bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Light-to-Moderate Alcohol Consumption During Pregnancy Increase the Risk for Renal Anomalies Among Offspring?
Authors: Moore Cynthia A. , Khoury Muin J. , Liu Yecai 
Published: August 2004

Objective. To determine the association between light-to-moderate prenatal alcohol exposure and congenital renal anomalies.Methods. Data from the population-based Atlanta Birth Defects Case-Control Study were used to examine the association between selected renal anomalies and self-reported maternal alcohol consumption during the period from 1 month before through 3 months after conception. Case infants were ascertained by a population-based birth defects registry with active case ascertainment; the case group consisted of 158 infants, born during 1968 through 1980 to metropolitan Atlanta residents, in whom these renal anomalies had been diagnosed. Two control groups were used. One had 3029 infants without birth defects, and the other had 4633 infants with birth defects exclusive of the urinary tract who were born during the same period.Results. Overall, there was a moderate association between renal anomalies and moderate prenatal alcohol exposure (odds ratio, 1.5; 95% confidence interval, 1.0 to 2.3). When the renal anomalies were subclassified, moderate prenatal alcohol exposure was significantly associated only with renal agenesis or hypoplasia (odds ratio, 2.5; 95% confidence interval, 1.2 to 5.1), and within this group only infants with bilateral defects and other major anomalies in addition to renal agenesis or hypoplasia had significantly elevated risks. There were no significant associations between reported light consumption and any category of the selected renal anomalies. No conclusions could be reached for reported heavy consumption because of sparse data. Adjustments for potential confounding factors did not alter these results.Conclusion. This study suggests that moderate alcohol consumption during pregnancy may increase a woman’s risk of giving birth to a child with renal agenesis or hypoplasia. renal anomalies, renal agenesis, prenatal ethanol exposure, multiple congenital anomalies.
A Descriptive Survey of Pediatric Human Immunodeficiency Virus–infected Long-term Survivors
Authors: Nielsen Karin , McSherry George , Petru Ann , Frederick Toni , Wara Diane , Bryson Yvonne , Martin Natasha , Hutto Cecelia , Ammann Arthur J. , Grubman Samuel , Oleske James , Scott Gwendolyn B. 
Published: August 2004

Objective. To identify the population of human immunodeficiency virus–infected pediatric long- term survivors (LTS) followed in major medical institutions in California, Florida and New Jersey.Methods. A cross-sectional survey was performed with data collection forms sent to all investigators. Demographic, clinical, and laboratory data were obtained on all living patients ≥8 years infected in the perinatal period with human immunodeficiency virus.Results. A total of 143 perinatally infected and 54 children infected by neonatal transfusion were identified. Fifty-four children (27%) had absolute CD4 counts ≥500 cells/mm3(group 1: mean age 9.8 years), 54 children (27%) had CD4 counts between 200 and 500 cells/mm3 (group 2: mean age 10.1 years), and 89 children (45%) had CD4 counts &lt;200 cells/mm3 (group 3: mean age 10.4 years). Ninety-five (48%) patients had developed AIDS defining conditions; 14 (26%) in group 1, 26 (48%) in group 2, and 55 (62%) in group 3. Ninety-two percent of patients had received antiretrovirals. Perinatally human immunodeficiency virus-infected children tended to be younger (mean age 9.8 years) than children infected via a blood transfusion (mean age 11 years). Generalized lymphadenopathy was the most prevalent clinical finding. Lymphoid interstitial pneumonia and recurrent bacterial infections were the most prevalent acquired immune deficiency syndrome-defining conditions. Twenty percent of LTS had CD4 counts ≥500 cells/mm3 and no immune deficiency syndrome-defining conditions.Conclusions. Pediatric LTS were in variable stages of disease progression. The proportion of children within each CD4 strata did not differ by mode of acquisition of infection. Increased CD4 counts were inversely proportional to age. Only 20% of pediatric LTS had minimal to no disease progression. HIV, pediatric long-term survivors, slow disease progression.
Morbidity and Mortality of Open Lung Biopsy in Children
Authors: Davies Lea , Dolgin Stephen , Kattan Meyer 
Published: August 2004

