bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decreased Morning Serum Cortisol Levels in Children With Asthma Treated With Inhaled Fluticasone Propionate
Authors: Eid Nemr , Morton Ronald , Olds Bradley , Clark Pamela , Sheikh Shahid , Looney Stephen 
Published: August 2004

Objective. In an observational long-term study, we followed 62 children (37 males, 25 females; mean age: 11.6 ± 2.9 years) with moderate-to-severe asthma for 2 years and studied the effects of fluticasone propionate (176–1320 μg/day) on the function of the hypothalamic-pituitary-adrenal axis.
Study Design. Morning cortisol levels were monitored after patients had been on fluticasone for a mean of 8.0 ± 5.2 months. Patients who had abnormal low morning cortisol levels (&lt;5.5 μg/dL) were then switched either to lower fluticasone dosage or to other inhaled steroid formulation. Exact methods based on the binomial distribution were used to construct a 95% confidence interval for the true proportion of abnormal readings among those treated, and the Wilcoxon signed rank test was used to test for a significant difference between cortisol levels taken before and after the switch.
Results. Twenty-two patients (36%) had abnormal morning cortisol levels while on fluticasone. Of the patients on a low dose (176 μg/day), 17% had abnormal values, whereas 43% of patients on a high dose (≥880 μg/day) were abnormal. Patients with abnormal results (17/22) had their morning cortisol levels repeated 3 months after the switch. Thirteen of these patients (77%) had normal levels. A stratified analysis of the difference in morning cortisol levels before and after the switch showed significant increase in morning cortisol levels in the group receiving 440 μg/day or less of fluticasone (median difference: 5.25; confidence interval: 3.60–8.15), as well as in the group receiving 440 μg/day or more (median difference: 3.85; confidence interval: 1.00–7.60).
Conclusion. Inhaled fluticasone, even at conventional doses, may have greater effects on the adrenal function than previously recognized, but the clinical significance of this suppression still remains to be established.
A Longitudinal Assessment of Thyroid Hormone Concentrations in Preterm Infants Younger Than 30 Weeks’ Gestation During the First 2 Weeks of Life and Their Relationship to Outcome
Authors: Biswas Sumita , Buffery June , Enoch Helen , Bland J. Martin , Walters Dafydd , Markiewicz Michael 
Published: August 2004

Objective. This trial examined the effects of triiodothyronine (T3) and hydrocortisone on lung disease. We present here the placebo data as this provides a natural history of thyroid hormone changes in this group of very preterm infants. We also examined the relationship between thyroid hormone levels and the outcome death and ventilator dependence at 2 weeks.Methods. Plasma-free T3 (FT3), free thyroxine (FT4), total T3, total T4, and thyroid-stimulating hormone were measured prospectively in preterm infants who were &lt;30 weeks’ gestation during the first 14 days of life. The data were obtained from the placebo arm of a multicenter, randomized, double-blind, clinical trial of T3 and hydrocortisone, called the THORN Trial.Results. A total of 128 infants were recruited into the placebo group. The mean FT3 level at &lt;5 hours of age was 4.9 pmol/L and remained below this level. FT4 levels decreased from 15 pmol/L to 9.7 pmol/L at 7 days and then increased to 11.0 pmol/L by day 14. Total T3 and total T4 levels fell after 5 hours of age and reached a minimum on day 3. Thyroid-stimulating hormone levels fell markedly from 9.2 mU/L to 1.8 mU/L at 72 hours and then increased to approximately 4 mU/L. We found that all thyroid hormones but particularly FT3 and FT4 hormones were highly significantly related to outcome. The lower the hormone levels, the worse the outcome (death or ventilator dependence at 2 weeks of age).Conclusion. 1) Thyroid hormone levels in preterm infants &lt;30 weeks were much lower than in term infants, 2) the postnatal surge of thyroid hormones normally seen at 24 to 48 hours of age in term infants did not occur in our group of preterm infant, and 3) low FT3 and FT4 levels are associated with higher mortality and severity of lung disease.
Use of Hymenal Measurements in the Diagnosis of Previous Penetration
Authors: Berenson Abbey B. , Chacko Mariam R. , Wiemann Constance M. , Mishaw Clifford O. , Friedrich William N. , Grady James J. 
Published: August 2004

