bluuebunny/crossref_metadata_2025_split huggingface dataset:
Formula Supplementation With Long-chain Polyunsaturated Fatty Acids: Are There Developmental Benefits?
Authors: Scott David T. , Janowsky Jeri S. , Carroll Robin E. , Taylor James A. , Auestad Nancy , Montalto Michael B. 
Published: August 2004

Objective.
To evaluate the developmental outcomes of children who participated in an augmented randomized clinical trial of supplementing a standard infant formula with long-chain polyunsaturated fatty acids.

Design.
Randomized clinical trial, augmented with a nonrandomized human milk comparison group. There were three randomized formula groups: standard formula, standard formula containing docosahexaenoic acid (DHA), and standard formula containing DHA and arachidonic acid.

Setting.
Three clinical sites serving diverse populations: Kansas City, MO; Portland, OR; and Seattle, WA.

Participants.
A total of 274 healthy full-term infants were enrolled in the infant-feeding protocol; of these, 197 (72%) participated in assessments of developmental outcome.

Formula Supplements.
In the randomized trial, one group received a standard formula, another group received a formula that had been supplemented with DHA from fish oil, and a third group received a formula supplemented with both DHA and arachidonic acid from an egg phospholipid.

Outcome Measures.
Mental and Motor Scales of the Bayley Scales of Infant Development at 12 months of age; vocabulary and gesture communication scores from the MacArthur Communicative Development Inventories at 14 months of age.

Results.
There were no statistically significant differences for either the Bayley Mental Scale or the Bayley Motor Scale, neither when the analysis was restricted to the three randomized formula groups nor when the analysis included all four groups. However, the DHA formula group had significantly lower scores on two of the MacArthur scales: the DHA group scored lower than the nonrandomized human milk comparison group on the Vocabulary Comprehension Scale, and the DHA group scored lower than the randomized control formula group on the Vocabulary Production Scale. Moreover, additional analyses both in the formula groups and in the human milk comparison group found significant negative correlations between DHA levels and vocabulary outcomes.

Conclusion.
We believe that additional research should be undertaken before the introduction of these supplements into standard infant formulas.
Pediatric Research in Office Settings (PROS): A National Practice-Based Research Network to Improve Children's Health Care
Authors: Wasserman Richard C. , Slora Eric J. , Bocian Alison B. , Fleming Gretchen V. , Baker Alison E. , Pedlow Steven E. , Kessel Woodie 
Published: August 2004

Objectives.To describe the establishment of a national pediatric primary care research network to improve children's health care—Pediatric Research in Office Settings (PROS), and to evaluate the network's progress toward achieving its objectives.Setting.Pediatric practices in all 50 states and Puerto Rico.Participants.Approximately 1400 pediatric practitioners from more than 470 practices.Results.Beginning in 1986, a core of volunteer pediatrician coordinators from participating American Academy of Pediatrics chapters were identified to oversee local PROS efforts, represent practitioners, and inform the development of proposed research studies. PROS subsequently recruited practitioners from around the country, building a research infrastructure and a system of collaboration between the practitioners, research staff at the AAP, and investigative teams at academic institutions. This PROS collaboration has developed and conducted 10 primary care research studies that have added to the knowledge base of pediatric primary care.Conclusions.PROS has accomplished two of its initial objectives—development of a structure and process for pediatric practice-based research and provision of research experience to practitioners. Successful and consistent achievement of a third objective—meaningful dissemination of study results to relevant audiences—will depend on meeting several challenges. primary care, health services research, child health, ambulatory care.
The Effect of Handling and Immobilization on the Response to Acute Pain in Newborn Infants
Authors: Porter Fran Lang , Wolf Cynthia M. , Miller J. Philip 
Published: August 2004

Background.
Previous reports have suggested that healthy, full-term newborn infants who are in more aroused behavioral states tend to respond more robustly to painful events. Others have shown that acutely ill premature and full-term infants who undergo significant handling and immobilization as part of required nursery procedures respond less robustly to concurrent painful events.