Objective. In patients with diffuse pulmonary infiltrates, when empiric therapy or less-invasive diagnostic procedures fail, physicians frequently resort to open lung biopsy (OLB) to provide a definite diagnosis and to help redirect therapeutic treatment. OLB is still widely regarded as a safe diagnostic procedure, even in the critically ill child. The objective of this study is to evaluate the accuracy of this view with regard to children with acute respiratory failure (ARF) and, for this purpose, compares the mortality and morbidity of such patients with those without ARF.Design. Retrospective chart review.Setting. University hospital.Patients. Forty-two patients (mean age, 6.6 years) underwent 47 OLBs for undiagnosed diffuse pulmonary infiltrates between July 1984 and December 1994. Twenty-six patients (55%) were in ARF. Fifteen of these patients were intubated and receiving mechanical ventilatory support before the OLB procedure.Results. The overall incidence of serious complications associated with the OLB procedure was 51%. Of the patients with ARF, 17 (65%) had at least one major complication compared with 3 (14%) of the patients without ARF. Pleural air complications (62% of the total) occurred only in patients with ARF: pneumothoraces and/or prolonged air leaks developed in 10 (38%) after their OLBs; 9 of these patients died, and 7 had pneumothorax complicating their chest tube removal, which required replacement chest tubes. All patients with ARF preoperatively required prolonged ventilatory support after the OLB procedure, whereas 90% of the patients without ARF could be extubated within 24 hours. Overall, 10 patients (24%) died after the OLB procedure. All deaths occurred in patients with ARF. Both ARF preoperatively and the presence of postoperative complications were significantly associated with decreased survival.Conclusions. The morbidity and mortality rates of children with ARF undergoing OLB for diffuse pulmonary infiltrates differ considerably from those of children without ARF. For children with ARF, OLB is associated with the risk of prolonged ventilatory support, recurrent pneumothoraces, and air leaks. These complications may be attributable to such patients' having diseased lungs with poor healing. Moreover, these complications may, in turn, contribute to the patients' poor outcomes.
Number and Activation of Circulating Polymorphonuclear Leukocytes and Platelets Are Associated with Neonatal Respiratory Distress Syndrome Severity
Authors: Brus Frank , van Oeveren Willem , Okken Albert , Oetomo Sidarto Bambang 
Published: August 2004

Objective. To determine whether number and activation of circulating polymorphonuclear leukocytes (PMNs) and platelets are associated with disease severity in neonatal respiratory distress syndrome (RDS).Design. Prospective study.Setting. Tertiary neonatal intensive care unit.Patients. Preterm infants with severe (n = 18) or mild to moderate (n = 18) RDS who were consecutively admitted.Interventions. PMN and platelet counts and plasma concentrations of elastase-α1-proteinase inhibitor (E-α1-PI) and thromboxane B2(TxB2) were recorded each day during the first 5 days of life. E-α1-PI-to-PMN and TxB2-to-platelet ratios were calculated to correct for the influence of the PMN and platelet count on elastase and thromboxane release.Results. From day 2, the severe RDS group had lower median PMN counts (1.5 vs 4.5 × 109/L), lower mean platelet counts (136 vs 230 × 109/L), and more elastase and thromboxane release, indicated by higher median E-α1-PI-to-PMN (39.2 vs 13.0 ng/106 PMNs on day 2) and TxB2-to-platelet (2.61 vs 0.52 pg/106 platelets on day 3) ratios than the mild-to-moderate group. Lower PMN and platelet counts and higher elastase and thromboxane release were correlated with birth asphyxia (lower 5-minute Apgar scores and umbilical arterial PH values), higher respiratory requirements (fraction of inspired oxygen and peak inspiratory pressure), and decreased values for continuous measures of RDS severity (ventilatory efficiency index and Pao2-to-alveolar oxygen tension ratio).Conclusion. Decreased PMN and platelet counts and increased elastase and thromboxane release are correlated with increased RDS severity. Birth asphyxia (hypoxia and acidosis) and tissue injury caused by high-pressure ventilation and hyperoxia may promote this activation process.
Pain Management in the Emergency Department: Patterns of Analgesic Utilization
Authors: Petrack Emory M. , Christopher Norman C. , Kriwinsky Jan 
Published: August 2004

