bluuebunny/crossref_metadata_2025_split huggingface dataset:
Congenital Myotonic Dystrophy: Assisted Ventilation Duration and Outcome
Authors: Campbell Craig , Sherlock Rebecca , Jacob Pierre , Blayney Marc 
Published: August 2004

Objective. To clarify the relationship between initial assisted ventilation duration and outcome for patients with congenital myotonic dystrophy (CDM).
Methods. A retrospective chart review was conducted of cases of CDM that presented to the Children’s Hospital of Eastern Ontario (Ottawa, Ontario, Canada) between 1980 and 2000. Inclusion criteria were conclusive testing for CDM and clinical presentation in the first 30 days of life. Duration of assisted ventilation, morbidity, mortality, and developmental outcome were measured.
Results. A total of 23 children met the inclusion criteria. One child died at 5 days of age, and 2 others had withdrawal of ventilation. The remaining 20 children were divided into 2 groups on the basis of whether they needed &gt; or &lt;30 days of ventilation. In the first year of life, 25% mortality was noted in the children with prolonged ventilation, whereas no child in the short ventilation duration group died. After 1 year of age, 1 child in each group died with follow-up of 2 to 16 years. The children with prolonged ventilation needed more hospitalizations. Delays were noted in development in both groups of children at ages 1, 3, and 6 years; however, there was an improvement in motor and language scores over time in all children. Children who required ventilation for &lt;30 days had better motor, language, and activities of daily living scores at all ages.
Conclusions. Children with CDM with prolonged ventilation experienced 25% mortality in the first year. The use of a specific time period of ventilation to decide on withdrawal of therapy must be reconsidered given these findings. Prolonged ventilation was followed by greater morbidity and developmental delay than children with shorter ventilation duration.
Recurrent Abdominal Pain, Anxiety, and Depression in Primary Care
Authors: Campo John V. , Bridge Jeff , Ehmann Mary , Altman Sarah , Lucas Amanda , Birmaher Boris , Lorenzo Carlo Di , Iyengar Satish , Brent David A. 
Published: August 2004

Objective. The prevalence of psychiatric disorder in children and adolescents with functional recurrent abdominal pain (RAP) is unknown. Our aim was to determine whether RAP is associated with psychiatric symptoms and disorders, anxious temperament, and functional impairment in pediatric primary care.Methods. Children and adolescents who were 8 to 15 years of age, inclusive, and presented with RAP (N = 42) or for routine care in the absence of recurrent pain (N = 38) were identified by a screening procedure in pediatric primary care office waiting rooms and recruited to participate in a case-control study. Outcome measures were psychiatric diagnoses generated by standardized psychiatric interview administered blind to subject status and self, parent, and clinician ratings of child psychiatric symptoms, temperamental traits, and functional status.Results. RAP patients were significantly more likely to receive a diagnosis of a psychiatric disorder, with a categorical anxiety disorder in 33 (79%) and a depressive disorder in 18 patients (43%), and higher levels of anxiety and depressive symptoms, temperamental harm avoidance, and functional impairment than control subjects. Anxiety disorders (mean age of onset: 6.25 [standard deviation: 2.17] years) were significantly more likely to precede RAP (mean age of onset: 9.17 [standard deviation: 2.75] years) in patients with associated anxiety.Conclusions. Youths who present with RAP in primary care deserve careful assessment for anxiety and depressive disorders. Future studies should examine treatments that are proved to be efficacious for pediatric anxiety and/or depressive disorders as potential interventions for RAP. Longitudinal, family, and psychobiological studies are needed to illuminate the nature of observed associations among RAP, anxiety, and depression.
The Effect of Skin-to-Skin Contact (Kangaroo Care) Shortly After Birth on the Neurobehavioral Responses of the Term Newborn: A Randomized, Controlled Trial
Authors: Ferber Sari Goldstein , Makhoul Imad R. 
Published: August 2004