Purpose.
To investigate, using an experimental manipulation, the effect of arousal associated with handling and immobilization on response to acute pain in generally healthy, premature and full-term newborn infants.

Methods.
Infants were randomly assigned to a group that underwent a series of handling and immobilization procedures before a heelstick or to a group that underwent the heelstick without previous handling and immobilization. Heart rate, behavioral state, and facial activity were compared between the handled (n = 21) and nonhandled (n = 27) infants during an undisturbed baseline, a preparatory, and a standard heelstick procedure.

Results.
In the handled group, heart rate increased over baseline levels in response to the handling but promptly returned to prehandling levels. There were no significant differences between handled and nonhandled groups in mean heart rate, behavioral state, or facial activity during the baseline or preparatory periods before the heelstick. However, in response to the heelstick, handled infants had a higher mean heart rate, greater behavioral arousal, and displayed more facial activity as compared with nonhandled infants.

Conclusions.
Healthy premature and full-term newborn infants who undergo common nursery experiences such as handling and immobilization as part of their routine care can exhibit greater physiologic and behavioral reactivity to subsequent painful procedures. The effects of the previous handling may be undetectable, using conventional indices of reactivity, until the painful event. These findings emphasize the importance of identifying reliable markers of previous stress, particularly for newborn infants who may become clinically compromised as a result of the physiologic instability associated with response to pain.
Changes in the Epidemiologic Profile of Sudden Infant Death Syndrome as Rates Decline Among California Infants: 1990–1995
Authors: Adams Elizabeth J. , Chavez Gilberto F. , Steen Donna , Shah Rugmini , Iyasu Solomon , Krous Henry F. 
Published: August 2004

Objectives.To evaluate changes in the rates and epidemiologic patterns of sudden infant death syndrome (SIDS) after implementation of public health campaigns to promote back sleeping and reduce exposure to cigarette smoke and environmental risk factors for SIDS.Methods.California vital statistics data were used to evaluate changes in SIDS rates (deaths/1000 live births) and in the proportions of SIDS deaths by age and season of occurrence for California infants of black or other races from 1990 through 1995.Results.From 1990 through 1995, 3508 SIDS deaths occurred. SIDS rates declined from 2.69 to 2.15 for black infants and from 1.04 to 0.61 for others between 1990 and 1995. Most SIDS deaths occurred during the 2nd to 4th months of life; the proportion of SIDS deaths during this period was unchanged for blacks but decreased for others from 70% to 65%. Of all SIDS deaths, 62% occurred during the colder season (October through March); the proportion of deaths in each season did not change for either race.Conclusion.California SIDS rates declined 20% for blacks and 41% for others between 1990 and 1995. Declines coincided with campaigns to reduce environmental risk factors for SIDS. Blacks continue to be at increased risk for SIDS compared with others, and the SIDS rate for blacks relative to others has increased. Reductions in SIDS mortality coinciding with interventions were smaller for blacks than for others. New strategies are needed to reduce further SIDS rates and narrow the gap between blacks and others.
A New Pattern of Cerebellar Hemorrhages in Preterm Infants
Authors: Merrill Jeffrey D. , Piecuch Robert E. , Fell Sean C. , Barkovich A. James , Goldstein Ruth B. 
Published: August 2004

Objective.
Posterior fossa hemorrhages may be underdiagnosed in surviving neonates, with cerebellar hemorrhage discovered in 10% to 25% of autopsy specimens from very low birth weight infants. Posterior fossa lesions have been difficult to visualize by the traditional ultrasonography approach through the anterior fontanelle. Late in 1994, routine posterior fossa imaging through the posterolateral fontanelle was instituted to improve the ultrasonographic visualization of the posterior fossa in neonates.