Objective. To compare the use of analgesia in children to adults in 3 different emergency department (ED) settings.Methods. Forty adult and 40 pediatric ED charts were randomly selected for review at each of 3 institutions: an academic medical center with separate pediatric and adult EDs (SEP ED), a community academic medical center with a combined adult and pediatric ED (COMB ED), and a community hospital with a combined ED (COMTY ED). All patients presenting to the EDs from July 1993 to June 1994 within 12 hours of an isolated long bone fracture were eligible for inclusion. Data were collected on demographics, training of providers, analgesic use and dosing in the ED and on discharge, and time from triage to analgesic use.Results. The mean pediatric and adult ages were 8.7 and 38.3 years, respectively. Overall, 152/240 (63%) patients received some form of analgesia in the ED, with the COMTY ED (41/80; 51%) offering significantly less analgesia than the COMB ED (58/80; 73%), but not the SEP ED (53/80; 66%). Pediatric patients (64/120; 53%) received significantly less analgesia in the ED than adult patients (88/120; 73%). This difference was significant at the COMB ED (pediatric 23/40; 58% vs adult 35/40; 88%) and COMTY ED (pediatric 15/40; 38% vs adult 26/40; 65%), but not at the SEP ED (pediatric 26/40; 65% vs adult 27/40; 68%). 195/240 (81%) patients received discharge pain medication. There were no differences between pediatric (93/120; 78%) and adult (102/120; 85%) discharge analgesic prescribing practices. Although there was no difference in appropriateness of analgesic doses in the ED, pediatric patients (20/74; 27%) were more likely than adult patients (3/88; 3%) to receive inadequate doses of analgesics on discharge from the ED.Conclusions. ED analgesia continues to be used less frequently in the pediatric compared with the adult population. Inadequate dosing of discharge analgesic medication in children is a significant problem. Patterns of analgesic utilization may differ in different types of ED settings.
Infant Sleep Position Instruction and Parental Practice: Comparison of a Private Pediatric Office and an Inner-city Clinic
Authors: Ray Brenda J. , Metcalf Sharon C. , Franco Sofia M. , Mitchell Charlene K. 
Published: August 2004

Objective. To determine infant sleep instructions that hospital personnel in our community were giving to parents and actual positions practiced after the April 15, 1992 American Academy of Pediatrics recommendation for nonprone positioning.Design. Survey of mothers of infants ≤4 months of age from November 1993 to March 1994 with follow-up survey of selected birth hospitals.Setting. A private practice (PP) serving predominantly white middle- and upper-income children and a pediatric clinic (CY) serving inner-city predominantly African-American low-income children in Louisville, Kentucky.Patients. Fifty infants from each practice site.Outcome Measure. The sleep instructions given and practiced, and other risk factors for sudden infant death syndrome (SIDS).Results. Nonprone sleeping instructions were received by 72% of the PP and only 48% of the CY parents, with 72% of the PP and 54% of the CY following the nonprone recommendations. Infants were more likely to be in smoking households (60% vs 12%) from the CY practice than the PP practice.Conclusions. Our study showed that, despite having a higher prevalence of SIDS risk factors, there was a greater delay in discontinuing prone positioning instructions in the hospital serving the CY infants. The evidence suggests that this population is as likely as the PP group to follow medical advice given. infant sleep position, SIDS, sleep instruction.
Children at Risk: Their Health Insurance Status by State
Authors: Yudkowsky Beth K. , Tang Suk-fong S. 
Published: August 2004

Objective. To inform policymakers and child health advocates about children’s health insurance coverage in each state as Congress debates proposals to restructure the Medicaid program amidst declining employer-based dependent health insurance coverage.Methods. Multiple years of data from the March supplement of the Current Population Surveys were pooled to yield more reliable estimates of changes in children’s health insurance coverage in each state from 1987 to 1993.Results. Overall, the number of uninsured children grew by nearly 1 million between 1987 and 1993. The proportion of infants and children &lt;7 years old without health insurance declined; the proportion of uninsured children between the ages of 7 and 22 increased. Between 1987–1990 and 1991–1993, six states experienced a significant increase in the number of uninsured children, only two states experienced a significant decrease in the number of uninsured children, although no progress was found in reducing the number of uninsured children in 43 states. Between 1987–1990 and 1991–1993, the proportion of children covered by employer-based private insurance decreased significantly in three-fourths of the states and the proportion of children with Medicaid coverage increased significantly in four-fifths of the states.Conclusions. In a period of fast-declining employer-based health insurance coverage for dependents, Medicaid expansions have worked to moderate the surge in the number of children without health insurance. Of the 30 million children without private health insurance in 1993, nearly 18 million were insured by Medicaid. As policymakers debate the future of the Medicaid program, they must consider seriously its role as the country’s largest insurer of children’s health and its efficacy as a vital safety net for the nation’s children. children, insurance, Medicaid, access, state.
Maternal and Perinatal Risk Factors for Later Delinquency
Authors: Conseur Amy , Rivara Frederick P. , Barnoski Robert , Emanuel Irvin 
Published: August 2004

