bluuebunny/crossref_metadata_2025_split huggingface dataset:
Community-Acquired Methicillin-Resistant Staphylococcus aureus in Southern New England Children
Authors: Dietrich Dinusha W. , Auld Dianne B. , Mermel Leonard A. 
Published: August 2004

Objective. This study was performed to understand the epidemiology of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in southern New England children.
Methods. A retrospective review was conducted of the medical records of children 0 to 18 years old with MRSA isolated by the Rhode Island Hospital microbiology laboratory (Providence, RI) between 1997 and 2001. A case was classified as either health care-associated MRSA (HCA-MRSA) or CA-MRSA based on time of culture and other strict criteria. The spectrum of illness of the HCA-MRSA and CA-MRSA cases was compared, as were the antibiotic-susceptibility patterns of their isolates. Risk factors for CA-MRSA acquisition were identified, and molecular subtyping of selected isolates was performed.
Results. Between 1997 and 2001, S aureus was isolated from 1063 children. Of these children, 57 had MRSA. During this period, both the absolute number of MRSA cases and the proportion of S aureus cases due to MRSA rose more than threefold due to increases in both CA-MRSA and HCA-MRSA infections. Of the 57 MRSA cases, 23 (40%) were CA-MRSA. CA-MRSA patients were more likely to have skin/soft-tissue infections than HCA-MRSA patients (83% vs 38%). Risk factors for acquisition of MRSA including intrafamilial spread, frequent antibiotic exposure, and child-care attendance were identified in 8 of the 23 (35%) CA-MRSA patients. CA-MRSA isolates were more likely to be susceptible to non-β-lactam antibiotics than HCA-MRSA isolates. All isolates were vancomycin susceptible.
Conclusions. MRSA accounts for an increasing proportion of all pediatric S aureus infections in southern New England. A significant percentage of these cases are due to CA-MRSA. Pediatricians should have heightened suspicion for CA-MRSA in children with presumed S aureus infections, especially if they have skin/soft-tissue infections or risk factors for MRSA acquisition.
Cerebellar Infarction in Adolescent Males Associated With Acute Marijuana Use
Authors: Geller Thomas , Loftis Laura , Brink David S. 
Published: August 2004

Objective. To demonstrate the clinical characteristics, radiologic findings, and neuropathological features of tetrahydrocannabinol-related posterior fossa ischemic stroke in adolescent patients.Design. A retrospective case and chart review of 3 cases encountered at a tertiary care institution over a span of 5 years.Setting. Inpatient and intensive care hospitalization units managing children and adolescents.Subjects. Male adolescent patients with ischemic cerebellar stroke after use of marijuana.Diagnostic Investigations. Computed tomography brain scans (3 subjects), magnetic resonance imaging brain study (1 subject), cerebral arteriography (1 subject), cerebellar biopsy (1 subject), and necropsy (2 subjects).Results. Three adolescent males had similar presentations of headache, fluctuating level of consciousness or lethargy, visual disturbance, and variable ataxia after self-administration of marijuana. They developed primary cerebellar infarctions within days after the exposure that could not be attributed to supratentorial herniation syndromes and only minimally involved brainstem structures.Conclusions. Episodic marijuana use may represent a risk factor for stroke in childhood, particularly in the posterior circulation. Early recognition of the cerebellar stroke syndrome may allow prompt neurosurgical intervention, reducing morbidity.
Extremely Elevated Relative Risk of Paraffin Lamp Oil Exposures in Orthodox Jewish Children
Authors: Hoffman Robert J. , Morgenstern Solomon , Hoffman Robert S. , Nelson Lewis S. 
Published: August 2004

