bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of IgE-Mediated Food Allergy Among Children With Atopic Dermatitis
Authors: Eigenmann Philippe A. , Sicherer Scott H. , Borkowski Teresa A. , Cohen Bernard A. , Sampson Hugh A. 
Published: August 2004

Objective. There is a growing body of clinical and laboratory evidence to support the notion that food allergy plays a role in the pathogenesis of atopic dermatitis (AD). However, the incidence of IgE-mediated food allergy in children with AD is not well established.Design. A prospective study to determine the prevalence of IgE-mediated food hypersensitivity among patients referred to a university-based dermatologist for evaluation of AD.Setting. University hospital pediatric dermatology clinic.Patients. A total of 63 patients with AD were recruited (35 male; 32 white, 24 African-American, 7 Asian).Methods. Patients were assigned an AD symptom score (SCORAD) and were screened for food-specific serum IgE antibodies to six foods (milk, egg, wheat, soy, peanut, fish) known to be the most allergenic in children. The levels of food-specific serum IgE were determined by the CAP System fluoroscein-enzyme immunoassay (CAP); patients with a value ≥0.7 kIUa/L were invited for an additional allergy evaluation. Those with CAP values below the cutoff were considered not food allergic. Patients were considered to be allergic if they met one of the following criteria for at least one food: 1) reaction on food challenge; 2) CAP value more than the 95% confidence interval predictive for a reaction; 3) convincing history of an acute significant (hives, respiratory symptoms) reaction after the isolated ingestion of a food to which there was a positive CAP or prick skin test.Results. A total of 63 patients (median age, 2.8 years; median SCORAD, 41.1) were recruited; 22 had negative CAP values (without a significant difference in age or SCORAD score, compared with the 41 with positive specific IgE values). Further allergy evaluation was offered to the 41 remaining patients; 10 were lost to follow-up and 31 were evaluated further. Of these, 19 underwent a total of 50 food challenges (36 double-blind, placebo-controlled, and 14 open), with 11 patients experiencing 18 positive challenges (94% with skin reactions). Additionally, 6 patients had a convincing history with a predictive level of IgE; 5 had a convincing history with positive, indeterminate levels of IgE; and 1 had predictive levels of IgE (to egg and peanut) without a history of an acute reaction. Overall, 23/63 (37%; 95% confidence interval, 25% to 50%) had clinically significant IgE-mediated food hypersensitivity without a significant difference in age or symptom score between those with or without food allergy.Conclusions. Approximately one third of children with refractory, moderate–severe AD have IgE-mediated clinical reactivity to food proteins. The prevalence of food allergy in this population is significantly higher than that in the general population, and an evaluation for food allergy should be considered in these patients.
QT Interval in Children and Infants Receiving Cisapride
Authors: Levine Arie , Fogelman Rami , Sirota Leah , Zangen Zili , Shamir Raanan , Dinari Gabriel 
Published: August 2004

Objectives. Life-threatening arrhythmias and prolonged QT interval have been reported in adults and children using cisapride, a medication structurally similar to procainamide. Premature infants have reduced activity of cytochrome p-450, the system responsible for metabolism of cisapride, which could lead to QT prolongation. Therefore, we prospectively studied premature infants and children receiving cisapride to analyze the effect of prolonged cisapride therapy on QT interval.
Design. Premature infants in a neonatal intensive care unit and children seen at a pediatric gastroenterology clinic in a tertiary care hospital had electrocardiography-analyzed and -corrected QT interval measured before cisapride (0.8/mg/kg per day) therapy, and again after 1 month of therapy. If baseline electrocardiography was not performed initially, it was obtained after cessation of therapy.
Results. A total of 30 children participated in the study. Mean corrected QT interval was similar at baseline and at 1 month after therapy. Significant QT prolongation was not found, and no adverse effects were recorded.
Conclusions. Corrected QT interval during prolonged cisapride therapy at 0.8 mg/kg per day appears to be similar for premature infants and children. An inherent trend toward QT prolongation was not detected in either group. In the absence of other risk factors that alter cisapride metabolism or predispose to arrhythmia, cisapride may be safe for use in premature infants as well as in children. Additional studies are needed to confirm these data.
Minimal Head Trauma in Children Revisited: Is Routine Hospitalization Required?
Authors: Roddy Sean P. , Cohn Stephen M. , Moller Beth A. , Duncan Charles C. , Gosche John R. , Seashore John H. , Touloukian Robert J. 
Published: August 2004