Methods.
Infants identified with posterior fossa hemorrhage by cranial ultrasonography between 1994 and 1996 were followed prospectively through discharge and their clinical courses reviewed. Infants diagnosed with posterior fossa hemorrhage between 1991 and 1994 were identified retrospectively from a comprehensive radiology database to use in comparison. All infants surviving to discharge were entered into neurodevelopmental follow-up using standard developmental assessments.

Results.
Approximately 525 infants underwent cranial sonography during the study period between October 1994 and September 1996, including 250 infants weighing &lt;1500 g. Thirteen infants were identified with posterior fossa hemorrhage using the posterolateral fontanellar approach. In contrast, only 2 infants were identified with posterior fossa hemorrhage between 1991 and 1994 using traditional anterior fontanellar views. Six very low birth weight infants were identified with cerebellar hemorrhages not associated with supratentorial, intraventricular hemorrhage. Each hemorrhage had a clinically silent presentation and, in 5 infants, was not well-appreciated by anterior fontanellar images. Magnetic resonance imaging studies were performed on 5 of the 6 infants and confirmed a cerebellar lesion in the area of previous echo density on ultrasonography. No infant is exhibiting motor abnormalities on neurologic examination, although 4 infants are demonstrating cognitive, developmental delay. Follow-up, however, is limited to a corrected age of ≤48 months.

Discussion.
Cerebellar hemorrhage is an underrecognized and poorly visualized complication in preterm infants. Consistent imaging via the posterolateral fontanelle may demonstrate cerebellar hemorrhage missed by the anterior fontanellar approach. Cerebellar hemorrhage in low birth weight infants may be clinically silent and not associated with a significant supratentorial hemorrhage. These infants may survive to discharge. Long-term neurodevelopmental follow-up is necessary to establish the ultimate outcome of these infants. Future prospective study, using posterolateral fontanellar imaging, may elucidate further the pathophysiology of cerebellar hemorrhage in low birth weight infants.
Musculoskeletal Pain in Primary Pediatric Care: Analysis of 1000 Consecutive General Pediatric Clinic Visits
Authors: de Inocencio Jaime 
Published: August 2004

Objectives.1) To determine the number of primary care clinic visits attributable to musculoskeletal pain (MSP) in children ≥3 and &lt;15 years of age. 2) To describe the demographic characteristics of this population assessed for limb/back pain. 3) To characterize the etiology of musculoskeletal pain in an urban general pediatric clinic in Madrid, Spain.Methods.Prospective evaluation of 1000 consecutive clinic visits to an urban general pediatric clinic. Inclusion criteria were 1) age ≥3 and &lt;15 years and 2) musculoskeletal evaluation requested by the family or patient. All consultations related to MSP were recorded via standard protocol and data record form.Results.During the study period, 61 of 1000 (6.1%; confidence interval: 4.6–7.5) clinic visits for children ≥3 and &lt;15 years were related to MSP. Patients' age, mean ± SD, was 9.7 ± 3.3 years. Musculoskeletal complaints were more frequent in boys (57.4%), although there was no statistical difference. The presenting complaints included knee arthralgias in 33%; other joint (eg, ankles, wrists, elbows) arthralgias in 28%; soft tissue pain in 18%; heel pain in 8%; hip pain in 6%; and back pain in 6%. Symptoms were attributable to trauma in 30%; overuse syndromes in 28% (eg, chondromalacia patellae, mechanical plantar fasciitis, overuse muscle pain); and normal skeletal growth variants (eg, Osgood–Schlatter syndrome, hypermobility, Sever's disease) in 18% of patients.Conclusion.MSP represents a frequent presenting complaint in general pediatric practice. A new heightened awareness of the frequent occurrence of MSP should be adopted when designing pediatrics continuing medical education and training programs. musculoskeletal pain, limb pain, arthralgia, children, general pediatrics, pediatric primary care.
Results of the Nationwide Epidemiologic Survey of Kawasaki Disease in 1995 and 1996 in Japan
Authors: Yanagawa Hiroshi , Nakamura Yosikazu , Yashiro Mayumi , Ojima Toshiyuki , Tanihara Shinichi , Oki Izumi , Zhang Tuohong 
Published: August 2004