Objective. To determine the usefulness of measurements of the vaginal opening and amount of hymenal tissue present inferiorly and laterally in the diagnosis of vaginal penetration.Methods. The transhymenal diameters and the amount of tissue present between the hymenal edge and vestibule inferiorly at 6 o’clock and laterally at 3 o’clock and 9 o’clock were measured from photographs of 189 prepubertal children with a validated history of digital or penile penetration and 197 children who denied previous sexual abuse. Statistical analyses were conducted to compare the mean values and hymenal symmetry between groups as well as to determine the sensitivity and specificity of various cutoff points.Results. Comparison of the mean diameters demonstrated that children with a penetration history had a significantly larger transverse opening than nonabused children when examined in the knee-chest position (5.6 vs 4.6 mm). However, there was extensive overlap in measurements between the 2 groups. No significant differences were noted between groups in the size of the vertical diameter, the amount of tissue present inferiorly or laterally, or the symmetry of the hymen in either position. Children with previous penetration were more likely than nonabused children to have a horizontal opening measuring &gt;6.5 mm in the knee-chest position, but the sensitivity and specificity of this test were low (29% and 86%, respectively). Higher values had better specificity but very low sensitivity. Less than 1.0 mm of hymenal tissue was detected at 6 o’clock only in those with a history of penetration (100% specificity), but the sensitivity was low (1%–2%).Conclusion. Most hymenal measurements lack adequate sensitivity or specificity to be used to confirm previous penetration. Less than 1.0 mm of hymenal tissue at 6 o’clock was detected only in victims of abuse, but the usefulness of this test is limited by the rarity of this finding.
Risk Reduction in Pediatric Procedural Sedation by Application of an American Academy of Pediatrics/American Society of Anesthesiologists Process Model
Authors: Hoffman George M. , Nowakowski Rhonda , Troshynski Todd J. , Berens Richard J. , Weisman Steven J. 
Published: August 2004

Objective. Guidelines for risk reduction during procedural sedation from the American Academy of Pediatrics (AAP) and the American Society of Anesthesiologists (ASA) rely on expert opinion and consensus. In this article, we tested the hypothesis that application of an AAP/ASA-structured model would reduce the risk of sedation-related adverse events.Methods. Prospectively coded sedation records were abstracted by a hospital quality improvement specialist with practical and administrative experience in pediatric sedation. Process variables included notation of nulla per os (NPO) status, performance of a guided risk assessment, assignment of ASA physical status score, obtaining informed consent, generation of a sedation plan, and assessment of sedation level using a quantitative scoring system. Content variables included adherence to AAP NPO guidelines, ASA class, target sedation level, actual sedation level, age, procedure, and drugs used. Complication risk was assessed by logistic regression and Mantel-Haenszel odds ratios (OR).Results. Complications were identified in 40 of 960 records (4.2%). The complication rate was 34 of 895 (3.8%) with planned conscious sedation and 6 of 65 (9.2%) with planned deep sedation ([DS]; OR: 2.6). Complications were reduced by performance of structured risk assessment (OR: 0.10), adherence to all process guidelines (OR: 0), and avoiding actual DS (OR: 0.4). The only drug associated with higher risk was chloral hydrate (OR: 2.1). Failure to adhere to NPO guidelines did not increase risk in this assessment; however, the adverse event rate was 0 if all process guidelines were followed.Conclusions. Presedation assessment reduces complications of DS. Repeated assessment of sedation score reduces the risk of inadvertent DS. The data provide direct evidence that AAP/ASA guidelines can reduce the risk of pediatric procedural sedation.
Effect of Children on Home Smoking Restriction by Inner-City Smokers
Authors: Okah Felix A. , Choi Won S. , Okuyemi Kolawole S. , Ahluwalia Jasjit S. 
Published: August 2004