Objective. Children with a question of occult head injury are routinely hospitalized despite having both normal central nervous system (CNS) and computed tomographic (CT) scan examinations. We determined the incidence of significant CNS morbidity after occult head injury to determine whether or not hospital admission was necessary in children after minimal head trauma.
Methods. We reviewed the records of children admitted to a level I trauma center with a question of closed head injury, an initial Glasgow Coma Scale equal to 15, a normal neurologic exam, and a normal head CT scan. Children with associated injuries requiring admission were excluded. The endpoints were deterioration in CNS exam, new CT findings, and the need for a prolonged hospital stay.
Results. Sixty-two patients were studied with a mean age of 7 years (range, 1 month to 15 years), and 65% were male. The primary mechanisms of injury were fall (45%) and vehicular crash (23%). The mean injury severity score was 4 ± 2. The mean length of stay was 1.2 days (range, 1 to 3 days). Prolonged hospitalization occurred in 9 patients (15%). No child developed significant CNS sequelae warranting hospital admission. Total charges for these hospitalizations were $177 874.
Conclusions. Children undergoing emergency department work-up of occult head injury, who have a normal CNS exam and a normal head CT scan, do not seem to be at risk for significant CNS sequelae. These patients can be discharged home with parental supervision and avoid unnecessary and costly hospitalization.
Acute Otitis Media in Children With Bronchiolitis
Authors: Andrade Marcelo A. , Hoberman Alejandro , Glustein Joseph , Paradise Jack L. , Wald Ellen R. 
Published: August 2004

Objective. We investigated the prevalence and the etiology of acute otitis media (AOM) in children with bronchiolitis to determine whether AOM in such children is due entirely or mainly to respiratory syncytial virus (RSV), in which case routine antimicrobial treatment would not be appropriate.Methods. The study group consisted of children aged 2 to 24 months with bronchiolitis. In patients with AOM at entry, nasal washings for RSV enzyme-linked immunosorbent assay were obtained, and Gram-stained smear, bacterial culture, and reverse transcriptase polymerase chain reaction to detect the presence of RSV were performed on middle-ear aspirates. Patients without AOM were reevaluated at 48 to 72 hours, 8 to 10 days, and 18 to 22 days.Results. Forty-two children with bronchiolitis were enrolled. Sixty-two percent had AOM at entry or developed AOM within 10 days. An additional 24% had or eventually developed otitis media with effusion. Only 14% remained free of both AOM and otitis media with effusion throughout the 3-week observation period. All patients with AOM had 1 or more bacterial pathogens isolated from one or both middle-ear aspirates. Of 33 middle-ear aspirates, Streptococcus pneumoniae was isolated in 15, Haemophilus influenzaein 8, Moraxella catarrhalis in 8, and Staphylococcus aureus in 2. Two middle-ear aspirates yielded 2 pathogens each; 2 aspirates had no growth. RSV was identified in 17 (71%) of 24 patients with AOM.Conclusion. Bacterial AOM is a complication in most children with bronchiolitis. Accordingly, in patients with bronchiolitis and associated AOM, antimicrobial treatment is indicated.
Treatment of Aural Foreign Bodies in Children
Authors: Ansley John F. , Cunningham Michael J. 
Published: August 2004

