bluuebunny/crossref_metadata_2025_split huggingface dataset:
Response to Immunization With Measles, Tetanus, andHaemophilus influenzaeType b Vaccines in Children Who Have Human Immunodeficiency Virus Type 1 Infection and Are Treated With Highly Active Antiretroviral Therapy
Authors: Melvin Ann J. , Mohan Kathleen M. 
Published: August 2004

Objective. To assess the level of immunity to measles, tetanus, and Haemophilus influenzae type b (Hib) in previously immunized children who have human immunodeficiency virus (HIV) infection and were treated with highly active antiretroviral therapy (HAART) and to determine the response to reimmunization.Methods. Retrospective review of clinical data from children who have HIV-1 infection and were treated with HAART. Children were included in the analysis when they had a history of immunizations before treatment with HAART; had specific immunoglobulin G levels to tetanus, measles, or Hib measured after starting HAART but before the receipt of additional immunizations; were reimmunized while on HAART; and had postimmunization immunoglobulin G levels available.Results. Nineteen children (median age: 7 years; range: 3–14 years) who were treated with 3 to 5 drug HAART regimens for a median of 20 months (range: 8–37) met the criteria for at least 1 antigen and were included in this review. Fifteen (79%) of the 19 had plasma RNA levels &lt;50 copies/mL. The median CD4% before HAART was 26% (range: 1–41) and at the time of immunization, 35% (range: 20–54). Before reimmunization, 1 (5%) of 18 children had detectable antibody levels to measles, 6 (35%) of 17 had detectable antibody levels to tetanus, and 14 (78%) of 18 had detectable antibody levels to Hib. After immunization, 15 (83%) of 18, 10 (90%) of 11, and 3 (75%) of 4 seroconverted to measles, tetanus, and Hib, respectively. Antibody levels remained detectable after 1 year in the majority of children tested.Conclusions. Consideration should be given to readministering childhood immunizations to children who have HIV infection and are treated successfully with combination antiretroviral therapy.
Evaluating the American Academy of Pediatrics Diagnostic Standard for Streptococcus pyogenes Pharyngitis: Backup Culture Versus Repeat Rapid Antigen Testing
Authors: Gieseker Karen E. , Roe Martha H. , MacKenzie Todd , Todd James K. 
Published: August 2004

Objective. The American Academy of Pediatrics recommends that all negative rapid diagnostic tests for Streptococcus pyogenes pharyngitis be backed up by culture, which creates a dilemma for clinicians who must make treatment decisions without complete diagnostic information at the time of visit. The use of a follow-up serial rapid antigen test instead of a follow-up culture would provide a more timely result.
Methods. Two swabs were collected from children who were suspected of having S pyogenes pharyngitis. Each swab was used for a culture and an OSOM Ultra Strep A Test rapid antigen test. The gold standard of comparison was defined as the identification of S pyogenes on either of the 2 culture plates. Three diagnostic strategies were evaluated: a single rapid antigen test, a rapid antigen test with follow-up rapid antigen test (rapid-rapid), and a rapid antigen test with follow-up culture (rapid-culture).
Results. A total of 210 (23.7%) of 887 throat cultures with matched data were identified with S pyogenes. A single rapid antigen test had a sensitivity of 87.6% (95% confidence interval [CI]: 83.2%–92.1%), the sensitivity of the rapid-rapid follow-up was 91.4% (95% CI: 87.6%–95.2%), and the sensitivity of the rapid-culture follow-up was 95.7% (95% CI: 93.0%–98.5%), which was significantly higher than the others. As shown in Fig 1, when these test strategies were evaluated on a subgroup with clinical symptoms commonly associated with S pyogenes pharyngitis, the sensitivities all increased and were no longer significantly different. None of the strategies reliably exceeded a 95% sensitivity threshold.
Conclusions. The American Academy of Pediatrics strategy for S pyogenes detection in children with pharyngitis, requiring a backup culture for those with negative antigen tests, was not exceeded by any other test strategy; however, a rapid-rapid diagnostic strategy may approximate it with the use of judicious clinical selection of patients.
Neurodevelopmental Outcome of Infants Supported With Extracorporeal Membrane Oxygenation After Cardiac Surgery
Authors: Hamrick Shannon E. G. , Gremmels David B. , Keet Corinne A. , Leonard Carol H. , Connell J. Kelly , Hawgood Samuel , Piecuch Robert E. 
Published: August 2004

