bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nutritional Rickets in Ichthyosis and Response to Calcipotriene
Authors: Thacher Tom D. , Fischer Philip R. , Pettifor John M. , Darmstadt Gary L. 
Published: August 2004

Nutritional rickets has occasionally been described in children with lamellar ichthyosis, but their vitamin D endocrine status has not been described. We report 3 cases of vitamin D-deficiency rickets associated with ichthyosis in African children.
A 13-month-old Nigerian boy with lamellar ichthyosis had rib beading, elevated alkaline phosphatase, and rachitic changes on radiographs. His rickets did not resolve with calcium therapy, and his 25-hydroxyvitamin D level was low. His rickets resolved with parenteral vitamin D treatment, but his skin did not improve. Topical 0.005% calcipotriene (an analog of 1,25-dihydroxyvitamin D that has been useful in treating adults with psoriasis) was similarly ineffective in improving the child's skin condition.
An 8-year-old Nigerian boy with life-long skin findings consistent with lamellar ichthyosis had windswept deformity of the legs with rib beading and enlargement of the wrists and ankles. Radiographs showed active rickets, and the boy had an elevated alkaline phosphatase level and a decreased calcium level. Before knowing that his 25-hydroxyvitamin D level was low, he was treated with calcium and showed radiologic improvement. The skin did not improve with resolution of the rickets but did improve with unilateral topical application of 0.005% calcipotriene.
A 7-year-old South African girl presented with progressive windswept deformities of the legs and a 4-year history of skin disease (and a skin biopsy consistent with X-linked ichthyosis). Radiographs and biochemical data confirmed active rickets. Her rickets improved dramatically with vitamin D treatment.
Thus, 3 African children with ichthyosis developed vitamin D-deficiency rickets, probably because of a combination of impaired skin production and sunlight avoidance. This is consistent with previous findings of hypovitaminosis D in adults with ichthyosis and other disorders of keratinization. Measurement of 25-hydroxyvitamin D may be indicated in children with ichthyosis to identify those at risk for vitamin D-deficiency rickets, because it is possible that the cutaneous synthesis of vitamin D in such children is impaired.
Although the ichthyosis did not improve with resolution of vitamin D deficiency and rickets, 1 of 2 children treated with topical calcipotriene showed improvement in the treated areas of skin. Calcipotriene does not seem to be effective in reversing systemic vitamin D deficiency but can be effective in improving the severity of skin disease in children with ichthyosis.
An Evidence-Based Review of Important Issues Concerning Neonatal Hyperbilirubinemia
Authors: Ip Stanley , Chung Mei , Kulig John , O'Brien Rebecca , Sege Robert , Glicken Stephan , Maisels M. Jeffrey , Lau Joseph ,   Subcommittee on Hyperbilirubinemia
Published: August 2004

This Technical Report was revised. See https://doi.org/10.1542/peds.2022-058865.
This article is adapted from a published evidence report concerning neonatal hyperbilirubinemia with an added section on the risk of blood exchange transfusion (BET). Based on a summary of multiple case reports that spanned more than 30 years, we conclude that kernicterus, although infrequent, has at least 10% mortality and at least 70% long-term morbidity. It is evident that the preponderance of kernicterus cases occurred in infants with a bilirubin level higher than 20 mg/dL. Given the diversity of conclusions on the relationship between peak bilirubin levels and behavioral and neurodevelopmental outcomes, it is apparent that the use of a single total serum bilirubin level to predict long-term outcomes is inadequate and will lead to conflicting results. Evidence for efficacy of treatments for neonatal hyperbilirubinemia was limited. Overall, the 4 qualifying studies showed that phototherapy had an absolute risk-reduction rate of 10% to 17% for prevention of serum bilirubin levels higher than 20 mg/dL in healthy infants with jaundice. There is no evidence to suggest that phototherapy for neonatal hyperbilirubinemia has any long-term adverse neurodevelopmental effects. Transcutaneous measurements of bilirubin have a linear correlation to total serum bilirubin and may be useful as screening devices to detect clinically significant jaundice and decrease the need for serum bilirubin determinations. Based on our review of the risks associated with BETs from 15 studies consisting mainly of infants born before 1970, we conclude that the mortality within 6 hours of BET ranged from 3 per 1000 to 4 per 1000 exchanged infants who were term and without serious hemolytic diseases. Regardless of the definitions and rates of BET-associated morbidity and the various pre-exchange clinical states of the exchanged infants, in many cases the morbidity was minor (eg, postexchange anemia). Based on the results from the most recent study to report BET morbidity, the overall risk of permanent sequelae in 25 sick infants who survived BET was from 5% to 10%.
Underimmunization Among Children: Effects of Vaccine Safety Concerns on Immunization Status
Authors: Gust Deborah A. , Strine Tara W. , Maurice Emmanuel , Smith Philip , Yusuf Hussain , Wilkinson Marilyn , Battaglia Michael , Wright Robert , Schwartz Benjamin 
Published: August 2004