Background. The method of skin-to-skin contact (kangaroo care [KC]) has shown physiologic, cognitive, and emotional gains for preterm infants; however, KC has not been studied adequately in term newborns.Aims. To evaluate the effect of KC, used shortly after delivery, on the neurobehavioral responses of the healthy newborn.Study Design. A randomized, controlled trial using a table of random numbers. After consent, the mothers were assigned to 1 of 2 groups: KC shortly after delivery or a no-treatment standard care (control group).Subjects. Included were 47 healthy mother-infant pairs. KC began at 15 to 20 minutes after delivery and lasted for 1 hour. Control infants and KC infants were brought to the nursery 15 to 20 and 75 to 80 minutes after birth, respectively.Results. During a 1-hour-long observation, starting at 4 hours postnatally, the KC infants slept longer, were mostly in a quiet sleep state, exhibited more flexor movements and postures, and showed less extensor movements.Conclusions. KC seems to influence state organization and motor system modulation of the newborn infant shortly after delivery. The significance of our findings for supportive transition from the womb to the extrauterine environment is discussed. Medical and nursing staff may be well advised to provide this kind of care shortly after birth.
Access to Care for Children of Migratory Agricultural Workers: Factors Associated With Unmet Need for Medical Care
Authors: Weathers Andrea , Minkovitz Cynthia , O’Campo Patricia , Diener-West Marie 
Published: August 2004

Objective. To assess the correlates of unmet need for medical care among migrant children.Design and Setting. A cross-sectional household survey used multistage sampling to identify migrant families in eastern North Carolina.Participants. Three hundred adult caretakers of 1 (per household) randomly selected child &lt;13 years old.Results. Fifty-three percent of the children had an unmet medical need. The most common reasons for unmet medical need were lack of transportation (80%) and lack of knowledge of where to go for care (20%). Unmet medical need was associated inversely with less than very good health (odds ratio [OR]: 0.31; 95% confidence interval [CI]: 0.16–0.61) and less than high school caretaker education (OR: 0.62; 95% CI: 0.39–0.98) and was associated directly with 1) having bed-days due to illness (OR: 2.46; 95% CI: 1.42–4.26), 2) lacking an annual well examination (OR:1.89; 95% CI: 1.12–3.20), 3) transportation dependence (OR:1.97; 95% CI: 1.24–3.13), 4) female gender (OR: 1.69; 95% CI: 1.07–2.67), 5) preschool age (OR: 2.24; 95% CI: 1.28–3.92), and 6) very high caretaker work pressure (OR: 5.01; 95% CI: 2.98–8.42). Adjustment using multiple logistic regression reveals unmet medical need to be independently associated with preschool age (OR: 2.08; 95% CI: 1.05–4.13) and very high caretaker pressure to work (OR: 5.93; 95% CI: 3.24–10.85). Of sampled children, 27% were preschool aged, and 40% had caretakers categorized with high work pressure.Conclusions. Medical-access barriers among migrant children are largely nonfinancial. Preschool-aged migrant children disproportionately experience unmet medical need. Decreasing forgone care among migrant children will likely require a combination of individual, health-system, and labor-policy modifications.
Randomized, Controlled Trial of Oral Creatine Supplementation (Not Effective) for Apnea of Prematurity
Authors: Bohnhorst Bettina , Geuting Tiana , Peter Corinna S. , Dördelmann Michael , Wilken Bernd , Poets Christian F. 
Published: August 2004

