bluuebunny/crossref_metadata_2025_split huggingface dataset:
Injury Prevention Education Using Pictorial Information
Authors: Powell Elizabeth C. , Tanz Robert R. , Uyeda Andrew , Gaffney Mary Beth , Sheehan Karen M. 
Published: August 2004

Background.Written materials used in pediatric public health settings often exceed the reading skills of caretakers.Objective.To compare a pictorial anticipatory guidance (PAG) sheet requiring limited reading skills to a TIPP (The Injury Prevention Program) sheet for providing injury prevention information to low-income urban families.Design and Setting.A convenience sample of families with children treated at an urban pediatric clinic affiliated with a teaching hospital.Methods.Parents of children ≤6 years old received either a PAG sheet or a TIPP sheet during a well-child care clinic visit; parents of children seen in the morning clinic received a PAG sheet and those seen during the afternoon clinic a TIPP sheet. All also received injury prevention counseling by a clinic nurse. The recall of injury prevention information was assessed by telephone questionnaire 14 to 28 days after the clinic encounter.Results.We interviewed 66 parents (57% of families enrolled): 46 were in the PAG group and 20 in the TIPP group. There were no differences between groups in mean parent age, percent minority race, or percent public aid. Eighty-seven percent of PAG and 100% of TIPP parents recalled receiving an information sheet; 17% of PAG and 20% of TIPP parents could recall no specific injury topics. The mean number of topics recalled was 2.1 ± 1.5 from parents in the PAG group and 1.6 ± 1.1 from those in the TIPP group. No specific injury topic was recalled by more than half the parents in either group.Conclusions.Recall of injury information several weeks after a clinic visit is limited. The use of PAG sheets did not improve recall; lack of literacy is not the sole cause of poor recall. Successful injury prevention counseling in this population may require comprehensive and repetitive efforts.
The Relationship Between Social Stratification and All-Cause Mortality Among Children in the United States: 1968–1992
Authors: DiLiberti John H. 
Published: August 2004

Background.US childhood poverty rates have increased for most of the past 2 decades. Although overall mortality among children has apparently fallen during this interval, these aggregate mortality rates may hide a disproportionate burden imposed on the least advantaged. This study assessed the impact of social stratification on long-term US childhood mortality rates and examined the temporal relationship between mortality attributable to social stratification and childhood poverty rates.Methods.Using US childhood mortality data obtained from the Compressed Mortality File (National Center for Health Statistics) and a county-level measure of social stratification (residential telephone availability), I evaluated the impact of social stratification on long-term trends (1968–1992) in age-adjusted mortality and compared the resulting attributable proportions to trends in childhood poverty rates.Results.Between 1968 and 1987 the proportion of US childhood deaths attributable to social stratification decreased from .22 to .17. Subsequently, it increased to .24 in 1992, despite continuous declines in overall childhood mortality rates. These proportions correlated strongly with earlier childhood poverty rates, taking into account an apparent 9-year lag. Among black children comparable trends were not observed, although throughout this time period their mortality rates were far higher than among the rest of the population and declined more slowly.Conclusions.Despite declining childhood mortality rates between 1968 and 1992, children living in the least advantaged counties continued to die at higher rates than those living in the most advantaged counties. This differential worsened considerably after 1987, and by 1992 had a substantive impact on US life expectancy at birth, resulting in perhaps the most significant (in terms of years of life lost) reversal in the health of the US public in the 20th century.
Does Sensitization to Contact Allergens Begin in Infancy?
Authors: Bruckner Anna L. , Weston William L. , Morelli Joseph G. 
Published: August 2004