Background. In observance of the Sabbath and other religious holidays, many Orthodox Jews maintain a burning lamp that uses paraffin lamp oil as fuel. Unintentional pediatric exposure to paraffin lamp oil, a hydrocarbon, is typically by ingestion and carries a risk of aspiration with subsequent pneumonitis. This investigation was prompted by an apparent increase in paraffin lamp oil exposures during the Jewish Sabbath, from sunset Friday until sunset Saturday, noted by the staff of our regional poison control center.Objective. In this investigation, we retrospectively reviewed all exposures to paraffin lamp oil occurring in our large city in children &lt;18 years old reported to our regional poison control center between January 1, 2000, and February 1, 2003. Reports were investigated to ascertain the frequency of occurrence of paraffin lamp oil exposures on the Jewish Sabbath and Jewish religious holidays. Caregivers of involved children were surveyed by telephone to determine the exposed child’s religion and circumstances of exposure.Results. During these 25 months, 45 cases met inclusion criteria, and all were ingestions. Orthodox Jews accounted for 32 cases (71%), 4 cases (9%) occurred in children who were not Orthodox Jews, and demographic data were unavailable in 9 cases (20%). Twenty-four cases (53%) occurred within 10 hours before or during the Jewish Sabbath or Jewish religious holidays. The relative risk of Orthodox Jewish children to ingest paraffin lamp oil, calculated by using census data, is 374 times that of other children.Conclusions. Public health authorities and caregivers of Orthodox Jewish children should be cognizant of this phenomenon. Educational efforts directed toward both Orthodox Jews and the general public aimed at preventing paraffin lamp oil exposures are warranted.
Are Complete Blood Cell Counts Useful in the Evaluation of Asymptomatic Neonates Exposed to Suspected Chorioamnionitis?
Authors: Jackson Gregory L. , Engle William D. , Sendelbach Dorothy M. , Vedro Debra A. , Josey Sue , Vinson Jodi , Bryant Carol , Hahn Gary , Rosenfeld Charles R. 
Published: August 2004

Objective. Chorioamnionitis complicates 1% to 10% of pregnancies and increases the risk of neonatal infection. Women with chorioamnionitis receive intrapartum antibiotics, often resulting in inconclusive neonatal blood cultures. Peripheral neutrophil values are used frequently to assist in the diagnosis of neonatal infection and to determine duration of antibiotics; we sought to determine the utility of this approach.
Methods. A prospective observational study was performed in 856 near-term/term neonates who were exposed to suspected chorioamnionitis. Each received antibiotics for 48 hours unless clinical infection or positive blood cultures occurred. Peripheral neutrophils were measured serially and analyzed using the reference ranges of Manroe et al; an additional analysis of only the initial neutrophil values used the normal ranges of Schelonka et al. Results of neutrophil analyses were not used to determine duration of therapy. Fifty percent of asymptomatic neonates were seen postdischarge to ascertain recurrent infection. Local patient charges were examined.
Results. Ninety-six percent of neonates were asymptomatic and had negative cultures, and antibiotics were discontinued at 48 hours. A total of 2427 neutrophil counts were analyzed. Although abnormal neutrophil values were more frequent in infected or symptomatic neonates, 99% of asymptomatic neonates had ≥1 abnormal value. The specificity and negative predictive values for abnormal neutrophil values ranged between 0.12 and 0.95 and 0.91 and 0.97, respectively; sensitivity was 0.27 to 0.76. Significant differences in interpretation of the initial neutrophil values were noted, depending on the normal values used. Follow-up was performed for 373 asymptomatic neonates until 3 weeks’ postnatal age. Eight required rehospitalization; none had evidence of bacterial infection. If neutrophil values had been used to determine duration of antibiotics, then local costs would have increased by $76 000 to $425 000 per year.
Conclusions. Single or serial neutrophil values do not assist in the diagnosis of early-onset infection or determination of duration of antibiotic therapy in asymptomatic, culture-negative neonates who are ≥35 weeks’ gestation and are delivered of women with suspected chorioamnionitis.
To Tap or Not to Tap: High Likelihood of Meningitis Without Sepsis Among Very Low Birth Weight Infants
Authors: Stoll Barbara J. , Hansen Nellie , Fanaroff Avroy A. , Wright Linda L. , Carlo Waldemar A. , Ehrenkranz Richard A. , Lemons James A. , Donovan Edward F. , Stark Ann R. , Tyson Jon E. , Oh William , Bauer Charles R. , Korones Sheldon B. , Shankaran Seetha , Laptook Abbot R. , Stevenson David K. , Papile Lu-Ann , Poole W. Kenneth 
Published: August 2004