Objectives. To evaluate the long-term neurodevelopmental outcome of infants who underwent cardiac surgery and required extracorporeal membrane oxygenation (ECMO) support, and to examine variables that predict death or disability in these patients.Methods. We studied all infants who had congenital heart disease and were supported postoperatively with ECMO from 1990 to 2001 at our institution (n = 53). Medical records were reviewed retrospectively to obtain clinical variables. Neurologic and age-appropriate developmental examinations occurred at ages 1, 1.5, 2.5, and 4.5 years. Median age at follow-up was 55 months (9–101). Cognitive outcome was defined as suspect when scores were between 1 and 2 SD below the mean for age and abnormal when scores were &gt;2 SD below mean for age. Neuromotor outcome was defined as suspect when the patient manifested clumsiness, tremor, or mild tone and reflex changes without functional limitations, and abnormal when there were functional limitations.Results. In-hospital survival was 17 (32%) of 53. Of survivors, 14 (88%) of 16 are living and 1 patient was lost to follow-up. Of the 53 patients, 7 survived completely intact (13%). Seven (50%) of 14 patients had a normal cognitive outcome, 3 (21%) had a suspect cognitive outcome, and 4 (29%) were abnormal. Ten (72%) of 14 patients had a normal neuromotor outcome, 1 (7%) patient had a suspect neuromotor outcome, and 3 (21%) were abnormal. No survivor with an aortic cross-clamp time &gt;40 minutes had a normal cognitive outcome. Nonsurvivors were more likely than survivors to have had cardiac arrest as an indication for ECMO (31% vs 6%), to have had a longer aortic cross-clamp time (mean 73 minutes vs 32 minutes), and to have required continuous arteriovenous hemofiltration (78% vs 35%). The age and weight at cannulation, gender, cardiac diagnosis, interval from surgery to ECMO, cardiopulmonary bypass time, diagnosis of sepsis or mediastinitis, and duration of ECMO were not significantly associated with survival.Conclusions. Although mortality was 68% in infants who had congenital heart disease and were treated with ECMO postoperatively, of those who survive to hospital discharge, 75% have a normal neuromotor outcome and 50% have a normal cognitive outcome. These high rates of mortality and disability suggest that increased attention be paid to neuroprotection in these complex disorders.
Which Psychiatric Patients Board on the Medical Service?
Authors: Mansbach Jonathan M. , Wharff Elizabeth , Austin S. Bryn , Ginnis Katherine , Woods Elizabeth R. 
Published: August 2004

Objectives. Patients who require psychiatric hospitalization may be admitted to a medical service only because there are no available inpatient psychiatric beds. These patients are psychiatric “boarders.” The goals of this study were to describe the extent of the boarder problem and to compare the characteristics of patients who are placed successfully into psychiatric facilities from the emergency department (ED) with those who require admission to the medical service as a boarder.
Methods. A retrospective cohort study of a large pediatric ED was conducted. Included were patients who required inpatient psychiatric admission between July 1, 1999, and June 30, 2000. Patients were excluded when they needed inpatient medical treatment before psychiatric placement. The main outcome measured was placement into a psychiatric facility or boarding on medical service.
Results. Of the 315 patients who presented to the ED and required psychiatric admission, 103 (33%) were boarded on the medical service. Multivariate logistic regression demonstrated an increased odds of boarding for age 10 to 13 years (adjusted odds ratio [AOR]: 3.5; 95% confidence interval [CI]: 1.8–6.6), black race (AOR: 2.3; 95% CI: 1.1–4.8), presenting on a weekend or holiday (AOR: 3.8; 95% CI: 1.6–8.8), and presenting from October to June (October–December 1999 [AOR: 4.7; 95% CI: 1.7–13.4], January–March 2000 [AOR: 14.5; 95% CI: 4.9–42.6], and April–June 2000 [AOR: 10.4; 95% CI: 3.5–30.2]) but a decreased odds for 1 insurance company (AOR: 0.08; 95% CI: 0.02–0.4). There was a linear increase in odds of boarding as severity of homicidal ideation increased from none to mild (AOR: 1.5; 95% CI: 1.2–1.8) to moderate (AOR: 2.3; 95% CI: 2.0–2.6) to severe (AOR: 3.5; 95% CI: 3.2–3.8). Suicidal patients also had increased risk of boarding (AOR: 2.2; 95% CI: 1.2–4.3).
Conclusions. Boarders are a problem in pediatrics, and this study identifies multiple characteristics that were associated with increasing a youth’s odds of becoming a boarder at this institution. The suicidal and homicidal symptom results suggest a reverse triage system in which sicker patients are not necessarily given priority by psychiatric facilities. These data highlight mental health practices that need to be reassessed to ensure optimal care for youths with acute mental illness.
Long-Term Safety of Fluticasone Propionate and Nedocromil Sodium on Bone in Children With Asthma
Authors: Roux Christian , Kolta Sami , Desfougères Jean-Luc , Minini Pascal , Bidat Etienne 
Published: August 2004