Objective. The home is the site of the most significant environmental tobacco smoke (ETS) exposure for children. Surveys show that adults, including smokers, agree that smoking should be restricted in homes of smokers with children. However, in a national survey, only 12.5% of such homes are actually smoke-free. This study examined factors associated with home smoking restriction among inner-city smokers.
Methods. A cross-sectional survey of 598 adult smokers who attended an inner-city community health center was conducted.
Results. Home smoking restriction was reported by 38.2% of all smokers (95% confidence interval [CI]: 33.6%–42.8%). Univariate analysis showed smoking restriction was positively associated with presence of children and of a nonsmoking adult partner in the home, intentional limiting of smoking, stages of change, and fewer number of cigarettes smoked daily. On multivariate analysis, home smoking restriction was more likely with the presence of a child (odds ratio: 2.63; 95% CI: 1.70–4.08) and a nonsmoking adult partner (odds ratio: 2.30; 95% CI: 1.32–4.02) in the home.
Conclusions. The presence of children and of nonsmoking adults is associated with the practice of smoking restriction in the homes of inner-city smokers. These findings suggest that inner-city smokers are concerned about health effects of ETS on children. Health professionals should target nonsmoking adult members of households with children and smokers but no home smoking restriction and emphasize the health effects of ETS on children as a motivation for smoking parents to limit exposure and to quit smoking.
Prenatal Prediction of Pulmonary Hypoplasia: Clinical, Biometric, and Doppler Velocity Correlates
Authors: Laudy Jacqueline A. M. , Tibboel Dick , Robben Simon G. F. , de Krijger Ronald R. , de Ridder Maria A. J. , Wladimiroff Juriy W. 
Published: August 2004

Objectives. To determine the value of pulmonary artery Doppler velocimetry relative to fetal biometric indices and clinical correlates in the prenatal prediction of lethal lung hypoplasia (LH) in prolonged (&gt;1 week) oligohydramnios.
Methods. Forty-two singleton pregnancies with oligohydramnios associated with premature rupture of membranes ([PROM]; n = 31) or bilateral renal pathology (n = 11) were examined using color-coded Doppler ultrasound in a cross-sectional study design. Mean gestational age was 28.0 ± 4.3 weeks (range: 20–36 weeks). Thoracic, cardiac, and abdominal circumference and the largest vertical amniotic fluid pocket were measured. Pulsed Doppler measurements of the arterial pulmonary branches were made at the level of the cardiac 4-chamber view. Diagnosis of LH was based on clinical, radiologic, and pathologic criteria. Clinicians were blinded to the prenatal measurements.
Results. The prevalence of lethal LH was 43%. In the PROM subset, combination of onset of PROM at ≤20 weeks, duration of oligohydramnios at ≥8 weeks, and degree of oligohydramnios at ≤1 cm presented the highest clinical prediction rate for lethal LH. For both the total group and the PROM subset, the highest prediction rate for lethal LH was presented by thoracic circumference/abdominal circumference ratio, peak systolic velocity in the proximal branch, and time-averaged and end-diastolic velocity in the middle branch of the pulmonary artery. In the PROM subset, the combination of all 3 clinical, biometric, and Doppler parameters revealed the most favorable combination to predict lethal LH (positive predictive value: 100%; accuracy: 93%; and sensitivity: 71%).
Conclusion. Doppler velocimetry may detect changes in pulmonary artery waveforms in the presence of LH but fails to be the ultimate test for the prenatal prediction of lethal LH. The best prediction can be achieved by combining clinical, biometric, and Doppler parameters.
Oral Rehydration, Emergency Physicians, and Practice Parameters: A National Survey
Authors: Ozuah Philip O. , Avner Jeffrey R. , Stein Ruth E. K. 
Published: August 2004

Background/Objective. Treatment of dehydrating gastroenteritis, a major cause of morbidity in children, remains controversial. Practice parameters issued by the American Academy of Pediatrics (AAP) recommend oral rehydration therapy (ORT) as the preferred treatment for losses from both mild and moderate dehydration. The objective of this study was to test the hypothesis that awareness of the AAP practice parameters would be associated with a higher rate of use of ORT among emergency physicians.Methods. A national random survey of emergency physicians selected from the mailing list of the AAP Section on Emergency Medicine was conducted. Respondents were asked about level of awareness of AAP guidelines and preferred route of rehydration for scenarios representing mild (≤5%), moderate (6%–9%), and severe (≥10%) dehydration. Respondents who were very familiar with the AAP practice parameters were designated as the familiar group; those who were less familiar were designated as the unfamiliar group. Differences in proportions of dichotomous variables were tested by χ2 or Fisher exact test as appropriate. Univariate logistic regression modeling was used to determine the independent influence of awareness of AAP guidelines on the use of ORT.Results. A total of 176 physicians responded (73% response rate). Most were board certified in 1 or more specialties: pediatrics (89%), pediatric emergency medicine (84%), and adult emergency medicine (63%). Median duration of practice was 16 years. Thirty-seven percent of respondents were very familiar with the AAP practice parameters. In contrast to the unfamiliar group, the familiar group was more likely to use ORT in scenarios of mild dehydration (81% vs 66%) and moderate dehydration (25% vs 10%). Logistic regression analysis confirmed that this familiar group overall was nearly 3 times more likely to use ORT (odds ratio: 2.85; 95% confidence interval: 2.46–3.24).Conclusions. This is the first national study to establish a relationship between awareness of the AAP practice parameters and physician practices in the treatment of dehydration. Emergency medicine physicians who were very familiar with the AAP parameters were significantly more likely to use ORT. These findings may have important implications for future efforts directed at increasing the rate of ORT use and for the evaluation of practice parameters in general.
A Randomized Trial of Moderately Early Low-Dose Dexamethasone Therapy in Very Low Birth Weight Infants: Dynamic Pulmonary Mechanics, Oxygenation, and Ventilation
Authors: Durand Manuel , Mendoza Maria E. , Tantivit Phuket , Kugelman Amir , McEvoy Cindy 
Published: August 2004