Context. Neonatal meningitis is associated with significant morbidity and mortality. We speculated that meningitis may be underdiagnosed among very low birth weight (VLBW) infants because of the failure to perform lumbar punctures (LPs) in infants with suspected sepsis.Objective. This study was undertaken to review the epidemiology of late-onset meningitis in VLBW (401–1500 g) infants and to evaluate the concordance of cerebrospinal fluid (CSF) and blood culture (BC) results.Methods. VLBW infants (excluding those with intraventricular shunts) born at centers of the National Institute of Child Health and Human Development Neonatal Research Network from September 1, 1998, through December 31, 2001, were studied. Late-onset meningitis was defined by culture-based criteria and classified as meningitis with or without associated sepsis. Unadjusted comparisons were made using χ2 tests and adjusted comparisons using regression models.Results. Of 9641 VLBW infants who survived &gt;3 days, 2877 (30%) had ≥1 LPs, and 6056 (63%) had ≥1 BC performed after day 3. One hundred thirty-four infants had late-onset meningitis (1.4% of all patients; 5% of those with an LP). Pathogens associated with meningitis were similar to those associated with sepsis. One third (45 of 134) of the infants with meningitis had negative BCs. Lower gestational age and prior sepsis increased risk for meningitis. Compared with uninfected infants, those with meningitis had a longer time on mechanical ventilation (28 vs 18 days), had longer hospitalizations (91 vs 79 days), were more likely to have seizures (25% vs 2%), and were more likely to die (23% vs 2%).Conclusions. Meningitis is a serious complication among VLBW infants, associated with increased severity of illness and risk of death. Of note, one third of the infants with meningitis had meningitis in the absence of sepsis. Because CSF cultures were performed only half as often as BCs, this discordance in blood and CSF culture results suggests that meningitis may be underdiagnosed among VLBW infants.
Associations Between Overweight and Obesity With Bullying Behaviors in School-Aged Children
Authors: Janssen Ian , Craig Wendy M. , Boyce William F. , Pickett William 
Published: August 2004

Objective. The prevalence of overweight and obesity in children is rising. Childhood obesity is associated with many negative social and psychological ramifications such as peer aggression. However, the relationship between overweight and obesity status with different forms of bullying behaviors remains unclear. The purpose of this article is to examine these relationships.
Methods. We examined associations between bullying behaviors (physical, verbal, relational, and sexual harassment) with overweight and obesity status in a representative sample of 5749 boys and girls (11–16 years old). The results were based on the Canadian records from the 2001/2002 World Health Organization Health Behaviour in School-Aged Children Survey. Body mass index (BMI) and bullying behaviors were determined from self-reports.
Results. With the exception of 15- to 16-year-old boys, relationships were observed between BMI category and peer victimization, such that overweight and obese youth were at greater relative odds of being victims of aggression than normal-weight youth. Strong and significant associations were seen for relational (eg, withdrawing friendship or spreading rumors or lies) and overt (eg, name-calling or teasing or hitting, kicking, or pushing) victimization but not for sexual harassment. Independent of gender, there were no associations between BMI category and bully-perpetrating in 11- to 14-year-olds. However, there were relationships between BMI category and bully-perpetrating in 15- to 16-year-old boys and girls such that the overweight and obese 15- to 16-year-olds were more likely to perpetrate bullying than their normal-weight classmates. Associations were seen for relational (boys only) and overt (both genders) forms of bully-perpetrating but not for sexual harassment.
Conclusions. Overweight and obese school-aged children are more likely to be the victims and perpetrators of bullying behaviors than their normal-weight peers. These tendencies may hinder the short- and long-term social and psychological development of overweight and obese youth.
The Effect of Prophylactic Ointment Therapy on Nosocomial Sepsis Rates and Skin Integrity in Infants With Birth Weights of 501 to 1000 g
Authors: Edwards William H. , Conner Jeanette M. , Soll Roger F. ,   for the Vermont Oxford Network Neonatal Skin Care Study Group
Published: August 2004

Objective. Extremely low birth weight infants have a high risk of developing nosocomial bacterial sepsis (NBS). Immature fragile skin may represent an inadequate protective barrier to bacteria colonizing the skin. We conducted a randomized, multicenter trial to determine whether prophylactic application of an emollient ointment would result in a lower incidence of death and/or NBS in the first 28 days of life, compared with routine skin care.Methods. Infants of birth weight 501 to 1000 g and gestational age ≤30 weeks were assigned randomly to receive generalized application of ointment twice a day through day 14 (prophylactic group [P]) or local application of ointment to the site of injury (routine skin care [R]). The study was conducted at 53 neonatal intensive care units that were members of the Vermont Oxford Network.Results. Included in the analysis were 1191 infants (P: 602; R: 589). No difference was found in the combined primary outcome of NBS or death (33.6% P vs 30.3% R; relative risk [RR]: 1.10; 95% confidence interval [CI]: 0.89, 1.27). The incidence of death was no different between the groups (10.8% P vs 12.1% R; RR: 0.87; 95% CI: 0.59, 1.25). More infants in the prophylactic group had NBS (25.8% P vs 20.4% R; RR: 1.26; 95% CI: 1.02, 1.54), predominantly in the lower birth weight infants (501–750 g) and for infections caused by coagulase-negative staphylococci. Infants in the prophylactic group had better skin condition on days 1 to 14 of life and less skin injury on days 15 to 28 of life. There was no difference between groups in other complications of prematurity.Conclusions. Prophylactic application of ointment did not lead to a difference in death and/or NBS in the first 28 days of life. There may be an increase in the risk of NBS associated with this practice.
Sleep Deprivation for Pediatric Sedated Procedures: Not Worth the Effort
Authors: Shields Cynthia H. , Johnson Sandi , Knoll Jeffery , Chess Cathy , Goldberg David , Creamer Kevin 
Published: August 2004

