bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost-Effective Use of Echocardiography in Children With Kawasaki Disease
Authors: Scott John S. , Ettedgui José A. , Neches William H. 
Published: August 2004

Objective.To determine whether a third echocardiogram, performed 6 months to 1 year after the onset of Kawasaki disease (KD), as recommended by current American Heart Association guidelines, identified any case of coronary artery abnormalities when previous echocardiograms were normal.Methods.Children diagnosed with KD were identified by searching our institution's database. Cases were included in the study if diagnosed between June 1988 and December 1996 and if at least two echocardiograms were documented, including at least one study between 2 weeks and 2 months from the onset of KD and another in follow-up. The patients' charts were reviewed and videotapes of the echocardiograms were reviewed if reports were unclear or contradictory. McNemar's test for discordant pairs was used for statistical analysis. Additionally, a complete review was performed in all other cases of KD in the database in which a coronary artery abnormality had been identified.Results.There were 203 patients diagnosed during the study period who had 2 or more echocardiograms performed, and 67 had the requisite studies in the subacute period and later follow-up. The median age at onset of KD was 3.0 years (range: 0.2–16), the median duration of follow-up was 12.5 months (range: 1.7–100), and the median number of echocardiograms performed was 3 (range: 2–8). Intravenous immunoglobulin was given in 62 cases, and high-dose aspirin was given in 63. There were 35 children with no echocardiographic abnormalities at any point, and 15 other children had early abnormalities (including coronary ectasia, perivascular brightness, pericardial effusion, and ventricular dysfunction) but had a normal echocardiogram between 2 weeks and 2 months. Of these 50 children, none were noted to have abnormalities on later studies. Three children had effusion and/or perivascular brightness after 2 weeks; follow-up studies were normal in each. Six children had coronary ectasia after 2 weeks; it persisted on follow-up in 1 child and had resolved in 5 children. Eight children had coronary aneurysms on studies after 2 weeks; in 3 children, the aneurysm resolved on later follow-up. No coronary abnormalities were demonstrated on a late follow-up echocardiogram in any child with normal coronaries between 2 weeks and 2 months.Conclusions.All children with KD should have an echocardiogram at the time of diagnosis with a follow-up study 4 to 6 weeks after the onset of fever. In the current environment of cost-containment, additional echocardiographic studies are justified only if abnormalities are present at 4 to 6 weeks. Kawasaki disease, coronary artery aneurysm, echocardiography, coronary ectasia.
Dexamethasone Therapy Increases Infection in Very Low Birth Weight Infants
Authors: Stoll Barbara J. , Temprosa Marinella , Tyson Jon E. , Papile Lu-Ann , Wright Linda L. , Bauer Charles R. , Donovan Edward F. , Korones Sheldon B. , Lemons James A. , Fanaroff Avroy A. , Stevenson David K. , Oh William , Ehrenkranz Richard A. , Shankaran Seetha , Verter Joel 
Published: August 2004

Background.Infection is a major complication of preterm infants, resulting in increased morbidity and mortality. We recently reported the results of a multicenter trial of dexamethasone initiated at 14 or 28 days in very low birth weight (VLBW) infants who were at risk for chronic lung disease; the results showed an increase in nosocomial bacteremia in the group receiving dexamethasone. This study is an in-depth analysis of bacteremia/sepsis and meningitis among infants enrolled in the trial.Methods.Data on cultures performed and antibiotic therapy were collected prospectively. Infections were classified as definite or possible/clinical.Results.A total of 371 infants were enrolled in the trial. There were no baseline differences in risk factors for infection. For the first 14 days of study, infants received either dexamethasone (group I, 182) or placebo (group II, 189). During this period, infants in group I were significantly more likely than those in group II to have a positive blood culture result (48% vs 30%) and definite bacteremia/sepsis/meningitis (22% vs 14%). Over the 6-week study period, 47% of those cultured had at least one positive blood culture result (53% in group I vs 41% in group II) and 25% of the infants had at least one episode of definite bacteremia/sepsis/meningitis (29% in group I vs 21% in group II). Among infants with definite infections, 46.8% were attributable to Gram-positive organisms, 26.6% to Gram-negative organisms and 26.6% to fungi. The factors present at randomization were evaluated for their association with infection. Group I assignment and H2blocker therapy (before study entry) were associated with increased risk of definite infection, whereas cesarean section delivery and increasing birth weight were associated with decreased risk.Conclusions.Infants who received a 14-day course of dexamethasone initiated at 2 weeks of age were more likely to develop a bloodstream or cerebrospinal fluid infection while on dexamethasone therapy than were those who received placebo. Physicians must consider this increased risk of infection when deciding whether to treat VLBW infants with dexamethasone.
Looking Beyond the Physical Injury: Posttraumatic Stress Disorder in Children and Parents After Pediatric Traffic Injury
Authors: de Vries Aiko P. J. , Kassam-Adams Nancy , Cnaan Avital , Sherman-Slate Elisabeth , Gallagher Paul R. , Winston Flaura K. 
Published: August 2004