Objective. To examine the attitudes, beliefs, and behaviors of parents whose children were underimmunized with respect to ≥2 vaccines that have recently received negative attention, compared with parents whose children were fully immunized with respect to the recommended vaccines.Design. Case-control study.Setting. A sample of households that participated in the National Immunization Survey were recontacted in 2001.Main Outcome Measure. Vaccination status was assessed. Case subjects were underimmunized with respect to ≥2 of 3 vaccines (diphtheria-tetanus-pertussis or diphtheria-tetanus-acellular pertussis, hepatitis B, or measles-containing vaccines), and control subjects were fully immunized.Results. The response rate was 52.1% (2315 of 4440 subjects). Compared with control households, case households were more likely to make $0 to $30 000 (adjusted odds ratio [OR]: 2.7; 95% confidence interval [CI]: 1.5–4.6) than at least $75 000, to have ≥2 providers (OR: 2.0; 95% CI: 1.3–3.1) than 1, and to have ≥4 children (OR: 3.1; 95% CI: 1.5–6.3) than 1 child. With control for demographic and medical care factors, case subjects were more likely than control subjects to not want a new infant to receive all shots (OR: 3.8; 95% CI: 1.5–9.8), to score vaccines as unsafe or somewhat safe (OR: 2.0; 95% CI: 1.2–3.4), and to ask the doctor or nurse not to give the child a vaccine for reasons other than illness (OR: 2.7; 95% CI: 1.2–6.1). Among case subjects, 14.8% of underimmunization was attributable to parental attitudes, beliefs, and behaviors.Conclusions. Attitudes, beliefs, and behaviors indicative of vaccine safety concerns contribute substantially to underimmunization in the United States. Although concerns were significantly more common among parents of underimmunized children, many parents of fully immunized children demonstrated similar attitudes, beliefs, and behaviors, suggesting a risk to the currently high vaccination levels. Efforts to maintain and improve immunization coverage need to target those with attitudes/beliefs/behaviors indicative of vaccine safety concerns, as well as those with socioeconomic and health care access problems.
Predicting Preschooler Obesity at Birth: The Role of Maternal Obesity in Early Pregnancy
Authors: Whitaker Robert C. 
Published: August 2004

Objective. Knowing risk factors at birth for the development of childhood obesity could help to identify children who are in need of early obesity prevention efforts. The objective of this study was to determine whether children whose mothers were obese in early pregnancy were more likely to be obese at 2 to 4 years of age.
Methods. A retrospective cohort study was conducted of 8494 low-income children who were enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Ohio and were followed from the first trimester of gestation until 24 to 59 months of age. Measured height and weight data from WIC were linked to birth certificate records for children who were born in the years 1992–1996. Obesity among 2- to 4-year-olds was defined as a body mass index (BMI) ≥95th percentile for age and gender. Mothers were classified as obese (BMI ≥30 kg/m2) or nonobese (BMI &lt;30 kg/m2) on the basis of BMI measured in the first trimester of the child’s gestation.
Results. The prevalence of childhood obesity was 9.5%, 12.5%, and 14.8% at 2, 3, and 4 years of age, respectively, and 30.3% of the children had obese mothers. By 4 years of age, 24.1% of children were obese if their mothers had been obese in the first trimester of pregnancy compared with 9.0% of children whose mothers had been of normal weight (BMI ≥18.5 and &lt;25 kg/m2). After controlling for the birth weight, birth year, and gender of the children plus the mothers’ age, race/ethnicity, education level, marital status, parity, weight gain, and smoking during pregnancy, the relative risk of childhood obesity associated with maternal obesity in the first trimester of pregnancy was 2.0 (95% confidence interval [CI]: 1.7–2.3) at 2 years of age, 2.3 (95% CI: 2.0–2.6) at 3 years of age, and 2.3 (95% CI: 2.0–2.6) at 4 years of age.
Conclusion. Among low-income children, maternal obesity in early pregnancy more than doubles the risk of obesity at 2 to 4 years of age. In developing strategies to prevent obesity in preschoolers, special attention should be given to newborns with obese mothers.
The Disappearing Income Gradient in New York City Birth Outcomes: Thirteen Years of Convergence From 1988 to 2001
Authors: Racine Andrew D. , Joyce Theodore J. 
Published: August 2004