Objective. Sleep deprivation is commonly used to enhance the effectiveness of pediatric sedation and to decrease sedation failures. We reviewed our sedation database to evaluate the efficacy of sleep deprivation.Methods. The entire pediatric sedation unit database (n = 5640) was reviewed retrospectively. Patients without complete data sets were excluded. The remaining patients were separated into 2 groups: 3272 patients who underwent noninvasive procedures and 1210 who underwent invasive procedures. A subgroup of noninvasive procedure patients &lt;2 years old (n = 1398) was also analyzed. The sedation failure rate (%) and nursing care hours for both sleep-deprived and non-sleep-deprived patients were analyzed.Results. In the noninvasive procedure group, the sedation failure rate was 5.7% for the sleep-deprived patients and 5.6% for the non-sleep-deprived patients, whereas the sedation failure rate for children &lt;2 years old was 4.2% for sleep-deprived patients and 4.7% for non-sleep-deprived patients. The sedation failure rate in the invasive procedure group was 7.5% for sleep-deprived patients and 7.2% for non-sleep-deprived patients. Nursing care hours in the noninvasive procedure group were significantly longer for the sleep-deprived patients (4.5 ± 1.6 hours) versus the non-sleep-deprived patients (3.8 ± 1.6 hours). This finding was true also for the subgroup of children &lt;2 years old (sleep-deprived patients: 4.2 ± 1.4 hours; non-sleep-deprived patients: 3.5 ± 1.4 hours). No difference was noted in nursing care hours for the invasive procedure group.Conclusions. Sleep deprivation had no effect in reducing the pediatric sedation failure rate. The patients having noninvasive procedures who were sleep deprived required significantly more nursing care hours than their non-sleep-deprived counterparts. Routine use of sleep deprivation for pediatric sedation should be critically reevaluated.
Preterm Delivery, Level of Care, and Infant Death in Sweden: A Population-Based Study
Authors: Johansson Stefan , Montgomery Scott M. , Ekbom Anders , Olausson Petra Otterblad , Granath Fredrik , Norman Mikael , Cnattingius Sven 
Published: August 2004

Objective. To elucidate the role of level of care in combination with other perinatal risk factors for infant death in very preterm deliveries.Design. Population-based cohort study.Setting. Sweden, 1992–1998.Subjects. Singleton infants (2285) born at 24 to 31 completed weeks of gestation to primiparous women.Main Outcome Measure. Infant mortality.Results. The rate of infant mortality increased from 5% among infants born at 31 weeks’ gestation to 56% among infants born at 24 weeks’ gestation. Compared with infants born at university hospitals, the unadjusted odds ratio (OR) of infant death was 0.70 (95% confidence interval [CI]: 0.54–0.90) among infants delivered at general hospitals. However, after adjustment, the OR of infant death shifted to 1.33 (95% CI: 0.88–2.02) for preterm births at general hospitals. This shift was primarily due to different gestational age distributions in regional and general hospitals. Among infants born at 24 to 27 weeks’ gestation, infant mortality rates were 23% (87 deaths) in university hospitals and 32% (73 deaths) in general hospitals, giving an adjusted OR of 2.00 for general versus university hospitals (95% CI: 1.15–3.49). The risk of death at 24 to 27 weeks’ gestation in general hospitals was increased specifically in pregnancies with placental complications.Conclusion. Taking obstetric complications into account, there is an excess mortality risk among extremely preterm infants born at general hospitals.
Discipline in the African American Community: The Impact of Socioeconomic Status on Beliefs and Practices
Authors: Horn Ivor B. , Cheng Tina L. , Joseph Jill 
Published: August 2004