Background.Traffic crashes are the leading health threat to children in the United States, resulting in nearly 1 million injuries annually. The psychological consequences of these injuries are primarily unknown. The aims of this study were to estimate the prevalence of posttraumatic stress disorder (PTSD) in traffic-injured children and their parents and to identify risk factors for PTSD development.Methods.A prospective cohort study of traffic-injured children between 3 and 18 years of age was conducted at a level 1 Pediatric Trauma Center. The children were enrolled as part of an ongoing surveillance system of traffic-related injuries. Presence and severity of PTSD were determined in the children and their parents through a validated diagnostic questionnaire 7 to 12 months after child injury.Results.Twenty-five percent of the children and 15% of the parents suffered diagnostic PTSD, but only 46% of the parents of affected children sought help of any form (including from friends) for their child and only 20% of affected parents sought help for themselves. Child PTSD was associated with older child age and parent PTSD. Parent PTSD was associated with younger child age, child PTSD, and parent witnessing the event. Injury severity was not predictive of PTSD.Conclusions.PTSD in children and their parents is a common, yet overlooked, consequence of pediatric traffic-related injury with prevalence rates similar to those found in children exposed to violence. Physicians managing the pediatric trauma patient, regardless of injury severity or whether the injury was intentional, should screen for PTSD and refer for treatment where appropriate.
Short-term Health and Economic Benefits of Smoking Cessation: Low Birth Weight
Authors: Lightwood James M. , Phibbs Ciaran S. , Glantz Stanton A. 
Published: August 2004

Objectives.
To estimate excess direct medical costs of low birth weight from maternal smoking and short-term cost savings from smoking cessation programs before or during the first trimester of pregnancy.

Methods.
Simulations using data on neonatal costs per live birth. Outcome measures are mean US excess direct medical cost per live birth, total excess direct medical cost, reductions in low birth weight, and savings in medical costs from an annual 1 percentage point drop in smoking prevalence among pregnant women.

Results.
Mean average excess direct medical cost per live birth for each pregnant smoker (in 1995 dollars) was $511; total cost was $263 million. An annual drop of 1 percentage point in smoking prevalence would prevent 1300 low birth weight live births and save $21 million in direct medical costs in the first year of the program; it would prevent 57 200 low birth weight infants and save $572 million in direct medical costs in 7 years.

Conclusions.
Smoking cessation before the end of the first trimester produces significant cost savings from the prevention of low birth weight.
Tumor Necrosis Factor-α, Interleukin-1β, and Interleukin-6 Levels in Febrile, Young Children With and Without Occult Bacteremia
Authors: Strait Richard T. , Kelly Kevin J. , Kurup Viswanath P. 
Published: August 2004