Background. Hypoxic ventilatory depression in mice and muscle fatigue in adult humans are improved by creatine supplementation (CS). Because these issues may be operative in apnea of prematurity (AOP), we hypothesized that CS reduces episodes of hypoxemia and bradycardia in infants with AOP.
Methods. Infants were eligible for this double-blind, controlled trial if gestational age was &lt;32 weeks and AOP was severe enough to require treatment with caffeine. If they had ≥1 desaturation (pulse oximeter saturation [SpO2] ≤ 80%) or bradycardia (heart rate ≤ two thirds of baseline) per hour in an initial 6-hour recording, they were randomized to a 2-week course of oral CS (200 mg/kg per day) or placebo (P). Infants then underwent 2 additional 6-hour recordings of breathing movements, nasal airflow, heart rate, pulse oximeter saturation (SpO2) and pulse waveforms after 7 and 14 days of treatment. Urinary creatine excretion was measured also. Recordings were analyzed for the frequency of bradycardia and desaturation, the primary outcome parameter, as well as for apnea (≥10 seconds), baseline heart and respiratory rate, and SpO2.
Results. Of 38 infants enrolled, 34 completed the study (17 in each group). Median (range) gestational age at birth was 27 (25–30) vs 27 (25–30) weeks, and at study 29 (26–36) vs 29 (27–33) weeks. Oral CS was well tolerated; no side effects were noted. Urinary creatine excretion was low in the P group (median: 27 mmol/mol of creatinine; range: 18–102) and increased in the CS group (6949 mmol/mol of creatinine; range: 1427–11807). CS, however, had no effect on the combined rate of bradycardia and desaturation (P: 2.7 per hour [range: 0.2–10.3]; CS: 4.1 per hour [range: 0.6–12.1]), nor was there any decrease in apnea rate (P: 1.7 per hour [range: 0–4.5]; CS: 2.2 per hour [range: 0.2–5.1]).
Conclusion. Despite a significant increase in creatine excretion, suggesting good enteral absorption, CS did not, in the dose and for the duration given in this study, improve symptoms of AOP in these infants.
The Bedding Environment, Sleep Position, and Frequent Wheeze in Childhood
Authors: Ponsonby Anne-Louise , Dwyer Terence , Trevillian Leigh , Kemp Andrew , Cochrane Jennifer , Couper David , Carmichael Allan 
Published: August 2004

Objective. Synthetic quilt use has been associated with increased childhood wheeze in previous studies. Our aim was to examine whether the adverse effect of synthetic quilt use on frequent wheeze differed by usual sleep position.
Design, Setting, and Participants. A population-based cross-sectional study of 6378 (92% of those eligible) 7-year-olds in Tasmania, Australia, was conducted in 1995. Exercise-challenge lung function was obtained on a subset of 414 children from randomly selected schools.
Exposure Measures. Child bedding including pillow and overbedding composition and usual sleep position by parental questionnaire.
Outcome Measures. Frequent wheeze (&gt;12 wheeze episodes over the past year), using the International Study of Asthma and Allergies in Childhood parental questionnaire, and baseline and postexercise forced expiratory volume in 1 second lung-function measures.
Results. Frequent wheeze (n = 117) was positively associated with synthetic quilts, synthetic pillows, electric blankets, and sleeping in a bottom bunk bed but did not vary by sleep position. In a nested case-control analysis, the association between synthetic quilt use and frequent wheeze differed by sleep position. Among children who slept supine, synthetic (versus feather) quilt use was associated with frequent wheeze (adjusted odds ratio: 2.37 [1.08, 5.23]). However, among nonsupine sleepers, overlying synthetic quilt use was not associated with frequent wheeze (adjusted odds ratio: 1.06 [0.60, 1.88]). This difference in quilt effect by sleep position was highly significant. Similarly, synthetic quilt use was associated with lower postexercise forced expiratory volume in 1 second measures among supine but not nonsupine sleeping children.
Conclusion. An increasing focus on the bedding environment immediately adjacent to the nose and mouth is required for respiratory disorders provoked by bedding, such as child asthma characterized by frequent wheeze.
Changes in Mortality for Extremely Low Birth Weight Infants in the 1990s: Implications for Treatment Decisions and Resource Use
Authors: Meadow William , Lee Grace , Lin Kathy , Lantos John 
Published: August 2004