Objective. To describe and compare disciplinary beliefs and practices among African American parents from diverse socioeconomic backgrounds.Methods. A cross-sectional survey was conducted of self-identified African American parents of children &lt;48 months of age at 2 ambulatory teaching clinics, 2 community health centers, and 3 private practices in Washington, DC, and the surrounding metropolitan area. Disciplinary beliefs and practices of African American parents were measured.Results. A total of 175 of the 189 parents who were approached for the study completed the survey for a participation rate of 92.5%. Middle/upper socioeconomic status (SES) parents in this study were more likely to be married (60.9% vs 14.7%), older (31.4 years vs 25 years), and more educated (80% having attended at least some college vs 34.4%) than lower SES parents. There were no significant differences between middle/upper and lower SES parents with regard to their belief in a preferred disciplinary method (teaching, spanking, removing) or approach (positive, negative). Lower SES parents were more likely to endorse spanking a 1- to 3-year-old child if they were doing something that was not safe (90.5% vs 78.3%). Middle/upper SES parents were significantly more likely to reward their child for positive behavior than lower SES parents (66.1% vs 47.1%).Conclusions. Lower and middle/upper SES parents in this study population were reasonably similar with respect to disciplinary beliefs and practices. Exceptions to this generalization were that lower SES parents were more likely to endorse spanking as a response to an unsafe behavior on the part of the child, and middle/upper SES parents reported higher levels of reward for positive behavior.
Clinical Features of Children With Screening-Identified Evidence of Celiac Disease
Authors: Hoffenberg Edward J. , Emery Lisa M. , Barriga Katherine J. , Bao Fei , Taylor Jennifer , Eisenbarth George S. , Haas Joel E. , Sokol Ronald J. , Taki Iman , Norris Jill M. , Rewers Marian 
Published: August 2004

Objective. At-risk groups commonly undergo screening for autoantibodies associated with celiac disease (CD). However, the clinical significance of a positive test remains uncertain. The objective of this study was to evaluate growth and clinical features of children who test positive for an autoantibody associated with CD.Methods. A case-control study of Denver area healthy infants and young children with and without CD autoantibodies was conducted. A cohort of HLA-characterized children were followed prospectively since birth for the development of immunoglobulin A antitissue transglutaminase autoantibodies (TG). Clinical evaluation, questionnaire, blood draw, and small bowel biopsy were performed. Growth and nutrition and frequency of positive responses were measured.Results. Compared with 100 age- and gender-matched TG-negative controls, 18 TG-positive children, 5.5 ± 0.5 years of age, had a greater number of symptoms and lower z scores for weight-for-height and for body mass index. Responses that were independently associated with TG-positive status were irritability/lethargy, abdominal distention/gas, and difficulty with weight gain.Conclusions. Screening-identified TG-positive children demonstrate mild alterations in growth and nutrition and report more symptoms than control subjects. Additional study is needed on the benefit and risk of identifying CD in at-risk groups.
Immune Parameters and Morbidity in Hard Drug and Human Immunodeficiency Virus-xposed but Uninfected Infants
Authors: Neu Natalie , Leighty Robert , Adeniyi-Jones Samuel , Diaz Clemente , Handelsman Edward , Kaufman Gary , Paul Mary E. , Rich Kenneth , Mofenson Lynne , Pitt Jane ,   for the Women and Infants Transmission Study
Published: August 2004

Objective. To examine the association of maternal hard drug use (injection drugs, cocaine, and opiates) on lymphocyte subsets and clinical morbidity in uninfected infants who are born to human immunodeficiency virus-infected mothers who were enrolled in the Women and Infants Transmission Study (1990–2000).Methods. Maternal hard drug use was identified by self-report and/or urine toxicology. Infant evaluations occurred at birth and at 1, 2, 4, 6, 9, 12, 18, and 24 months of age.Results. A total of 401 (28%) of the 1436 uninfected infants were born to drug-using mothers. Maternal CD4 lymphocyte percentage and RNA at delivery were not significantly different between drug users and nonusers. Infants who were born to drug-using mothers had lower mean gestational age (37.8 vs 38.5 weeks) and birth weight (2.9 vs 3.1 kg). Infants with intrauterine drug exposure had lower CD4 lymphocyte percentage over the first 4 months of life after adjusting for covariates and higher natural killer lymphocyte percentage. When the analysis was stratified by time period of entry, the incidence of clinical events was not different between infants who were born to drug users versus nonusers.Conclusion. Maternal hard drug use is associated with immunologic changes in infants early in life, although these changes did not seem to be associated with increased risk of infections.