Objective.Because previous studies have found allergic contact sensitization common in children by 5 years of age, our aim was to determine the prevalence of positive epicutaneous test results in children &lt;5 years of age and to determine whether sensitization to contact allergens was as common in infancy.Methods.We recruited 95 asymptomatic children 6 months to 5 years of age from well-child visits at Denver area pediatric practices for epicutaneous patch testing using the T.R.U.E. Test system. Allergens were placed on the skin for 48 hours, and at a later follow-up visit, positive reactions were evaluated.Results.A total of 85 patients completed the study. Of these, 20 (24.5%) had 1 or more positive reactions to the tested allergens. Positive reactors ranged from 6 to 65.5 months of age, with an average of 30.4 months of age. Of the children, 16 reacted to 1 allergen, and 4 reacted to 2. Eleven positive reactions were observed to nickel, followed by 8 to thimerosal. Other positive reactions were to neomycin, cobalt, and kathon CG.Conclusions.Children as young as 6 months of age may be sensitized to contact allergens. Within this pediatric population, the prevalence of sensitization is 24.5%. Sensitization to contact allergens may occur in infants.
Granulocyte Colony-Stimulating Factor Is Present in Human Milk and Its Receptor Is Present in Human Fetal Intestine
Authors: Calhoun Darlene A. , Lunøe Mathilde , Du Yan , Christensen Robert D. 
Published: August 2004

Objective.
Human milk provides neonates with a meaningful degree of protection from infection, but the responsible mechanisms are not well understood. Discovering these mechanisms is important, because of the possibility of supplementing infant formulas with factors that simulate human milk's protective capacity. We postulated that granulocyte colony-stimulating factor (G-CSF), a cytokine known to augment antibacterial defenses through its salutory effect on neutrophil production, might be one such factor. To test this hypothesis, we quantified G-CSF in milk of healthy women and those with intraamniotic infection, and sought the presence of functional G-CSF receptors (G-CSF-R) in fetal/neonatal intestinal villi.

Study Design.
G-CSF was measured by enzyme-linked immunoassay in 126 milk samples obtained from breast-feeding women, and the concentrations were analyzed according to gestational age, postpartum day of collection (first 2 days vs greater 2 days), and the presence versus absence of intraamniotic infection. G-CSF-R messenger ribonucleic acid transcripts were sought from fetal/neonatal intestine using reverse transcriptase polymerase chain reaction, and localized using in situ RT-PCR. G-CSF-R protein, and specific intracellular signaling proteins (Janus tyrosine kinase-1, Janus tyrosine kinase-2, and tyrosine kinase-2), were sought by immunohistochemistry.

Results.
All milk samples contained G-CSF, and significantly more G-CSF was contained in milk collected during the first 2 postpartum days than during subsequent days. Milk from women who delivered prematurely had less G-CSF during the first 2 postpartum days than milk from women who delivered at term. When intraamniotic infection was present, the concentration of G-CSF in milk was elevated significantly compared with concentrations in milk of noninfected women. G-CSF concentrations were also higher in milk collected during the first 2 postpartum days from women who had received intrapartum recombinant G-CSF treatment, compared with milk obtained from women with intraamniotic infection, regardless if they delivered prematurely or at term. G-CSF-R messenger ribonucleic acid and protein were expressed on fetal villus enterocytes, and Janus tyrosine kinase-1, Janus tyrosine kinase-2, and tyrosine kinase-2 were present within the cytoplasm of these cells.

Conclusions.
Human milk contains substantial quantities of G-CSF. G-CSF-R are abundant on villus enterocytes, and specific proteins associated with G-CSF-R signaling are present in these cells.
Influence of Congenital Heart Disease on Mortality After Noncardiac Surgery in Hospitalized Children
Authors: Baum Victor C. , Barton David M. , Gutgesell Howard P. 
Published: August 2004

Objective.
To evaluate the incremental risk of congenital heart disease on mortality after noncardiac surgery in children.

Design.
We reviewed the clinical information network database of the University Hospital Consortium for the period January 1, 1993, through December 31, 1996, and identified 191 261 patients &lt;18 years old having 1 or more noncardiovascular surgical procedures. Of these patients, 6.5% had a diagnosis of congenital heart disease. Patients having ambulatory surgery are excluded from this database. Short-term (1-, 2-, and 3-day) and 30-day mortality were compared, as well as mortality for neonates, infants (31 days to 1 year), and older children (1–17 years); mortality for the 100 most common surgical procedures, mortality for 10 relatively minor surgical procedures, and mortality in subgroups of patients with minor versus severe cardiac diagnoses.

Results.
Short-term and 30-day mortality was increased in the patients with congenital heart disease patients (30-day mortality odds ratio 3.5; 95% confidence limit, 3.2–3.9). Mortality was also increased in patients with congenital heart disease in the 2 youngest age groups, for the 100 most common operations, and for 10 relatively minor operations. Children with more severe heart disease diagnoses had higher mortality than did children carrying less serious cardiac diagnoses.