Objective. Inhaled corticosteroids are recommended as first-line therapy for pediatric asthma. However, few controlled long-term studies have investigated their effect on bone mineral density (BMD) and growth.
Methods. Children who were aged 6 to 14 years and had persistent asthma were randomized to 24 months’ treatment with fluticasone propionate (FP) 200 μg/d or nedocromil sodium (NS) 8 mg/d (if uncontrolled, maximum doses of 400 μg/d and 16 mg/d, respectively). BMD was assessed blind and analyzed at a central facility on the basis of dual-energy x-ray absorptiometry measurements of the lumbar spine and femoral neck at months 0, 6, 12, and 24. Height was measured at months 0, 12, and 24. Efficacy parameters (lung function, asthma control, occurrence of exacerbations) were measured every 3 months.
Results. In total, 174 children were randomized to treatment (87 received FP, and 87 received NS). At month 24, the adjusted mean percentage increase in lumbar spine BMD was 11.6% in the FP group compared with 10.4% in NS-treated children (95% confidence interval for treatment difference: −0.7% to 3.1%). The corresponding increases in femoral neck BMD were 8.9% and 8.5%, respectively. There was no significant difference in growth between the 2 groups: adjusted mean growth rates were 6.1 cm/y with FP and 5.8 cm/y with NS. FP was significantly superior for every efficacy parameter investigated and was similarly well tolerated as NS.
Conclusions. The long-term effects of FP and NS on BMD accrual and growth are similar among children with asthma. The benefit:risk ratio of FP may be considered superior to that of NS.
Fluoroquinolone Safety in Pediatric Patients: A Prospective, Multicenter, Comparative Cohort Study in France
Authors: Chalumeau Martin , Tonnelier Sylvie , d’Athis Philippe , Tréluyer Jean-Marc , Gendrel Dominique , Bréart Gérard , Pons Gérard ,   the Pediatric Fluoroquinolone Safety Study Investigators
Published: August 2004

Objective. To evaluate the safety of fluoroquinolones (FQ) in comparison with other antibiotics in pediatric patients.
Methods. A multicenter, observational, comparative cohort study was conducted between 1998 and 2000 in French pediatric departments. Patients who were receiving systemic FQ were included and matched to control patients who were receiving other antibiotics. Antibiotic-associated potential adverse events (PAEs) were recorded prospectively in both groups, and their rates were compared using univariate and multivariate analyses.
Results. Patients were recruited from 73 centers: 276 patients were exposed to FQ, and 249 composed the control group. Among patients who were exposed to FQ, 23% were younger than 2 years, 33% had cystic fibrosis, and PAEs occurred in 52 patients, leading to withdrawal for 11. The odds ratio for PAE in the FQ group was 3.7 (95% confidence interval: 1.9–7.5) and was not significantly modified after adjustment for potential confounders. Musculoskeletal PAEs also occurred more frequently in the FQ group (3.8%) than in controls (0.4%); they were recorded in 10 patients who were receiving standard FQ doses and were of moderate intensity and transient.
Conclusion. The rates of PAEs and musculoskeletal PAEs were higher for the FQ group than the control group. This observation supports the American Academy of Pediatrics statement restricting off-label FQ use in pediatric patients to second-line treatment in a limited number of situations.
Rest-Activity Patterns in Children With Hypopituitarism
Authors: Rivkees Scott A. 
Published: August 2004