Objective. Dexamethasone is used in very low birth weight (VLBW) ventilator-dependent infants to prevent or decrease the severity of chronic lung disease. We reported a significant increase in respiratory compliance during a 7-day weaning course of moderately early dexamethasone therapy (0.5 mg/kg/d) in VLBW infants, along with a shorter duration of mechanical ventilation and O2 supplementation. Although 0.5 mg/kg/d has been the most commonly used dose in preterm infants, the use of a lower dose of dexamethasone may reduce potential adverse effects of steroid therapy. Quantification of dynamic pulmonary mechanics in VLBW infants who receive low-dose dexamethasone has not been reported. The objective of this study was to compare the effect of 2 dose regimens of dexamethasone on dynamic pulmonary mechanics, mean airway pressure (MAP), and fractional inspired oxygen concentration (Fio2) in intubated VLBW infants who were at risk for chronic lung disease.Methods. We studied 47 VLBW (birth weight: 550-1290 g; gestational age: 24–30 weeks) ventilator-dependent infants at 7 to 14 days of age. Twenty-three infants were randomized to receive dexamethasone at 0.5 mg/kg/d intravenously for 3 days (high dose), 0.25 mg/kg/d for 3 days, and 0.1 mg/kg/d during the 7th day; 24 infants received low-dose dexamethasone as 0.2 mg/kg/d for 3 days and 0.1 mg/kg/d for 4 days. Respiratory compliance (Crs) and resistance were measured before and on days 2, 5, and 7 of dexamethasone therapy. We recorded airway pressure, flow, and tidal volume, and mechanical breaths were analyzed.Results. Crs significantly increased during dexamethasone therapy in both groups of infants when compared with baseline (74% increase in the high-dose group and 66% increase in the low-dose group). Dexamethasone increased tidal volume and significantly reduced Fio2 and MAP in both groups of infants. A transient increase in blood pressure was noted in both groups.Conclusions. Our findings indicate that 1) comparable significant increases in Crs are present in the low-dose dexamethasone as well as the high-dose dexamethasone groups on days 2, 5, and 7 of steroid therapy; and 2) MAP and Fio2 are significantly decreased during dexamethasone therapy in both groups of infants. We conclude that low-dose and high-dose dexamethasone, as used in this study, have comparable beneficial effects on dynamic pulmonary mechanics and subsequently on oxygen requirement and applied ventilatory support in VLBW infants.
Newborn Screening Program Practices in the United States: Notification, Research, and Consent
Authors: Mandl Kenneth D. , Feit Shlomit , Larson Cecilia , Kohane Isaac S. 
Published: August 2004