Objective. Much has changed in neonatal intensive care unit (NICU) care over the past decade. High-frequency oscillation, inhaled nitric oxide, and antenatal corticosteroids are now widely available. We wondered how these medical advances had affected both the epidemiology and ethics of life and death for extremely low birth weight (ELBW) infants in the NICU.Methods. We identified 1142 ELBW infants (birth weight [BW] &lt; 1000 g) consecutively admitted to our NICU between 1991 and 2001. We abstracted BW, gestational age, survival or death, and length of stay in the NICU. Statistical analyses were performed by using linear regression and 2-way analysis of variance.Results. Both increasing BW and later year were significantly associated with improved survival. However, for larger ELBW infants, survival was ∼90% for the entire decade, and large-scale improvement was hardly possible. For smaller infants, greater improvements were both possible and observed, at least early in the decade. From 1991 to 1997, overall ELBW survival increased steadily (∼4% per year). However, from 1997 to 2001, there was no significant improvement in survival for ELBW infants. There was no change in the distribution of deaths accounted for by BW subgroups within the ELBW population from 1991 to 2001. Median length of stay for infants who eventually expired before discharge rose from 2 days in 1991 to 10 days in 2001. As a consequence, during the past decade, the percentage of infants whose outcome was “undeclared” by day of life 4 rose from 10% to 20% for ELBW infants overall and to 33% for infants with BWs of 450 to 700 g. The percentage of ELBW NICU bed-days occupied by nonsurvivors remained very low (∼7%) from 1991 to 2001.Conclusions. 1) Fewer infants in all ELBW subgroups are dying, compared with a decade ago, and the improvement has been most prominent for BWs of 450 to 700 g, at which mortality was and remains to be greatest. 2) This progress seems to have slowed, or even stopped, by the end of the decade. 3) Although most NICU nonsurvivors still expire early, doomed infants are lingering longer. 4) Nonsurvivors continue to occupy a constant (and extremely small) fraction of NICU bed-days.
Postnatal Depression and Faltering Growth: A Community Study
Authors: O’Brien Louise Margaret , Heycock Elizabeth Gardner , Hanna Mariam , Jones Peter Watts , Cox John Lee 
Published: August 2004

Objective. To investigate the association between faltering growth in children and maternal postnatal depression.
Methods. Children aged ≤2 years were identified from community child health surveillance records if their weights fell across 2 centile channels on standardized growth charts or fell below the second centile. Mothers of these index children were invited to complete the Edinburgh Postnatal Depression Scale and the anxiety subscale of the Hospital Anxiety and Depression Scale. Those who scored above threshold values on either scale were interviewed with the revised Clinical Interview Schedule. Matched control children were obtained from health visitor records, and records of their weights were obtained. Mothers of control children completed the same questionnaires.
Results. A total of 196 index children and 567 control children were studied. Significantly more mothers in the index group scored above the threshold for both the Edinburgh Postnatal Depression Scale (33% vs 22%; odds ratio [OR]: 1.71; 95% confidence interval [CI]: 1.16-2.53) and the Hospital Anxiety and Depression Scale (24% vs 13%; OR: 2.08; 95% CI: 1.33-3.25) questionnaires. Furthermore, clinical interviews with these mothers demonstrated that 21% of the index group and 11% of the control group fulfilled criteria for depressive episode (OR: 1.88; 95% CI: 1.21-2.94).
Conclusions. Depression in mothers of children with faltering growth during the first 2 years of life is significantly greater than in mothers of children who are gaining weight appropriately. In view of the high rates of maternal depression in children with poor weight gain, clinical management at presentation of either problem should focus on both members of the mother–child dyad and on the interaction between mother and child. These findings have implications for all professionals who work in primary and secondary health care.
More Evidence for Reach Out and Read: A Home-Based Study
Authors: Weitzman Carol Cohen , Roy Lisa , Walls Theodore , Tomlin Ricarda 
Published: August 2004