Background. The early identification of risk factors for juvenile offending is one important step in preventing youth violence and offending. This cohort study examined whether perinatal circumstances predicted offending during adolescence.
Methods. Washington State birth certificates from 1974 to 1975 were linked to juvenile justice data to identify all individuals adjudicated between 10 and 17 years of age. Thirteen thousand five hundred seventy-three offenders were compared with a sample of 38 387 nonoffenders matched on gender and birth order.
Results. Both male and female children of mothers who were teenagers at the child's birth or at her first birth, or who were born to unmarried mothers, had significantly increased risk for any juvenile offending, and for being adjudicated for five or more crimes (chronic offending). Males born to unmarried mothers under 18 years old had an 11-fold increased risk of chronic offending compared with males born to married mothers ≥20 years old. Low birth weight and preterm gestational age carried no increased risk for juvenile offending.
Conclusions. Birth to teenage or unmarried mothers are strongly associated with later risk of juvenile delinquency. Although there are multiple, interrelated risk factors for juvenile delinquency, prevention of births to teenage and/or unmarried mothers may help to prevent subsequent juvenile delinquency.
The Utility of Body Mass Index as a Measure of Body Fatness in Children and Adolescents: Differences by Race and Gender
Authors: Daniels Stephen R. , Khoury Philip R. , Morrison John A. 
Published: August 2004

Objective. To evaluate whether body mass index (BMI) is a representative equivalent measure of body fatness independent of age, race, gender, sexual maturation, and distribution of fat in children and adolescents.
Study Design. Cross-sectional study of 192 healthy subjects (100 boys and 92 girls, 103 white and 89 black) age 7 to 17 years.
Methods. Height and weight were measured in the standard fashion, and BMI (kg/m2) was calculated from these values. Fat mass and percent body fat were determined using dual-energy x-ray absorptiometry. Sexual maturation was evaluated by physical assessment. Distribution of fat was determined by the waist:hip ratio.
Results. There were no significant differences by gender and ethnic group for any of the demographic or anthropometric variables, except waist:hip ratio, which was higher in white compared with black boys. BMI was significantly and positively correlated with age, stage of maturation, and all of the anthropometric variables in each race-sex group. The correlation of maturation stage with BMI was stronger than the correlation between age and BMI. A multiple regression analysis showed that BMI, gender, race, sexual maturation, and distribution of fat were all significant independent correlates of the percent body fat (multiple R2 = .77). The percent body fat-BMI relationship was dependent on the stage of sexual maturation, gender (for an equivalent BMI, girls have greater amounts of body fat than boys), race (for equivalent BMI, whites have higher body fat than blacks), and waist:hip ratio (for equivalent BMI, those with central obesity have greater body fatness than those with peripheral obesity).
Conclusion. BMI is not an equivalent measure of the percent body fat for each race-sex group. When BMI is used as a measure of body fatness in a research or clinical setting, particularly when comparisons are made across race and gender, it may be important to consider the maturation stage, race, gender, and distribution of body fat in the interpretation of the results.
Inhaled Nitric Oxide and Hypoxic Respiratory Failure in Infants With Congenital Diaphragmatic Hernia
Authors:   The Neonatal Inhaled Nitric Oxide Study Group (NINOS)
Published: August 2004