Conclusion.
A diagnosis of congenital heart disease adds significant incremental risk of mortality in children requiring inpatient noncardiovascular surgery. This outcome difference is present for both minor and major surgical procedures, and regardless of whether mortality is measured at 1, 3, or 30 days. The incremental risk is greatest in neonates and infants where the presence of congenital heart disease is associated with a 2-fold increase in mortality from noncardiac surgery.
Changes in Mesenteric Blood Flow Response to Feeding: Conventional Versus Fiber-optic Phototherapy
Authors: Pezzati Marco , Biagiotti Roberto , Vangi Venturella , Lombardi Enrico , Wiechmann Lisa , Rubaltelli Firmino F. 
Published: August 2004

Objective.To evaluate whether fiberoptic phototherapy influences the postprandial increase in mesenteric blood flow velocity similarly to conventional phototherapy in preterm infants.Patients and Methods.With the use of Doppler color ultrasonography, blood flow velocity in the superior mesenteric artery was measured both preprandially and postprandially in 19 preterm infants during and after conventional phototherapy, and in 20 preterm infants during and after fiber-optic phototherapy. The mean arterial blood pressure/mean flow velocity ratio was calculated as an estimate of relative vascular resistance of the superior mesenteric artery.Results.The study shows that conventional phototherapy blunts the postprandial mesenteric blood flow response to feeding in preterm infants. Furthermore, it shows that the postprandial increase in intestinal blood flow is not attenuated when fiber-optic phototherapy is administered, and that such postprandial increase of blood flow is significantly greater than in infants receiving conventional phototherapy. During and after fiber-optic phototherapy, a significant reduction in postprandial relative vascular resistance was found; such reduction was significantly greater than during conventional phototherapy.Conclusions.Fiber-optic phototherapy is preferable to conventional phototherapy for the treatment of hyperbilirubinemia in preterm infants because it does not affect the physiologic postprandial redistribution of blood flow from the periphery to the gastrointestinal system as does conventional phototherapy.
Can Peak Expiratory Flow Predict Airflow Obstruction in Children With Asthma?
Authors: Eid Nemr , Yandell Ben , Howell Laura , Eddy Martha , Sheikh Shahid 
Published: August 2004

Study Objectives.A recent trend in the treatment of asthma has been the widespread, independent use of peak expiratory flow (PEF). We examined whether PEF monitoring creates inaccuracies in assessment of children with moderate to severe asthma.Methods.We compared the negative predictive value of PEF in relation to the forced expiratory volume in 1 second (FEV1), and to the forced expiratory flow between 25% and 75% of the vital capacity (FEF25–75%) at different levels of air trapping as determined by the residual volume over total lung capacity ratio (RV/TLC).Results.The study included 244 patients, ages 4 to 18 years with all classes of asthma severity, with FEV1ranging from 28% to 134% of predicted value. We analyzed 367 sets of pulmonary function tests performed throughout a 3-year period. Thirty percent of patients with a normal PEF value had an abnormal FEV1 or FEF25–75%. As air trapping increased, the ability of a normal PEF to predict normal FEV1 and FEF25–75% readings fell from 83% to 53%. The negative predictive value was significantly lower for patients with RV/TLC ratio &gt;30 compared with patients with RV/TLC &lt;30.Conclusions.The results of this study suggest that it might be possible to identify children for whom the PEF is likely to give false-negative results. As air trapping increases, it causes the PEF to give misleading reassurance of normal pulmonary function. Furthermore, poor predictiveness of PEF is obtained when values 80% of predicted for age are considered normal.
The Incidence of Necrotizing Enterocolitis After Introducing Standardized Feeding Schedules for Infants Between 1250 and 2500 Grams and Less Than 35 Weeks of Gestation
Authors: Kamitsuka Michael D. , Horton Mary K. , Williams Michelle A. 
Published: August 2004