Objectives. Physical lesions in the region of the suprachiasmatic nuclei, which are the site of a circadian clock, result in abnormal circadian rhythmicity in animals, yet the extent of biological rhythm problems in individuals with anatomic or functional lesions in the hypothalamic-pituitary region are largely unknown. To address this issue, we examined patterns of rest and activity of children with hypopituitarism.
Methods. Children who were between the ages of 2 and 18 years and had the diagnosis of panhypopituitarism were evaluated. Twenty children were studied, including children with septo-optic dysplasia (SOD), congenital hypopituitarism, brain tumors, closed head trauma, and head irradiation. For assessing patterns of activity, individuals wore Actiwatches for 3–4 weeks to measure patterns of gross motor activity.
Results. Seventeen children had normal patterns of rest and activity, with an average period length of 24.01 ± 0.01 hours. Three children, including 2 with SOD and 1 with a hypothalamic germinoma, showed abnormal activity patterns in which there was not consolidated rest at night. One patient with an optic glioma had nonentrained circadian phase.
Conclusions. A proportion of children with hypopituitarism have abnormal daily rest-activity patterns. Children with anterior hypothalamic tumors and SOD seem to be at risk for circadian system dysfunction.
Diffusion-Weighted Imaging of the Brain in Preterm Infants With Focal and Diffuse White Matter Abnormality
Authors: Counsell Serena J. , Allsop Joanna M. , Harrison Michael C. , Larkman David J. , Kennea Nigel L. , Kapellou Olga , Cowan Frances M. , Hajnal Joseph V. , Edwards A. David , Rutherford Mary A. 
Published: August 2004

Objective. The most common finding on magnetic resonance imaging (MRI) of the brain in preterm infants at term-equivalent age is diffuse excessive high signal intensity (DEHSI) in the white matter. It is unclear whether DEHSI represents a biological abnormality. This study used diffusion-weighted imaging (DWI) to compare apparent diffusion coefficient (ADC) values in DEHSI with infants with normal imaging and those with overt brain damage to determine whether DEHSI shows the diffusion characteristics of normal or abnormal tissue.
Methods. MRI, using conventional and diffusion-weighted imaging (DWI), was performed in 50 preterm infants at term-equivalent age using a 1.5 Tesla MR scanner. The infants were divided into 3 groups on the basis of their MRI results: 1) normal white matter, 2) DEHSI, or 3) overt white matter pathology. ADC values were measured in the frontal, central, and posterior white matter at the level of the centrum semiovale. ADC values in the 3 groups of preterm infants were compared using a 1-way analysis of variance with a Bonferroni test for multiple comparisons.
Results. ADC values were significantly higher in infants with DEHSI and infants with overt white matter pathology than in infants with normal white matter. There was no significant difference between ADC values in infants with DEHSI and those with overt white matter pathology.
Conclusions. This study provides objective evidence that DEHSI represents diffuse white matter abnormality.
A Population-Based Study of the 22q11.2 Deletion: Phenotype, Incidence, and Contribution to Major Birth Defects in the Population
Authors: Botto Lorenzo D. , May Kristin , Fernhoff Paul M. , Correa Adolfo , Coleman Karlene , Rasmussen Sonja A. , Merritt Robert K. , O’Leary Leslie A. , Wong Lee-Yang , Elixson E. Marsha , Mahle William T. , Campbell Robert M. 
Published: August 2004

Objectives. Although several studies describe the 22q11.2 deletion, population-based data are scant. Such data are needed to evaluate properly the impact, distribution, and clinical presentation of the deletion in the population. Our goals were to assess the population-based birth prevalence of the 22q11.2 deletion and its associated phenotype and its impact on the occurrence of heart defects.
Methods. We evaluated data on infants who were born from 1994 through 1999 to women who resided in metropolitan Atlanta. We matched records from the Metropolitan Atlanta Congenital Defects Program (a population-based registry with active case ascertainment), the Sibley Heart Center at Children’s Healthcare of Atlanta, and the Division of Medical Genetics at Emory University. We used birth certificate data for the denominators of the rates.
Results. We identified 43 children with laboratory-confirmed 22q11.2 deletion among 255 849 births. The overall prevalence was 1 in 5950 births (95% confidence interval: 1 in 4417 to 1 in 8224 births). The prevalence was between 1 in 6000 and 1 in 6500 among whites, blacks, and Asians and 1 in 3800 among Hispanics. Most affected children (81%) had a heart defect, and many (1 in 3) had major extracardiac defects (other than velopalatal anomalies), including anomalies of the central nervous system. Overall, the deletion contributed to at least 1 of every 68 cases of major heart defects identified in the total birth cohort and, in particular, to 1 of every 2 cases diagnosed with interrupted aortic arch type B, 1 of every 5 with truncus arteriosus, and 1 of every 8 with tetralogy of Fallot.
Conclusions. The 22q11.2 deletion was common in this birth population. The clinical phenotype included a wide and variable spectrum of major cardiac and extracardiac anomalies. From these population-based data, one can estimate that at least 700 affected infants are born annually in the United States. Population-based estimates such as these should be useful to medical professionals and policy makers in planning for the optimal care of people with the 22q11.2 deletion.
Comparison of Propofol/Fentanyl Versus Ketamine/Midazolam for Brief Orthopedic Procedural Sedation in a Pediatric Emergency Department
Authors: Godambe Sandip A. , Elliot Vanessa , Matheny Dana , Pershad Jay 
Published: August 2004