Objective.The objective of the study is to describe recent epidemiologic patterns of Kawasaki disease based on information included in patient records that had been obtained through a nationwide hospital survey in Japan.Methods.A questionnaire and diagnostic criteria for Kawasaki disease that had been approved by the Kawasaki Disease Research Committee were sent to all pediatric departments of hospitals (2638 hospitals) with a bed capacity of at least 100. The subjects all were new patients who were treated during a 2-year period from 1995 to 1996.Results.A total of 12 531 children contracted the disease during the observation period. The incidence was 102.6 for 1995 and 108.0 for 1996 per 100 000 children younger than age 5 years. The male:female ratio was 1.37. The age distribution pattern showed a peak near 6 months of age. Geographic variations in the incidence suggested the existence of local outbreaks. Cardiac sequelae were seen in 12% of the patients.Conclusion.More than 6000 patients suffered from Kawasaki disease each year, and its annual incidence is increasing steadily. The probable existence of local outbreaks is worthy of note. Other epidemiologic patterns were unchanged from previous years.
One-Year Follow-up of Symptoms of Gastroesophageal Reflux During Infancy
Authors: Nelson Suzanne P. , Chen Edwin H. , Syniar Gina M. , Christoffel Katherine Kaufer ,   for the Pediatric Practice Research Group
Published: August 2004

Objectives.1) Determine what percentage of infants outgrow regurgitation over 1 year. 2) Determine whether they develop feeding or mealtime problems. 3) Determine whether they develop frequent respiratory illnesses, including ear, sinus, and upper respiratory infections, or wheezing episodes.Design.One-year follow-up survey of parents of children identified at 6 to 12 months of age as those who regurgitate (case subjects) and matched control subjects.Participants.Sixty-three case subjects and 92 control subjects attending 12 different (urban, suburban, and rural) practices in the Pediatric Practice Research Group in the Chicago area.Primary Outcome Measures.The Infant Gastroesophageal Reflux Questionnaire–Shortened and Revised Form and the Children's Eating Behavior Inventory (CEBI).Results.At 1-year follow-up, no parents of case or control subject described spitting up as currently a problem. The parent of only one control subject (and no case subject) reported spitting up one or more times a day. Parents of subjects were more likely than those of control subjects to report frequent feeding refusal: odds ratio = 4.2, adjusted by age (95% confidence interval: 1.4–12.0). Case and control subjects had comparable average total CEBI scores (case subjects, x̄ = 83 ± 10 vs control subjects, x̄ = 82 ± 11) and comparable average proportion of items identified as a problem (8% ± 11% case subjects vs 6% ± 9% control subjects). Case subjects were more likely to respond positively to two CEBI questions indicating specific feeding problems: 1) “my child takes more than an hour to eat his/her meals” (8% case subjects vs 0% control subjects) and 2) “I get upset when I think about our meals” (14% case subjects vs 4% control subjects). The frequencies of ear, sinus, and upper respiratory infections and of episodes of wheezing were comparable in both groups.Conclusions.1) Infants with daily or problematic regurgitation at 6 to 12 months of age outgrew this within the following year. 2) Infants with daily or problematic regurgitation were more likely to develop feeding problems. 3) There was no increase in respiratory illnesses in infants with a history of regurgitation.
Inborn Errors of Metabolism in Infancy: A Guide to Diagnosis
Authors: Burton Barbara K. 
Published: August 2004

