherapy. Given the lack of adolescent report and knowledge of treatment availability, inquiry about symptoms of urinary incontinence should be part of the routine assessment of female adolescents with CF.
Respiratory Support in Spinal Muscular Atrophy Type I: A Survey of Physician Practices and Attitudes
Authors: Hardart M. Kathleen Moynihan , Burns Jeffrey P. , Truog Robert D. 
Published: August 2004

Objective. To determine whether there is variability in the attitudes and practices of physicians regarding treatment of respiratory failure in children with spinal muscular atrophy type I (SMA type I) and, if so, whether this variation is associated with professional training.Methods. This was a descriptive, cross-sectional survey mailed to a randomly selected subset of the Child Neurology Society, pediatric members of the Society of Critical Care Medicine and to the membership of the Pediatric Interest Section of the American Academy of Physical Medicine and Rehabilitation. A scenario of a child with SMA type I in respiratory distress was followed by questions that explored practices and attitudes regarding mechanical ventilation.Results. Fifty-seven percent of intensivists (75 of 132), 39% physiatrists (61 of 155), and 34% of neurologists (61 of 155) responded. Specialists differed as to whether they offered and/or recommended respiratory support to patients with SMA type I. Intensivists were less likely to offer and recommend tracheostomy than physiatrists. Intensivists were also significantly less likely than physiatrists to agree with statements supporting the ethical necessity of noninvasive mechanical ventilation (NIMV) and intubation in the setting of an acute respiratory illness, and NIMV and tracheostomy in the setting of chronic respiratory failure. Although parallel differences were found between physiatrists and neurologists regarding their attitudes toward mechanical ventilation, no significant differences were detected between intensivists and neurologists. Finally, physicians who reported that a high percentage of their patients with SMA type I received “comfort care only” also tended to view mechanical ventilation, ie, use of NIMV for chronic respiratory failure, use of intubation for an acute respiratory infection, and use of tracheostomy for chronic respiratory failure as an unreasonable intervention in most circumstances.Conclusions. We found a wide variation in physician practice regarding the mechanical ventilation of patients with SMA type I. This study suggests a wide variation not only in what is recommended but also in what is actually offered to families of these children. Furthermore, the study suggests that physician training and attitudes affect recommendations regarding mechanical ventilation and ultimately family decision making.