Objective.To evaluate the incidence of necrotizing enterocolitis (NEC) after implementing standardized feeding schedules.Method.This was a cohort study, which retrospectively reviewed the incidence of NEC for a 3-year period before implementing feeding schedules and prospectively evaluated the incidence of NEC for a 3-year period after implementing feeding schedules in infants with birth weights between 1250 and 2500 g and &lt;35 weeks' gestation. The feeding schedules were comprised of 3 parts. First, no group was fed within the first 24 hours of life. Feeds were started between 24 to 72 hours of life based on birth weight. Second, the initial feed was full-strength breast milk or half-strength formula. Half-strength formula was changed to full-strength formula on the fourth day for all groups. Third, the daily feeding volume increase was no greater than 20 mL/kg for all groups.Results.In the 477 infants before the feeding schedules, there were 23 (4.8%) cases of definite NEC defined as pneumatosis on abdominal film or NEC confirmed at the time of surgery, and in the 466 infants after the feeding schedules, there were 5 (1.1%) cases of NEC. Before the feeding schedules, those who developed NEC started feeds sooner 1.5 ± 1.5 (± standard deviation [SD]) days versus 3.0 ± .7 (±SD) days, reached full feeds sooner 4.0 ± 1.8 (± SD) days versus 9.8 ± .5 (±SD) days and were more likely to have been started on formula than those who developed NEC after implementing the feeding schedules. The mean time for NEC to occur after the feeding schedules increased from 5.9 ± 4.1 (±SD) days to 19.4 ± 16.3 (± SD) days, although not statistically significant. The number of mothers who received prenatal steroids increased after the feeding schedules. The number of infants with NEC, however, significantly decreased whether their mothers were pretreated with steroids. The risk of NEC was reduced 84% after the introduction of feeding schedules as determined by multiple logistic regression analysis and adjusting for confounding by birth weight, white race, prenatal steroid exposure, day of life of first feed, day of life to reach full feeds, and breast milk.Conclusion.The incidence of NEC was significantly decreased after the implementation of standardized feeding schedules, which was independent of birth weight, prenatal steroid exposure, breast milk, day of life of first feed, and the number of days to reach full feeds.
Granulocyte Colony-Stimulating Factor Serum and Urine Concentrations in Neutropenic Neonates Before and After Intravenous Administration of Recombinant Granulocyte Colony-Stimulating Factor
Authors: Calhoun Darlene A. , Lunøe Mathilde , Du Yan , Hutson Alan D. , Veerman Mark , Christensen Robert D. 
Published: August 2004

Background.
Recombinant granulocyte colony-stimulating factor (rG-CSF) has been suggested as a treatment for certain varieties of neonatal neutropenia, but little is known about the pharmacologic disposition of rG-CSF in that population.

Methods.
Ten neutropenic neonates were treated with rG-CSF, 10 μg/kg intravenously once daily for 3 to 5 days. Serum and urine samples were obtained before rG-CSF dosing and at intervals thereafter for G-CSF quantification by enzyme-linked immunosorbent assay.

Results.
Five of the neutropenic neonates (termed group 1) were not infected but likely had hyporegenerative neutropenia (4 were born after pregnancy-induced hypertension/intrauterine growth restriction, and 1 had Rh hemolytic disease). Five other infants (group 2) had neutropenia accompanying bacterial sepsis and shock. Before receiving the first dose of rG-CSF, endogenous G-CSF serum and urine concentrations were relatively low in group 1, averaging 130 pg/mL (range: 48–209) in serum and 53 pg/mL (range: 15–141) in urine. Serum concentrations immediately before the final dose were much higher (range: 81–24 835 pg/mL), whereas urine concentrations were unchanged (range: &lt;7 pg/mL–126 pg/mL). In group 2 patients, before receiving the first-dose of rG-CSF, endogenous concentrations were very high, averaging 59 575 pg/mL (range: 20 028–98 280) in serum and 3189 pg/mL (range: 23–4770) in urine. Predose serum concentrations before the final dose (range: 427–14 460 pg/mL) were lower than before the first dose. The area under the concentration curve after the first dose of rG-CSF administration in group 1 was significantly lower than after the first dose in group 2, but no difference in area under the concentration curve was observed between groups 1 and 2 after the last dose of rG-CSF.