Objective. To determine the proper treatment of children and adolescents with foreign bodies of the external auditory canal (EAC).
Design. Retrospective case series.
Setting. Specialty care referral hospital.
Patients. All patients younger than 18 years of age who presented in the emergency ward or office setting with a foreign body of the EAC during a 5-year period.
Results. One hundred ninety-one patients with aural foreign bodies were identified. Age at presentation ranged from 10 months to 17 years with 141 patients (74%) younger than 8 years old. Twenty-seven different objects were encountered with pebbles, beads, insects, and plastic toys the most common. Fifty-seven (30%) of the patients required surgical removal of the aural foreign body under general anesthesia.
Conclusion. Adequate immobilization and proper instrumentation allow the uncomplicated removal of many EAC foreign bodies in the pediatric population. The use of general anesthesia is preferred in very young children and in children of any age with aural foreign bodies whose contour, composition, or location predispose to traumatic removal in the ambulatory setting. Criteria for otolaryngologic referral and consideration of operative microscopic removal are outlined.
Mainstream End-tidal Carbon Dioxide Monitoring in the Neonatal Intensive Care Unit
Authors: Rozycki Henry J. , Sysyn Gregory D. , Marshall M. Kathy , Malloy Raymond , Wiswell Thomas E. 
Published: August 2004

Background. Continuous noninvasive monitoring of arterial carbon dioxide (CO2) in neonatal intensive care unit (NICU) patients would help clinicians avoid complications of hypocarbia and hypercarbia. End-tidal CO2monitoring has not been used in this population to date, but recent technical advances and the introduction of surfactant therapy, which improves ventilation-perfusion matching, might improve the clinical utility of end-tidal monitoring.Objective. To determine the accuracy and precision of end-tidal CO2 monitoring in NICU patients.Design. Nonrandomized recording of simultaneous end-tidal and arterial CO2 pairs.Setting. Two university NICUs.Patients. Forty-five newborn infants receiving mechanical ventilation who had indwelling arterial access, and a predefined subsample of infants who were &lt;1000 g birth weight, &lt;8 days of age, and who received surfactant therapy (extremely low birth weight [ELBW] &lt;8).Outcome Measures. The correlation coefficient, degree of bias, and 95% confidence interval were determined for both the overall population and the ELBW &lt;8 subgroup. Those factors which significantly influenced the bias were identified. The ability of the end-tidal monitor to alert the clinician to instances of hypocarbia or hypercarbia was determined.Results. There were 411 end-tidal/arterial pairs analyzed from 45 patients. The correlation coefficient was 0.833 and the bias was −6.9 mm Hg (95% confidence interval, ±11.5 mm Hg). The results did not differ markedly in the ELBW &lt;8 infants. Measures of the degree of lung disease, the ventilation index and the oxygenation index, had small influences on the degree of bias. This type of capnometry identified 91% of the instances when the arterial CO2 pressure was between 34 and 54 mm Hg using an end-tidal range of 29 to 45 mm Hg. End-tidal values outside this range had a 63% accuracy in predicting hypocarbia or hypercarbia.Conclusion. End-tidal CO2 monitoring in NICU patients is as accurate as capillary or transcutaneous monitoring but less precise than the latter. It may be useful for trending or for screening patients for abnormal arterial CO2 values.
Single-dose and Steady-state Pharmacokinetics of a New Oral Suspension of Ciprofloxacin in Children
Authors: Peltola Heikki , Ukkonen Pentti , Saxén Harri , Staβ Heino 
Published: August 2004