Recent advances in the diagnosis and treatment of inborn errors of metabolism have improved substantially the prognosis for many of these conditions. This makes it essential that the practicing pediatrician be familiar with the clinical presentation of these disorders. A practical clinical approach to the recognition of inborn errors of metabolism in the young infant is presented in this review. Indications for specific laboratory studies are discussed. Guidelines are provided for the stabilization and emergency treatment of critically ill infants. This approach will identify those infants who will benefit from additional evaluation and specific treatment.
Many of the inborn errors of metabolism, including urea cycle defects, organic acidemias, and certain disorders of amino acid metabolism, present in the young infant with symptoms of an acute or chronic metabolic encephalopathy. Typical symptoms include lethargy, poor feeding, apnea or tachypnea, and recurrent vomiting. Metabolic acidosis and/or hyperammonemia are observed in many of these conditions, but there are notable exceptions, including nonketotic hyperglycinemia and molybdenum co-factor deficiency. Therefore, appropriate laboratory testing for metabolic disorders should be performed in any infant who exhibits these findings. Although sepsis may be the initial consideration in a neonate with these symptoms, inborn errors of metabolism should always be in the differential diagnosis, particularly in a full-term infant with no specific risk factors.
Hypoglycemia may be the predominant finding in a number of inborn errors of metabolism, including glycogen storage disorders, defects in gluconeogenesis, and fatty acid oxidation defects. The latter disorders, among the most common encountered, exhibit marked clinical variability and also may present as a sudden death, a Reye's-like episode, or a cardiomyopathy. Jaundice or other evidence of hepatic dysfunction is the mode of presentation of another important group of inborn errors of metabolism including galactosemia, hereditary tyrosinemia, neonatal hemochromatosis, and a number of other conditions. A subset of lysosomal storage disorders may present very early with coarse facial features, organomegaly, or even hydrops fetalis. Specific patterns of dysmorphic features and congenital anomalies characterize yet another group of inherited metabolic disorders, such as Zellweger syndrome and the Smith–Lemli–Opitz syndrome. Each of these symptom complexes, and the appropriate evaluation of the affected infants, is discussed in more detail in this review.
Charges for Childhood Asthma by Hospital Characteristics
Authors: Meurer John R. , Kuhn Evelyn M. , George Varghese , Yauck Jennifer S. , Layde Peter M. 
Published: August 2004

Background.The ownership, location, and teaching status of hospitals affect their missions, policies, finances, and operations.Objective.This study assesses the relationship of hospital ownership, location, and teaching status with charges and length of stay for children with asthma, the most common reason for pediatric admission after birth.Methods.All 28 545 complete records of patients ≤18 years of age with the principal diagnosis asthma in 1994 were extracted from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, providing a stratified sample of 735 nonfederal, acute-care hospitals in 17 states. Multiple regression analysis on log transformed data was used to calculate mean total charges and average length of stay (ALOS) after adjusting for illness severity and mortality risk (four All Patient Refined–Diagnosis Related Group classes based on secondary diagnoses and procedures); payer (Medicaid, private, uninsured, other); patient age, sex, income (four categories based on ZIP code of residence); state; bed size (three categories varying by location); hospital ownership; location; teaching status; and admission month.Results.Asthma severity did not differ significantly by hospital location or teaching status. Nonprofit hospitals treated a slightly higher proportion of children with major or extreme severity asthma than either public or for-profit hospitals. Urban teaching hospitals treated more children with asthma who lived in low-income neighborhoods, were uninsured, or received Medicaid coverage than urban nonteaching hospitals. For-profit hospitals admitted fewer children with asthma from low-income areas than did public hospitals. The ALOS was 2.5 days and did not differ significantly by hospital ownership, location, or teaching status. However, the mean total charges, after adjusting for all other significant covariates, was higher at for-profit ($4203) than at nonprofit ($3640) or public hospitals ($3620). Average charges also were higher at urban teaching ($4230) and lower at rural institutions ($2910) compared with urban nonteaching hospitals ($3424).Conclusions.Despite similar ALOS, mean charges for childhood asthma varied significantly by hospital ownership, location, and teaching status.Implications.Additional clinical and outpatient data are needed to study variations in quality of care by hospital characteristics. With the proliferation of investor-owned hospitals, both the reasons for and the impact of higher average charges at for-profit institutions require additional investigation. With the expanding needs of the medically underserved, socially just policies are required for financing hospitals that care for a disproportionate share of economically disadvantaged children.