Objective.To determine the utility of plasma levels of tumor necrosis factor-α (TNF), interleukin 1β (IL-1), and interleukin 6 (IL-6) in the prediction of occult bacteremia in febrile, young children.Study Design.Prospective, case-control study conducted in a large, urban, children's hospital emergency department. Eligibility criteria were: 0 to 36 months of age, febrile, nontoxic appearing, immunocompetent, no apparent bacterial source for fever on physical examination, and blood culture obtained. Additional blood, procured at the time of the blood culture, was analyzed by enzyme-linked immunosorbent assay for TNF, IL-1, and IL-6. Children with positive blood cultures for pathogenic bacteria served as cases. Two age-matched controls for each case were selected from the children with negative cultures.Results.Out of 1329 enrollees, 33 cases and 66 controls were evaluated. IL-6 levels were significantly higher for the cases than controls but with moderate overlap in their ranges. TNF and IL-1 levels were not significantly different between cases and controls. Height of fever, duration of fever, acute illness observation score, absolute band count, and white blood cell count were all much less predictive of bacteremia than either IL-6 or absolute neutrophil count (ANC). The optimum IL-6 threshold value had a sensitivity of 88%, a specificity of 70%, a positive predictive value (PPV) of 7.0%, a negative predictive value (NPV) of 99.6%, and an odds ratio (OR) of 16.7 (95% confidence interval [CI], 4.8–71.6). The optimum ANC threshold value had a sensitivity of 82%, a specificity of 74%, a PPV of 7.5%, a NPV of 99.4%, and an OR of 12.8 (95% CI, 3.2–59.7). The best predictor was a combination of IL-6 and ANC. It had a sensitivity of 100%, a specificity of 78%, a PPV of 10.4%, a NPV of 100%, and an OR which is undefined because of the 100% sensitivity (95% CI, 33.0-∞). For comparison, a WBC &gt;15 × 109 cells/L had a sensitivity of 48%, a specificity of 79%, a PPV of 5.5%, a NPV of 98.3%, and an OR of 3.5 (95% CI, 1.1–10.7).Conclusions.In febrile children 0 to 36 months of age, IL-6 levels may be helpful in the prediction of occult bacteremia, but TNF and IL-1 levels are not. IL-6 levels alone or notably when combined with an ANC were more predictive of occult bacteremia than traditional tests and clinical criteria. The wide range in the IL-6 values for cases and controls detracts from the precision of the findings. The lack of rapid processing and clinical availability of IL-6 assays hampers its present application. However, despite these drawbacks and given the poor ability of traditional clinical and laboratory criteria to predict occult bacteremia, these results suggest a possible future role for IL-6 in predicting occult bacteremia when rapid assays become available.
Wood's Lamp Utility in the Identification of Semen
Authors: Santucci Karen A. , Nelson David G. , McQuillen Kemedy K. , Duffy Susan J. , Linakis James G. 
Published: August 2004

Background.
The accurate detection of semen is critical to forensic, medical, and legal personnel. The Wood's lamp (WL) emits ultraviolet light (UVL) and has been identified as useful in rape evaluations because it is purported to cause semen to fluoresce. This study was intended to determine if semen can be distinguished from other products by WL analysis.

Methods.
Investigators reviewed the previous training and frequency of use of the WL by emergency medicine and pediatric emergency medicine physicians at 2 medical centers. The participants were asked to use a WL to distinguish between a semen sample (&lt;6 hours old) and 13 commonly used products. Next, 29 semen samples were collected and evaluated under high-power microscopy and under UVL.

Results.
A total of 41 physicians participated in the study (68% male). The number of years practicing in an emergency setting spanned from .3 to 25 years with a mean of 7.1 years. A total of 51% of participants trained in emergency medicine, 23% in pediatrics and pediatric emergency medicine. A total of 22% reported formal training in the collection of forensic evidence. A total of 62% of the physicians believed they have identified semen in the past; one third felt they could differentiate semen from other products under UVL. None of the 41 physicians were able to differentiate semen from other products using a WL. Moreover, the semen samples used for the study did not fluoresce under WL analysis. None of the 29 semen samples fluoresced whether wet or dry. The medicaments most commonly mistaken for semen were A&D ointment (Cardinal Health, Inc, Dublin, OH), Surgilube (Division of Atlanta, Inc, Melville, NY), Barrier cream (Carrington Laboratories, Inc, Irving, TX), and bacitracin (Division of Atlanta, Inc, Melville, NY).