Objective. Income has long been identified as a potent determinant of infant mortality, yet little is known about the stability of its influence over time in defined populations. The objective of this study was to characterize trends in the income gradient in infant mortality in New York City from 1988 to 2001.Methods. An ecological analysis was conducted of infant, neonatal, and postneonatal mortality rates in 30 health districts from 14 years (1988-2001) of birth cohorts of the 5 boroughs of New York City divided by quartile of income based on the 1990 census (N = 1 692 721 births). Infant mortality (deaths occurring at &lt;365 days of age), neonatal mortality (deaths occurring at &lt;28 days of age), and postneonatal mortality (deaths occurring from 28 to 364 days of age) expressed as rates per 1000 live births were measured.Results. From 1988 to 2001, infant mortality in the highest income quartile in New York City fell 50.5% from 10.5 to 5.2, whereas in the lowest income quartile, it fell 62.6% from 17.4 to 6.5 per 1000 live births. The equivalent declines in neonatal mortality were 46.6% from 7.3 to 3.9 in the highest income quartile and 61.4% from 11.4 to 4.4 per 1000 live births in the lowest income quartile. For postneonatal mortality, rates fell 58.1% from 3.1 to 1.3 in the highest income quartile and 65% from 6 to 2.1 per 1000 live births in the lowest income quartile. Adjusted for covariates, relative to the highest income quartile, infant, neonatal, and postneonatal morality rates in the lowest income quartile declined 0.36 (95% confidence interval [CI]: −0.52 to −0.19), 0.20 (95% CI: −0.34 to −0.07), and 0.15 (95% CI: −0.23 to −0.07) per 1000 live births more per year.Conclusions. From 1988 to 2001, New York City witnessed a significant convergence in the income gradients of infant, neonatal, and postneonatal mortality rates. Understanding the origins of this trend should constitute an important public policy priority.
Hepatitis A in Hispanic Children Who Live Along the United States–Mexico Border: The Role of International Travel and Food-Borne Exposures
Authors: Weinberg Michelle , Hopkins Jackie , Farrington Leigh , Gresham Louise , Ginsberg Michele , Bell Beth P. 
Published: August 2004

Objectives. Hispanic children who live along the United States–Mexico border historically have had among the highest hepatitis A rates in the United States, but risk factors have not been well characterized. The objective of this study was to examine risk factors associated with acute hepatitis A virus (HAV) infection in Hispanic children who live along the United States–Mexico border in San Diego County, California.
Methods. In this case-control study, hepatitis A cases among Hispanic children who were younger than 18 years reported from June 1998 through August 2000 were matched by age group and exposure period to Hispanic children who were susceptible to HAV infection. Participants and their families were interviewed about demographic information and potential sources of HAV infection, including attending child care, food and waterborne exposures, cross-border and other international travel, and travel-related activities.
Results. Participants included 132 children with hepatitis A and 354 control subjects. The median age of study participants was 7 years (range: 1–17). Sixty-seven percent of case-patients traveled outside the United States during the incubation period, compared with 25% of the children without hepatitis A (odds ratio [OR]: 6.3; 95% confidence interval [CI]: 4.0–9.7); all children, except 1, had traveled to Mexico. In multivariate analysis, hepatitis A was associated with having eaten food from a taco stand or street food vendor (adjusted OR: 17.0; 95% CI: 4.1–71.1) and having eaten salad/lettuce (adjusted OR: 5.2; 95% CI: 1.3–20.1) during travel.
Conclusions. Hepatitis A among Hispanic children who live in an urban area of the United States–Mexico border is associated with cross-border travel to Mexico and food-borne exposures during travel. Travelers to areas where hepatitis A is endemic should receive hepatitis A vaccine before travel.
Conscious Sedation of Children With Propofol Is Anything but Conscious
Authors: Reeves Scott T. , Havidich Jeana E. , Tobin D. Patrick 
Published: August 2004