Speculation.
The principal means of clearing G-CSF from the serum is by saturable binding to specific G-CSF receptors (G-CSF-Rs). Therefore, the very high G-CSF serum and urine concentrations of group 2 patients before the first rG-CSF dose implies that their G-CSF-Rs were saturated before the dose was given. We speculate that if G-CSF-Rs are saturated with endogenous G-CSF, treatment with rG-CSF will add little or nothing to the granulocytopoietic effort. On this basis, we judge that neonates with septic shock and neutropenia are unlikely to derive benefit from rG-CSF administration.
Unintentional Pediatric Superwarfarin Exposures: Do We Really Need a Prothrombin Time?
Authors: Mullins Michael E. , Brands Christina L. , Daya Mohamud R. 
Published: August 2004

Objective.To determine whether routine follow-up coagulation studies are useful in children with accidental exposures to rodenticides containing superwarfarin compounds.Design.Retrospective review of poison center charts involving pediatric superwarfarin exposures occurring in two 2-year periods.Setting.An American Association of Poison Control Centers-certified regional poison control center with an annual call volume of 55 000 calls per year from a 2-state area with a combined population of 4 million people.Outcome Measures.Prothrombin times and/or international normalized ratios and reported clinical signs of excessive anticoagulation after exposure.Results.Of 542 children in 4 years of data collection, follow-up prothrombin times and/or international normalized ratios measurements did not detect any significant coagulation abnormalities. No child developed bleeding complications. No child required or received antidotal treatment with vitamin K.Conclusion.Normal preschool-aged children with unintentional acute exposures to superwarfarin rodenticides do not require any routine follow-up laboratory studies and do not require any medical intervention.
Liver Failure Attributable to Hepatitis A Virus Infection in a Developing Country
Authors: Shah Uzma , Habib Zehra 
Published: August 2004

In young children hepatitis A virus (HAV) infections are usually subclinical events. However, HAV is also associated with progressive hepatic failure and even death in some patients. This study was undertaken to characterize the course of hepatitis A-related acute liver failure in children from a developing country where hepatitis A is endemic and produces significant morbidity.
Patients &lt;15 years of age with confirmed hepatitis A, seen at the Aga Khan University Hospital between January 1991 and August 1998 were identified using the patient registry. Of the 2735 patients seen with hepatitis A, 232 were admitted to the hospital. Of these 30 patients developed progressive hepatic dysfunction and liver failure. During this period, 45 children were admitted with liver failure attributable to other causes. Of the patients admitted with hepatitis A-related liver failure, 25 (83.3%) were encephalopathic at presentation and 36.7% of the patients died. The prothrombin time was the most significant predictor of survival. There was a significant difference between those who survived and those who died on discriminant analysis with respect to age, grade of hepatic encephalopathy, duration of hospitalization, prothrombin time, and duration of jaundice when taken as a group.
There is a striking prevalence of liver dysfunction progressing to hepatic failure among children seen at a hospital in Karachi, Pakistan. This study demonstrates the significant morbidity and mortality that can attend HAV infections in children in a developing country despite tertiary medical facilities. The risk of HAV and its sequelae could probably be effectively reduced in these settings with improved sanitation and universal immunization.
The Pediatrician and Childhood Bereavement
Authors:   Committee on Psychosocial Aspects of Child and Family Health
Published: August 2004

This Policy statement was revised. See https://doi.org/10.1542/peds.2016-2147.
Pediatricians should understand and evaluate children's reactions to the death of a person important to them by using age-appropriate and culturally sensitive guidance while being alert for normal and complicated grief responses. Pediatricians also should advise and assist families in responding to the child's needs. Sharing, family support, and communication have been associated with positive long-term bereavement adjustment.
Prevention and Management of Pain and Stress in the Neonate
Authors:   Committee on Fetus and Newborn, Committee on Drugs, Section on Anesthesiology, Section on Surgery,   Canadian Paediatric Society, Fetus and Newborn Committee
Published: August 2004

This Policy Statement was revised. See https://doi.org/10.1542/peds.2015-4271.
This statement is intended for health care professionals caring for neonates (preterm to 1 month of age). The objectives of this statement are to:
1.  Increase awareness that neonates experience pain; 2.  Provide a physiological basis for neonatal pain and stress assessment and management by health care professionals; 3.  Make recommendations for reduced exposure of the neonate to noxious stimuli and to minimize associated adverse outcomes; and 4.  Recommend effective and safe interventions that relieve pain and stress.