Objective. Quinolones are used ever increasingly in pediatrics, although officially they are still contraindicated. Lack of evidence of arthropathic effects in human offspring favors their use, but little is known about the pharmacokinetics of oral or parenteral ciprofloxacin in children, especially those without cystic fibrosis.
Design. We studied 16 non-cystic fibrosis patients ranging in age from 0.3 to 7.1 years to whom the new suspension formulation of ciprofloxacin (10 mg/kg body weight) was given orally three times daily. Single-dose and steady-state pharmacokinetic parameters were elucidated.
Results. Ciprofloxacin was rapidly absorbed. The maximum plasma concentrations, with the means varying from 1.7 to 3.6 mg/L, were reached within 1 hour, almost regardless of whether single-dose administration or steady state. The mean oral clearance was lower in children &lt;6 years of age than in those ≥6 years. Terminal half-life values, with the means varying only between 4.2 and 5.1, suggest that dosing recommendations based on body weight are pertinent, although caution should be exercised in small infants. No arthropathic or other adverse events attributable to ciprofloxacin suspension were observed.
Conclusion. A dose of the suspension form of ciprofloxacin of 10 mg/kg body weight given orally three times daily seems appropriate in children, provided the drug is clearly indicated.
Congenital Anomalies in the Offspring of Mothers With a Bicornuate Uterus
Authors: Martı́nez-Frı́as María Luisa , Bermejo Eva , Rodrı́guez-Pinilla Elvira , Frı́as Jaime Luis 
Published: August 2004

Background. Most of the reports on mothers with bicornuate uterus analyze fertility, reproductive capacity, and pregnancy outcomes. Very few of them, however, mention the risk for congenital anomalies in their offspring. Further, to our knowledge, no epidemiologic studies estimating the risk for congenital defects and analyzing the type of anomalies observed in infants born to mothers with bicornuate uterus have been reported.
Methods. Using a case-control study series, we estimated the risk of congenital anomalies in the offspring of women with a bicornuate uterus. To identify the specific defects associated with the presence of a bicornuate uterus in the mother, we analyzed 26 945 consecutive malformed infants from the Spanish Collaborative Study of Congenital Malformations and assessed the frequency of congenital anomalies in the offspring of mothers with a bicornuate uterus and in those born to mothers with a normal uterus. We then calculated the relative frequency, which is the quotient of the frequency of the individual defects in each group. This figure expresses the times each congenital defect is more frequent in infants of mothers with a bicornuate uterus than in those born to mothers with a normal uterus.
Results. Offspring of mothers with a bicornuate uterus had a risk for congenital defects four times higher than infants born to women with a normal uterus. The risk was statistically significant for some specific defects such as nasal hypoplasia, omphalocele, limb deficiencies, teratomas, and acardia-anencephaly.
Conclusions. Offspring of mothers with bicornuate uterus are not only at high risk for deformations and disruptions, but also for some type of malformations.
Comparison of Length of Stay for Asthma by Hospital Type
Authors: Samuels Barbara N. , Novack Alvin H. , Martin Diane P. , Connell Frederick A. 
Published: August 2004

Objective. To determine whether length of stay (LOS) for asthma admissions at a local university-affiliated children's hospital (UACH) is similar to that of community hospitals within the same county.Methods. A retrospective analysis was performed using computerized hospital abstract records from 1989 through 1994. The study population was children 1 to 18 years old whose first or only hospitalization for a primary diagnosis of asthma occurred during the study period at either the UACH or one of the 17 community hospitals in King County, WA, that admit pediatric patients (n = 2491). Transfers and patients with chronic obstructive asthma or secondary diagnoses such as cystic fibrosis were not included in the study. Asthma patients were compared by sociodemographic and health risk characteristics such as age, sex, insurance status, and a comorbidity severity score. Differences between the two hospital populations were tested by χ2 and t tests. The effect of hospitalization at the UACH or the community hospitals on LOS was determined using analysis of covariance after adjusting for the sociodemographic and health risk covariates.Results. Sixty-two percent (62%) of the asthma patients in the study population were discharged from the UACH. Compared with patients discharged from the community hospitals, the UACH patients were significantly younger, more often male, used public insurance, and resided in areas with lower median household incomes. The severity of comorbidities was not different between the two hospital groups. Overall, adjusted mean LOS was not significantly longer at the UACH (2.1 days) than at the community hospitals (2.0 days); however, adjusted mean LOS for specific subgroups, most notably poor children and those with public insurance, was significantly longer at the UACH.Conclusion. LOS for first or only asthma hospitalizations during 1989 through 1994 at the UACH was similar to local community hospitals within the same county. Specific subgroups of children were hospitalized for a longer period at the UACH, but children with private insurance and from areas with higher median household incomes had similar LOS, and presumably costs, at the UACH and the community hospitals.
Telephone Charges and Payments in a Diabetes Clinic
Authors: Kirkland John L. , Copeland Kenneth C. 
Published: August 2004