Objective. To determine the depth of sedation required for bone marrow aspiration and intrathecal injection of chemotherapeutic agents in children using a bispectral (BIS) index monitor and clinical assessment by an independent observer.
Methods. Sixteen children who were undergoing 19 intrathecal chemotherapy and bone marrow aspirations were enrolled in the study. Their ages ranged from 23 months to 190 months with a mean of 79 months. The BIS index was recorded every 5 minutes by an independent observer. The patients received only intravenous propofol for sedation. There were no complications during the procedures.
Results. The mean BIS score was 62.8 ± 9.6. The mean low BIS score was 29.7 ± 13.7, indicating a level of deep sedation and/or general anesthesia was necessary to induce the desired stated of consciousness that would permit the practitioner to perform the procedure. The average dose of propofol was 166 ± 47 μg/kg/min. Mean Aldrete score for level of consciousness was 0.9 ± 0.4, indicating a depressed level of consciousness. The mean activity level was 1.0 ± 0.4, indicating impaired movement.
Conclusions. Children who undergo conscious sedation with propofol for intrathecal chemotherapy and bone marrow aspiration demonstrate BIS values and clinical assessments consistent with deep sedation. Because of an increased risk of adverse events when children undergo deep sedation, appropriate parental informed consent, age-appropriate resuscitative equipment, and skilled anesthesia personnel should be present for rescue in the event of cardiovascular and respiratory complications from deep sedation.
Neonatal Procedural Pain and Preterm Infant Cortisol Response to Novelty at 8 Months
Authors: Grunau Ruth E. , Weinberg Joanne , Whitfield Michael F. 
Published: August 2004

Objectives. Stress systems may be altered in the long term in preterm infants for multiple reasons, including early exposure to procedural pain in neonatal intensive care. This question has received little attention beyond hospital discharge. Stress responses (cortisol) to visual novelty in preterm infants who were born at extremely low gestational age (ELGA; ≤28 weeks), very low gestational age (VLGA; 29–32 weeks), and term were compared at 8 months of age corrected for prematurity (corrected chronological age [CCA]). In addition, among the preterm infants, we evaluated whether cortisol levels at 8 months were related to neonatal exposure to procedural pain and morphine in the neonatal intensive care unit.
Methods. Seventy-six infants, 54 preterm (≤32 weeks’ GA at birth) and 22 term-born infants who were seen at 8 months CCA composed the study sample, after excluding those with major sensory, motor, or cognitive impairment. Salivary cortisol was measured before (basal) and 20 minutes after introduction of novel toys (post 1) and after developmental assessment (post 2).
Results. Salivary cortisol was significantly higher in ELGA infants at 8 months, compared with the VLGA and term groups before and after introduction of visual novelty. Term-born and VLGA infants showed a slight decrease in cortisol when playing with novel toys, whereas the ELGA group showed higher basal and sustained levels of cortisol. After controlling for early illness severity and duration of supplemental oxygen, higher basal cortisol levels in preterm infants at 8 months’ CCA were associated with higher number of neonatal skin-breaking procedures. In contrast, cortisol responses to novelty were predicted equally well by neonatal pain or GA at birth. No relationship between morphine dosing and cortisol response was demonstrated in these infants.
Conclusions. ELGA preterm infants show a different pattern of cortisol levels before and after positive stimulation of visual novelty than more maturely born, VLGA preterm and term-born infants. Exposure to high numbers of skin-breaking procedures may contribute to “resetting” basal arousal systems in preterm infants.
Epidemiology of Childhood Tuberculosis in the United States, 1993–2001: The Need for Continued Vigilance
Authors: Nelson Lisa J. , Schneider Eileen , Wells Charles D. , Moore Marisa 
Published: August 2004