Objective. We designed and conducted a randomized, double-masked, controlled multicenter study to determine whether inhaled nitric oxide (INO) in term and near-term infants with congenital diaphragmatic hernia (CDH) would reduce the occurrence of death and/or the initiation of extracorporeal membrane oxygenation (ECMO).Patients and Methods. Infants of 34 weeks gestation or more, &lt;14 days of age with CDH, without known structural heart disease, requiring assisted ventilation for hypoxemic respiratory failure with two oxygenation indices (OIs) of 25 or more at least 15 minutes apart, were eligible for this trial. Infants were centrally randomized and then received masked treatment with 20 ppm NO or 100% oxygen as control. Infants with less than a full response to 20 ppm NO (increase in Pao2 &gt;20 Torr) after 30 minutes were evaluated at 80 ppm NO/control study gas.Results. The 28 control and 25 treated infants enrolled by the 13 participating centers were not significantly different at randomization for any of the measured variables including prerandomization therapies and initial OIs (45.8 ± 16.3 for controls, 44.5 ± 14.5 for INO). Death at &lt;120 days of age or the need for ECMO occurred in 82% of control infants compared with 96% of INO infants (ns). Death occurred in 43% of controls and 48% of the INO group (ns), and ECMO treatment was used for 54% of control and 80% of INO-treated infants. There was no significant improvement in Pao2 (Δ Pao2 7.8 ± 19.8 vs 1.1 ± 7.6 Torr, ns) nor significant reduction in OI (-2.7 ± 23.4 vs 4.0 ± 14.8, ns) associated with INO treatment. Mean peak nitrogen dioxide (NO2) concentration was 1.9 ± 1.3 ppm and the mean peak methemoglobin was 1.6 ± 0.8 mg/dL. No infant had study gas discontinued for toxicity. There were no differences between the control and INO groups for the occurrence of intracranial hemorrhage, specific grades of intracranial hemorrhage, periventricular leukomalacia, brain infarction, and pulmonary or gastrointestinal hemorrhages.Conclusions. Although the immediate short-term improvements in oxygenation seen in some treated infants may be of benefit in stabilizing responding infants for transport and initiation of ECMO, we conclude that for term and near-term infants with CDH and hypoxemic respiratory failure unresponsive to conventional therapy, inhaled NO therapy as used in this trial did not reduce the need for ECMO or death.
Adolescents and Anabolic Steroids: A Subject Review
Authors:   Committee on Sports Medicine and Fitness
Published: August 2004

This Policy Statement was retired December 2009.This revision of a previous statement by the American Academy of Pediatrics provides current information on anabolic steroid use by young athletes. It provides the information needed to enable pediatricians to discuss the benefits and risks of anabolic steroids in a well-informed, nonjudgmental fashion.
Vaginal Gonococcal Cultures in Sexual Abuse Evaluations: Evaluation of Selective Criteria for Preteenaged Girls
Authors: Ingram David L. , Everett V. Denise , Flick Lauren A. R. , Russell Theresa A. , White-Sims Susanne T. 
Published: August 2004

Objective. Accurate selective criteria could limit the number of vaginal cultures for Neisseria gonorrhoeae performed on preteenaged girls as part of their sexual abuse evaluations. This study was performed to determine whether the published selective criteria by the American Academy of Pediatrics (AAP) Committee on Child Abuse and Neglect and by Siegel et al would have accurately detected all cases of vaginal gonococcal infections in our large study population.
Methods. We prospectively studied girls, ages 1 to 12 years, who were referred to our Child Sexual Abuse Team (CSAT) at Wake Medical Center in Raleigh, NC, between July 1, 1976 to July 1, 1996, for sexual abuse evaluations which were performed using a protocol that included collecting historical information, a sexual abuse interview, and a detailed genital examination which included a vaginal culture forN gonorrhoeae.
Results. Our study population consisted of 2898 girls of whom 2731 (94%) had vaginal cultures successfully performed forN gonorrhoeae. There were 84 girls with vaginal gonococcal infections, 80 of whom had a vaginal discharge. The four girls without a vaginal discharge included two with a history of having vaginal intercourse with an alleged perpetrator with gonorrhea, one withN gonorrhoeae isolated from a urine culture, and one whose preteenaged sister had gonorrhea. All of the 84 girls would have been identified using the selective culturing criteria of the AAP Committee on Child Abuse and Neglect: culturing when epidemiologically indicated (interpreted as the girl having another sexually transmitted disease [STD], a child sibling, child household member, a close child associate or a perpetrator with a known STD) or when the history and/or physical findings suggest the possibility of oral, genital, or rectal contact, or Siegel et al’s more selective criteria: only culturing prepubertal girls for N gonorrhoeae if there is a vaginal discharge at the time of presentation or if there is a high risk for STD acquisition, defined as having a STD diagnosed, a sibling with a STD, contact with a perpetrator known to have a STD, contact with multiple perpetrators, or Tanner stage III or above.
Conclusion. Both the selective criteria of the AAP Committee on Child Abuse and Neglect and the more selective criteria of Siegel et al as we interpreted them were accurate when applied to identifying girls with vaginal gonococcal infections in our study population. Neisseria gonorrhoeae, female children, sexual abuse evaluation, vaginal cultures.