Objectives. To determine reimbursement rates after initiation of charges for certain telephone calls in a pediatric diabetes care center.
Design. A review of charges and payments data during 1996.
Results. Four hundred seventy-two telephone calls initiated by patients and parents were billed during the study period. These calls regarded treatment of hypoglycemia, hyperglycemia, ketonuria, sick day treatment, and insulin dose changes. Insured patients were charged for 384 telephone calls and indigent patients were charged for 88 telephone calls. Telephone calls from insured patients generated charges of $9215 and payments of $3074. Insurance payments were $1677 (18% of charges), and patient payments were $1396 (15% of charges). Telephone calls from uninsured patients covered by Texas Medicaid or Chronically Ill and Disabled Children funding generated charges of $2193 and no payments.
Conclusions. Telephone charges were reimbursed by all payors at an overall rate of 27%.
A Randomized Comparison of Surfactant Dosing via a Dual-lumen Endotracheal Tube in Respiratory Distress Syndrome
Authors: Valls-i-Soler Adolf , Fernández-Ruanova Begoña , y Goya Jon López-Heredia , Etxebarrı́a Lourdes Román , Rodriguez-Soriano Juan , Carretero (Caceres) Valentin ,   Spanish Surfactant Collaborative Group
Published: August 2004

Aim. To determine if 1-minute instillation of Curosurf via a dual-lumen endotracheal tube without interruption of mechanical ventilation could decrease the incidence of hypoxia (drop in oxygen saturation [Sao2] to &lt;80%, or of transcutaneous partial pressure of oxygen [Ptco2] to &lt;50 mm Hg [6.6 kPa]) and bradycardia (heart rate below 80 beats/minute) at dosing, without affecting the efficacy of the standard bolus delivery.Design. Prospective, multicenter, randomized, nonblinded clinical trial.Setting. Neonatal intensive care units of the Spanish Surfactant Collaborative Group.Patients and Methods. One hundred ninety-eight infants (birth weight 600–2000 g) with respiratory distress syndrome needing mechanical ventilation with a fraction of inspired oxygen [Fio2] ≥0.40 were randomized before 24 hours to receive 200 mg/kg of Curosurf, either by bolus instillation (n = 99) or by a simplified dosing technique (n = 99), giving the full dose in 1 minute via a dual-lumen endotracheal tube without positioning, interruption of mechanical ventilation, or bagging. Two additional doses (100 mg/kg) were given within 12 and 24 hours of first dose, by the same method, if the infant still needed mechanical ventilation and had a Fio2 ≥0.30. The effects of both procedures on the incidence of acute adverse events at dosing, gas exchange, ventilator requirements, and outcome at 28 days were compared.Results. Fewer episodes of hypoxia (18 vs 40% of doses), and a smaller decrease in heart rate and Sao2were observed in the dual-lumen group. Efficacy of surfactant, based on improvement of oxygenation, ventilator requirements, and number of doses required, was similar in both groups. Infants in the dual-lumen group had a lower total time exposure to supplemental oxygen (195 ± 199 vs 266 ± 221 hours). No differences in the incidence of air leaks, intraventricular hemorrhage, patent ductus arteriosus, bronchopulmonary dysplasia, or survival were observed.Conclusion. A simplified 1-minute Curosurf dosing procedure via a dual-lumen endotracheal tube without fractional doses, ventilator disconnection, changes in the infant's position, or manual bagging was found to reduce the number of dosing-related adverse transient episodes of hypoxia. Although the simplified method appeared to be as effective as bolus delivery, this should be confirmed in a larger trial.