Objective. Reach Out and Read (ROR), a clinic-based literacy program, has been shown to improve literacy outcomes in impoverished children. No study has used direct observation to assess a child’s home literacy environment or to control for important confounders, such as the quality of the home environment. The objective of this study was to determine the relationship between the frequency of ROR encounters that a family receives during well-child visits and a child’s home literacy profile, while accounting for important confounders, such as the quality of the home environment.
Methods. A cross-sectional study was conducted of 137 children (aged 18-30 months) who received pediatric well-child care at the Yale-New Haven Hospital Primary Care Center. The number of ROR encounters that the family received was determined though parent interview, direct observation, and a review of the medical record. After a brief waiting room interview, a home visit was conducted. An assessment of the child’s home literacy environment was completed on the basis of 10 variables that were obtained from parent report and direct observation within the home. These variables were summed to form a Child Home Literacy Index. The Home Observation for Measurement of the Environment, a standardized measure of the nurturing quality of the home environment, was also administered. Hierarchical linear regression was conducted to determine the significance of ROR on a child’s home literacy environment.
Results. A total of 100 families completed both a waiting room interview and a home visit. Families received between 0 and 6 books in the ROR program. A total of 93% of families reported reading to their children, but only 35% of parents identified reading as a favorite activity of their child and 45% of parents reported that this was a favorite joint activity. Hierarchical linear regression demonstrated that increasing frequency of ROR encounters contributed a small but significant portion of the variance explaining a child’s home literacy profile (5%), with this model accounting for a total of 19% of the variance.
Conclusions. A modest literacy intervention, such as ROR, can have a significant impact on a child’s home literacy environment.
Spanking in Early Childhood and Later Behavior Problems: A Prospective Study of Infants and Young Toddlers
Authors: Slade Eric P. , Wissow Lawrence S. 
Published: August 2004

Objective. To explore the relationship of spanking frequency before age 2 with behavior problems near time of entry into school.Methods. Children who were younger than 2 years were followed up ∼4 years later, after they had entered school. The likelihood of significant behavior problems at follow-up was estimated in multivariate analyses that controlled for baseline spanking frequency and other characteristics. Participants were mothers from a large-scale national study and their children. Statistical analysis included an ethnically diverse sample of 1966 children aged 0 to 23 months at baseline. Two dichotomous indicators of behavior problems were used. The first indicated that maternal rating of child behavior problems exceeded a threshold. The second indicated that a mother met with a school administrator to discuss her child's behavior problems.Results. White non-Hispanic children who were spanked more frequently before age 2 were substantially more likely to have behavior problems after entry into school, controlling for other factors. For Hispanic and black children, associations between spanking frequency and behavior problems were not statistically significant and were not consistent across outcome measures.Conclusion. Among white non-Hispanic children but not among black and Hispanic children, spanking frequency before age 2 is significantly and positively associated with child behavior problems at school age. These findings are consistent with those reported in studies of children older than 2 years but extend these findings to children who are spanked beginning at a relatively early age.
Placement Stability and Mental Health Costs for Children in Foster Care
Authors: Rubin David M. , Alessandrini Evaline A. , Feudtner Chris , Mandell David S. , Localio A. Russell , Hadley Trevor 
Published: August 2004

Objective. Although prior population-based studies have found that children in foster care use more mental health services than their Medicaid peers, less is known about how different experiences in foster care impact the likelihood of mental health service use. The primary aim of this study is to test the hypothesis that instability of foster care placements is associated with higher costs for mental health care services. The secondary aim is to test the hypothesis that foster care children are also more likely to generate high costs for mental health services if they generate higher costs for non–mental health claims.Methods. Using administrative child welfare data linked to Medicaid claims, we assembled a unique retrospective cohort of adjudicated dependent children &gt;2 years old who entered foster care between July 1993 and June 1995, spent at least 9 months in care, and were Medicaid eligible during a 1-year follow-up period. The primary outcome was high mental health service use, defined as having costs in the top decile of the sample. The primary independent variables were the number of foster care placements during the year and whether placements were interrupted by a return home for at least 1 month during that year (episodic foster care). We used logistic regression to estimate the association between placements and service utilization, with adjustment for age and physical health care costs.Results. Of the 1635 children in the study, 41% had ≥3 foster care placements, and 5% had episodic foster care during the year of observation. The top 10% of mental health service users accounted for 83% of the $2.4 million in mental health costs. Both multiple placements and episodic foster care increased the predicted probability of high mental health service use. Higher physical health care costs also increased the probability of high mental health use for all children, but this increased probability was most dramatic among children with episodic foster care (probability of high mental health use: 0.78; 95% confidence interval: 0.42–0.94).Conclusions. Foster care placement instability was associated with increased mental health costs during the first year in foster care, particularly among children with increasing general health care costs. These findings highlight the importance of interventions that address the global health of children in foster care and may permit better targeting of health care resources to subgroups of children most likely to use services.