Objective. To define current practice among US newborn screening programs for notification of results, research, and consenting procedures.
Methods. A telephone survey of all US newborn screening program supervisors.
Results. All 51 programs participated. All states reported abnormal results to the infant’s physician, and some also reported to the hospital and parents. Cases with abnormal results were tracked to different endpoints but usually (92.1%) at least until a follow-up appointment was made. A total of 66.6% of programs can communicate with programs in other states; 9.8% enable families to suppress reporting of results to the infant’s physician. No state has a mechanism for parents to prevent results from entering the medical record. Parents or physicians who request results are often authenticated by providing their name (52.9%). Many programs (45.1%) report only to physicians and require just their name (43.5%), an identification number (17.4%), a letter (26.1%), or a parent’s signature (26.1%). A total of 70.6% retain residual blood samples; of these, only 8.3% store them completely devoid of patient identifiers. A total of 49.0% of programs aggregate data for research. In 16.0% of these, the data are publicly available. In 24.0%, researchers obtain approval at their own institution; in 24.0%, researchers obtain approval through the state laboratory Institutional Review Board. In 74.5% of programs, parents are notified but not asked for consent before collection of the sample; 19.6% neither notify parents nor obtain consent before screening.
Conclusions. There is wide variation in practice among the US newborn screening programs. Because the programs collectively manage a comprehensive nationwide genomic databank, careful consideration of how information technology and high-throughput genomic analysis are used will be essential to allow progress in clinical care, public health, and research while protecting individual privacy.
National Underascertainment of Sudden Unexpected Infant Deaths Associated With Deaths of Unknown Cause
Authors: Overpeck Mary D. , Brenner Ruth A. , Cosgrove Candace , Trumble Ann C. , Kochanek Kenneth , MacDorman Marian 
Published: August 2004

Objective. To investigate underascertainment of unexpected infant deaths at the national level as a result of probable classification as attributable to unknown cause.
Methods. Using linked birth and death certificates for all US birth cohorts from 1983–1991 and 1995–1996, we identified 53 470 sudden infant death syndrome (SIDS) fatalities, 9071 unintentional injury deaths, 3473 injury deaths classified with intentional or suspicious intent, and 8097 deaths with unknown underlying cause. For these deaths, we compared relative risks (RRs) for maternal and infant variables available on birth certificates known to be predictive of SIDS, unintentional injury, and homicides. Variables available on death certificates were compared for unlinked and linked records. Factors related to state and national management of cases pending final cause determination are reviewed.
Results. For deaths from unknown cause, rates were consistently high among the same risk groups that have been shown to be at increased risk for SIDS, unintentional injury, and homicides. For most risk factors, RRs for deaths attributable to unknown causes were somewhat lower than for RRs for intentional/suspicious injury deaths but higher than for SIDS or unintentional injury, indicating combined contributions from all causes. For example, age at death from unknown cause includes RRs that more strongly resemble patterns of intentional/suspicious injuries than SIDS or unintentional injury. Deaths from unknown cause were more likely to occur during the first week of life for unattended births occurring outside clinical settings or when birth certificates were not found, similar to intentional/suspicious injury deaths.
Conclusions. Risk profiles indicate that deaths of unknown cause are likely to represent a mixture of unexpected deaths. The process for determination of cause of unexpected death affects national underascertainment of SIDS and injury deaths. Better coordination among child fatality review teams and local, state, and national officials should reduce underascertainment and improve documentation of circumstances surrounding deaths for prevention efforts.
Xylitol Administered Only During Respiratory Infections Failed to Prevent Acute Otitis Media
Authors: Tapiainen Terhi , Luotonen Leevi , Kontiokari Tero , Renko Marjo , Uhari Matti 
Published: August 2004

Objective. As regular administration of xylitol had been effective in preventing acute otitis media (AOM) in children, we tested whether xylitol administered only at times of acute respiratory infection (ARI) reduces the occurrence of AOM.
Methods. Healthy children (N = 1277) were recruited from child care centers and randomized after screening with tympanometry to receive either control mixture (n = 212), xylitol mixture (n = 212), control chewing gum (n = 280), xylitol chewing gum (n = 286), or xylitol lozenges (n = 287) during an ARI. The trial was randomized and double blinded within the mixture and chewing gum groups. The parents began administering the products to their children at the onset of symptoms of ARI. The follow-up lasted until resolution of the symptoms or up to 3 weeks.
Results. A total of 1253 of the 1277 randomized children were eligible for the analysis. Altogether, 980 (78%) of 1253 children had at least 1 episode of ARI during the 4 months that the trial lasted. The occurrence of AOM during this episode was 34 (20.5%) of 166 in the xylitol mixture group, as compared with 32 (20.4%) of 157 among the children who received the control mixture. Among the older children who received control chewing gum, xylitol chewing gum, or xylitol lozenges, AOM was experienced by 24 (11.0%) of 218, 31 (14.1%) of 220, and 34 (15.5%) of 219, respectively. None of the differences between the groups was statistically significant.
Conclusions. Xylitol administered only during an ARI was ineffective in preventing AOM.