Conclusions.
Participating physicians were unable to distinguish between semen and other common products, using the WL. Although the WL has been purported to be a useful tool as a screening device for the detection of seminal stains, the investigators have found it to be unreliable. Semen, previously reported to fluoresce under WL analysis, does not appear to do so. The correct identification of semen may be complicated by the presence of previously existing ointments and creams, some of which may be iatrogenically introduced (ie, Surgilube).
Risk Factors for Chronic Lung Disease in the Surfactant Era: A North Carolina Population-based Study of Very Low Birth Weight Infants
Authors: Marshall Diane D. , Kotelchuck Milton , Young Thomas E. , Bose Carl L. , Kruyer Lauree , O'Shea T. Michael ,   the North Carolina Neonatologists Association
Published: August 2004

Objective.To identify risk factors for chronic lung disease (CLD) in a population-based cohort of very low birth weight infants, born in an era of surfactant usage. We specifically investigated the effects of antenatal steroids, nosocomial infection, patent ductus arteriosus (PDA), fluid management, and ventilator support strategies.Methods.Data were prospectively collected on 1244 infants born in North Carolina in 1994 with birth weights 500 to 1500 g, and treated at 1 of the 13 intensive care nurseries across the state. The outcome of interest was CLD, defined as dependency on supplemental oxygen at 36 weeks' postmenstrual age. Multivariate odds ratios (OR) and 95% confidence intervals (CI) were estimated with logistic regression models.Results.Among 865 survivors to 36 weeks' postmenstrual age, 224 (26%) had CLD. Nosocomial infection (OR: 2.0; 95% CI: 1.4–3.3), fluid intake on day 2 (OR: 1.06 per 10 mL increase; 95% CI: 1.01–1.11), and the need for ventilation at 48 hours of life (OR: 2.2; 95% CI: 1.3–3.7) were associated with an increased risk of CLD. Among infants ventilated at 48 hours, nosocomial infection (OR: 1.64; 95% CI: 1.02–2.62) and PDA (OR: 1.9; 95% CI: 1.2–3.1) were associated with an increased risk. No association was found with antenatal steroid receipt or increased levels of ventilator support.Conclusion.This analysis suggests that with widespread use of surfactant, nosocomial infection, PDA, and water balance persist as risk factors for CLD.
Persistence of Dyslexia: The Connecticut Longitudinal Study at Adolescence
Authors: Shaywitz Sally E. , Fletcher Jack M. , Holahan John M. , Shneider Abigail E. , Marchione Karen E. , Stuebing Karla K. , Francis David J. , Pugh Kenneth R. , Shaywitz Bennett A. 
Published: August 2004

Objective.
The outcome in adolescence of children diagnosed as dyslexic during the early years of school was examined in children prospectively identified in childhood and continuously followed to young adulthood. This sample offers a unique opportunity to investigate a prospectively identified sample of adolescents for whom there is no question of the childhood diagnosis and in whom highly analytic measures of reading and language can be administered in adolescence.

Design.
Children were recruited from the Connecticut Longitudinal Study, a cohort of 445 children representative of those children entering public kindergarten in Connecticut in 1983. Two groups were selected when the children were in grade 9: children who met criteria for persistent reading disability in grades 2 through 6 (persistently poor readers [PPR]; n = 21) and a comparison group of nondisabled children, subdivided into average readers (n = 35) and superior readers (n = 39). In grade 9, each child received a comprehensive assessment of academic, language, and other cognitive skills.

Results.
Measures of phonological awareness (but not orthographic awareness) were most significant in differentiating the 3 reading groups, with smaller contributions from measures of word finding and digit-span. Academic measures that best separated good from poor readers were decoding and spelling, whereas measures of math and reading comprehension did not. Measures of phonological awareness, followed next by teacher rating of academic skills were the best predictors of decoding, reading rate, and reading accuracy. In contrast, the best predictor of reading comprehension was word finding, with digit span and socioeconomic status also contributing significantly. Using a growth curve model (quadratic model of growth to a plateau) all 3 groups demonstrated similar patterns of growth over time, with the superior group outperforming the average group, and the average group outperforming the PPR group. There was no evidence that the children in the PPR group catch up in their reading skills.