Purpose. To compare the effectiveness of 2 medication regimens, propofol/fentanyl (P/F) and ketamine/midazolam (K/M), for brief orthopedic emergency department procedural sedation. This study was powered to compare recovery times (RT) and procedural distress as measured by the Observational Score of Behavioral Distress-revised (OSBD-r; range: 0–23.5 with 23.5 representing maximal distress).Methods. We conducted a prospective, partially-blinded controlled comparative trial comparing intravenous P/F with K/M in a convenience sample of 113 patients aged 3 to 18 years old undergoing orthopedic procedural sedation. All medications were administered by the intermittent intravenous bolus method. An independent sedation nurse recorded total sedation time and RT. Effectiveness was measured using 6 parameters: 1) patient distress as assessed by independent blinded observers after videotape review using the OSBD-r; 2) orthopedic satisfaction score (Likert scale 1–5); 3) sedation nurse satisfaction score (Likert 1–5); 4) parental perception of procedural pain using a 0 to 100 mm Visual Analog Scale with the upper limit being “most pain”; 5) patient recall of the procedure; and 6) 1 to 3 week follow-up.Results. RT and total sedation time were significantly less in the P/F group than in the K/M group (33.4 minutes vs 23.2 minutes). The mean OSBD-r scores during manipulation were 0.084 and 0.278 for the K/M and P/F groups, respectively. Although this difference was statistically significant (95% confidence interval for the mean difference −0.34 to −0.048), both regimens were successful in keeping the scores low. There was no statistical difference between the groups in the other measures of effectiveness. There was a statistically significant difference between the groups in the occurrence of desaturation and late side effects.Conclusions. RT with P/F is shorter than with K/M. P/F is comparable to K/M in reducing procedural distress associated with painful orthopedic procedures in the pediatric emergency department. Although propofol has a greater potential of respiratory depression and airway obstruction as compared with ketamine, it offers some unique advantages including a quicker offset and smoother recovery profile.
Appropriateness of Admissions and Days of Stay in Pediatric Wards of Italy
Authors: Bianco Aida , Pileggi Claudia , Trani Francesca , Angelillo Italo F. 
Published: August 2004

Objective. The objective of this study was to measure inappropriateness of admission and inpatient days in pediatric hospital wards in Catanzaro, Italy, and the effect of different variables on such inappropriateness.Design. A retrospective application was made using the Pediatric Appropriateness Evaluation Protocol list of criteria. For each patient, there were recorded data on: sociodemographic characteristics; distance from home to hospital; date, day of the week, ward, and type of admission; overall and pre-index day length of hospital stay; and location within the stay of the day reviewed.Results. A total of 656 children were reviewed. Overall, 30% of the hospital admissions and 55.5% of days of stay were judged to be inappropriate; for about one third of those admitted inappropriately, the hospital stay was judged to be appropriate. Multiple logistic regression analysis indicated that the inappropriate admission was significantly higher if the admission occurred during the daytime. The inappropriate number of days of hospitalization was significantly higher if the patient was female, if the admission was urgent, in medical wards, for patients who were inappropriately admitted, and for those sampled close to discharge. The main reasons for inappropriate use were hospital organization and an over-cautious physician in the management of a patient.Conclusions. The high degree of inappropriate admission or days of stay in pediatric wards and the reasons for such unnecessary hospital use suggest the need for a more vigilant interaction between hospital and community-based services to mitigate such inappropriateness and for a continuing education system to define standardized guidelines.