Objective. To describe trends and highlight epidemiologic and clinical characteristics of childhood tuberculosis (TB) in the United States.
Methods. All verified TB cases reported to the national TB surveillance system from 1993 to 2001 were included. A child was defined as a person younger than 15 years.
Results. A total of 11 480 childhood TB cases were reported. Case rates (TB cases/100 000 population) in all children declined from 2.9 (n = 1663) in 1993 to 1.5 (n = 931) in 2001. Among children, those who were younger than 5 years had the highest rate. California, Texas, and New York accounted for 48% of all childhood TB cases. In 2001, TB case rates were higher for foreign-born (12.2) than US-born children (1.1). Hispanic and non-Hispanic black children accounted for nearly three quarters of all cases. Twenty-four percent of children with TB were foreign-born children, with the largest number originating from Mexico (39.8%), the Philippines (8.6%), and Vietnam (5.7%). Most children had evidence of pulmonary TB disease (78.9%). Among culture-positive cases without previous TB, drug resistance to at least isoniazid was 7.3% and to isoniazid and rifampin was 1.6%. In 1999, 82.9% of children received directly observed therapy for at least part of their treatment and 94.8% completed treatment.
Conclusions. Although the overall TB case number among children is declining in the United States, certain groups of children (eg, younger children, racial and ethnic minorities, foreign-born) are at higher risk for TB. As the United States moves toward the elimination of TB, future efforts should endeavor to prevent all cases of childhood TB.
Developing Community-Specific Recommendations for First-Line Treatment of Acute Otitis Media: Is High-Dose Amoxicillin Necessary?
Authors: Garbutt Jane , St. Geme Joseph W. , May Ariane , Storch Gregory A. , Shackelford Penelope G. 
Published: August 2004

Objectives. National recommendations are to use high-dose amoxicillin (80–90 mg/kg per day) to treat uncomplicated acute otitis media (AOM) in children who are at high risk for infection with nonsusceptible Streptococcus pneumoniae (NSSP). However, high-dose treatment may not be necessary if the local prevalence of NSSP is low. The objective of this study was to estimate the local prevalence of NSSP in children with acute upper respiratory illnesses and to develop community-specific recommendations for first-line empiric treatment of AOM.
Methods. We conducted a cross-sectional prevalence study in the offices of 7 community pediatricians in St Louis, Missouri. S pneumoniae was isolated from nasopharyngeal swabs collected from children who were younger than 7 years and had AOM, nonspecific upper respiratory infection, cough, acute sinusitis, or pharyngitis. Children were excluded from the study when they had received an antibiotic in the previous 4-week period. Parents and providers completed a brief questionnaire to assess risk factors for carriage of NSSP. On the basis of National Clinical Chemistry Laboratory Standards, isolates with a penicillin minimum inhibitory concentration ≥0.12 μg/mL were considered to be nonsusceptible to penicillin (NSSP), and isolates with a penicillin minimum inhibitory concentration &gt;2 μg/mL were categorized as nonsusceptible to standard-dose amoxicillin (35–45 mg/kg per day; NSSP-A).
Results. S pneumoniae was isolated from the nasopharynx of 85 (40%) of 212 study patients (95% confidence interval [CI]: 33%–47%); 41 (48%) of 85 isolates were NSSP (95% CI: 37%–59%), and 6 (7%) were NSSP-A (95% CI: 1.5%–13%). Among the 212 study patients, the prevalence of NSSP was 19% (95% CI: 14%–25%), and the prevalence of NSSP-A was 3% (95% CI: 0.6%–5%). Carriage of NSSP was increased in child care attendees compared with nonattendees (29% vs 14%; odds ratio: 2.6; 95% CI: 1.3–5.2).
Conclusions. In our community, although the prevalence of NSSP among isolates of S pneumoniae identified from the nasopharynx of symptomatic children is high (48%), the probability of NSSP-A infection among symptomatic children is &lt;5%. Our data support a recommendation to treat most children who have uncomplicated AOM with standard-dose amoxicillin. Children who attend child care or have recently received an antibiotic may require treatment with high-dose amoxicillin. Other communities may benefit from a similar assessment of the prevalence of NSSP and NSSP-A.