Conclusions.
Deficits in phonological coding continue to characterize dyslexic readers even in adolescence; performance on phonological processing measures contributes most to discriminating dyslexic and average readers, and average and superior readers as well. These data support and extend the findings of previous investigators indicating the continuing contribution of phonological processing to decoding words, reading rate, and accuracy and spelling. Children with dyslexia neither spontaneously remit nor do they demonstrate a lag mechanism for catching up in the development of reading skills. In adolescents, the rate of reading as well as facility with spelling may be most useful clinically in differentiating average from poor readers.
Previously Healthy Infants May Have Increased Risk of Aspiration During Respiratory Syncytial Viral Bronchiolitis
Authors: Khoshoo Vikram , Edell Dean 
Published: August 2004

Objective.
Respiratory illnesses may cause feeding difficulties in infants. We studied the safety of oral feeding during respiratory syncytial viral (RSV) bronchiolitis in previously healthy infants.

Methods.
Twelve previously healthy infants (3–12 months) with RSV bronchiolitis underwent barium swallow studies during the acute phase of illness. Those with abnormal studies underwent repeat studies 2 to 4 weeks later.

Results.
The initial barium studies revealed aspiration in 3 infants. All repeat studies, performed 2 to 4 weeks later, were normal.

Conclusions.
Even previously healthy infants may be at risk of aspiration during RSV bronchiolitis.
Prevention of Poliomyelitis: Recommendations for Use of Only Inactivated Poliovirus Vaccine for Routine Immunization
Authors:   Committee on Infectious Diseases
Published: August 2004

This Policy Statement was retired October 2003.
Since 1997, when the American Academy of Pediatrics (AAP) initially recommended expanded use of inactivated poliovirus vaccine (IPV) for routine childhood immunization against poliovirus infection, the occurrence of vaccine-associated paralytic poliomyelitis (VAPP) has decreased in the United States. However, VAPP will not be eliminated until oral poliovirus vaccine (OPV) no longer is given. As a result of continuing progress toward global eradication of poliomyelitis, the risk of imported infection has continued to decrease. Concomitantly, the use of IPV has increased substantially with the corresponding decrease in the use of OPV, indicating widespread acceptance by health care professionals and parents of the sequential or all-IPV immunization schedule previously recommended by the AAP. In addition, availability of OPV will be substantially diminished beginning in early 2000. To eliminate VAPP in the context of decreasing risk of wild-type poliovirus importation, the AAP recommends an all-IPV schedule for routine childhood immunization beginning in early 2000. The AAP further recommends that, effective immediately, OPV no longer should be purchased for routine use. Guidelines are given for utilization of remaining supplies of OPV during the transition in early 2000 to the all-IPV schedule.
The Management of Minor Closed Head Injury in Children
Authors:   Committee on Quality Improvement, American Academy of Pediatrics Commission on Clinical Policies and Research, American Academy of Family Physicians
Published: August 2004

This Clinical Practice Guideline was retired January 2012.
The American Academy of Pediatrics (AAP) and its Committee on Quality Improvement in collaboration with the American Academy of Family Physicians (AAFP) and its Commission on Clinical Policies and Research, and in conjunction with experts in neurology, emergency medicine and critical care, research methodologists, and practicing physicians have developed this practice parameter. This parameter provides recommendations for the management of a previously neurologically healthy child with a minor closed head injury who, at the time of injury, may have experienced temporary loss of consciousness, experienced an impact seizure, vomited, or experienced other signs and symptoms. These recommendations derive from a thorough review of the literature and expert consensus. The methods and results of the literature review and data analyses including evidence tables can be found in the technical report. This practice parameter is not intended as a sole source of guidance for the management of children with minor closed head injuries. Rather, it is designed to assist physicians by providing an analytic framework for the evaluation and management of this condition. It is not intended to replace clinical judgment or establish a protocol for all patients with a minor head injury, and rarely will provide the only appropriate approach to the problem.
The practice parameter, “The Management of Minor Closed Head Injury in Children,” was reviewed by the AAFP Commission on Clinical Policies and Research and individuals appointed by the AAFP and appropriate committees and sections of the AAP including the Chapter Review Group, a focus group of office-based pediatricians representing each AAP District: Gene R. Adams, MD; Robert M. Corwin, MD; Diane Fuquay, MD; Barbara M. Harley, MD; Thomas J. Herr, MD, Chair; Kenneth E. Matthews, MD; Robert D. Mines, MD; Lawrence C. Pakula, MD; Howard B. Weinblatt, MD; and Delosa A. Young, MD.
The supporting data are contained in a technical report available athttp://www.pediatrics.org/cgi/content/full/104/6/e78.