bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Comparison of On-Site and Off-Site Patent Ductus Arteriosus Ligation in Premature Infants
Authors: Gould Douglas S. , Montenegro Lisa M. , Gaynor J. William , Lacy Suzanne P. , Ittenbach Richard , Stephens Paul , Steven James M. , Spray Thomas L. , Nicolson Susan C. 
Published: August 2004

Introduction. Persistent patent ductus arteriosus (PDA) often produces hemodynamic and respiratory derangement necessitating use of inotropic drugs and escalating ventilatory support in premature infants. When medical therapy fails, surgical ligation is indicated. Because of the risks of transferring unstable neonates to the operating room, ductal ligation is routinely performed at the neonatal intensive care unit (NICU) bedside. Some patients, however, require transfer from hospitals without pediatric cardiac surgical teams. In an attempt to eliminate the risks associated with transfer, a surgical team from our institution offered to perform duct ligation in the NICUs of referring institutions. This experienced team consisted of a pediatric cardiac attending anesthesiologist and certified registered nurse anesthetist, cardiac operating room nurses, an attending cardiothoracic surgeon, and a cardiothoracic surgery fellow. We retrospectively reviewed our experience.
Methods. After approval from the Committee for the Protection of Human Subjects, the charts of premature neonates who underwent PDA ligation in the NICU at the Children’s Hospital of Philadelphia NICU or in a network NICU between January 1996 and April 2002 were reviewed. Data abstracted included institution, gender, gestational age, birth weight, weight at surgery, and number of courses of indomethacin. Mean arterial blood pressure and use of inotropic drugs and ventilatory parameters (fraction of inspired oxygen, peak inspiratory pressure) were recorded at the time of surgery and 96 hours postoperatively. Perioperative complications were recorded.
Results. Seventy-two patients met the criteria for inclusion. PDA ligation was performed in the Children’s Hospital of Philadelphia NICU in 38 of 72 patients, 53% (group 1). The remainder, 34 of 72 (47%) underwent PDA ligation in the NICU at 1 of 6 referring institutions (group 2). There were no significant differences between groups with respect to demographics, number of courses of indomethacin, or use of inotropic drugs or ventilatory support. The incidence of perioperative complications did not differ between groups: 3 in group 1 (bleeding, chylothorax, and pleural effusion) and 3 in group 2 (pneumothorax [3]). There were no anesthetic-related complications. Seven patients died (4 in group 1 and 3 in group 2), none within 96 hours of surgery and none secondary to the procedure.
Discussion. The data demonstrate that an experienced team can perform PDA ligation safely in NICUs of hospitals without on-site pediatric cardiac surgical capabilities in critically ill neonates without incurring the risks inherent in patient transport. Most importantly, patient care is continued by the neonatology team most familiar with the infant’s medical and social history, and the patient’s family is minimally inconvenienced.
Postreduction Management of Intussusception in a Children’s Hospital Emergency Department
Authors: Bajaj Lalit , Roback Mark G. 
Published: August 2004

Objective. To evaluate the current management of patients with intussusception who have undergone successful reduction by contrast enema in a tertiary care children’s hospital. To compare differences in the incidence of recurrence and adverse events between those patients who were hospitalized after enema reduction and those who were observed in the emergency department (ED).
Methods. This was a retrospective cohort study of children 0 to 18 years of age who underwent uncomplicated enema reduction for intussusception. Hospitalization versus ED observation management were compared for length of stay, incidence of recurrence, and adverse events.
Results. One hundred twenty-three children were identified with an International Classification of Diseases, Ninth Revision code for intussusception. Of those, 106 patients (86%) had an enema reduction attempted. Three had a normal enema and were given the diagnosis of “resolved intussusception.” Eighty-three (80%) of the patients had a successful reduction. Seventy-eight (94%) of those patients had no preexisting condition and had complete medical records. Of those 78 patients, 27 (35%) were hospitalized and 51 (65%) were observed in the ED. The mean length of hospitalization was 22.7 hours (range: 10–50 hours), and the mean length of ED observation was 7.2 hours (range: 0–21 hours). Eleven recurrences were observed in 8 of these 78 patients (10% recurrence rate). Four patients in the hospitalized group and 4 patients in the ED observation group had recurrences (5 hours-10.9 months). Four of the 8 patients had a recurrence within the first 48 hours. All first recurrences occurred after the patient had been discharged from the hospital or ED observation unit. No adverse events occurred in any of the patients who had a successful initial reduction (95% confidence interval [0%–4.6%]).
Conclusions. The postreduction management of intussusception is variable at our institution. Previously healthy patients who have undergone successful enema reductions are unlikely to have adverse outcomes. Postreduction observation in the ED or the hospital does not seem to affect outcomes in this clinical setting.
Prevalence of Blood Lead Levels ≥5 μg/dL Among US Children 1 to 5 Years of Age and Socioeconomic and Demographic Factors Associated With Blood of Lead Levels 5 to 10 μg/dL, Third National Health and Nutrition Examination Survey, 1988–1994
Authors: Bernard Susan M. , McGeehin Michael A. 
Published: August 2004

Objectives. As part of an investigation into the impact of a potential revision in federal childhood lead poisoning prevention policy that would result in screening children for blood lead levels (BLLs) ≥5 μg/dL rather than the current 10 μg/dL, we analyzed the most recent available, nationally representative data to identify prevalence of BLLs ≥5 μg/dL and socioeconomic and demographic characteristics of 1- to 5-year-old children with BLLs ≥5 but &lt;10 μg/dL.
Methods. We performed statistical analyses on data from the Third National Health and Nutrition Examination Survey (NHANES III) (1988–1994) to describe trends in BLLs ≥5 μg/dL overall and among subpopulations of children &lt;6 years old and to compare risk factors for falling within 1 of 3 groups of children (those with BLLs ≥5 but &lt;10 μg/dL; ≥10 but &lt;20 μg/dL; and ≥20 μg/dL) using the group reported as 0.7 to &lt;5 μg/dL as the referent.
Results. Overall prevalence of BLLs ≥5 μg/dL among 1- to 5-year-old children was 25.6%, although most (76%) of these children had BLLs &lt;10 μg/dL. Children with BLLs ≥5 μg/dL included 46.8% of non-Hispanic black children, 27.9% of Mexican American children, and 18.7% of non-Hispanic white children; 42.5% of children in housing built before 1946, 38.9% of children in housing built between 1946 and 1973, and 14.1% of children in housing built after 1973 had BLLs ≥5 μg/dL. Compared with non-Hispanic white children, non-Hispanic black children were 3 times more likely to have a BLL ≥5 but &lt;10 μg/dL, 7 times more likely to have a BLL of 10–20 μg/dL, and 13.5 times more likely to have a BLL ≥20 μg/dL. Similar increases in the association between risk factor and BLL were seen with respect to other known risk factors including age of housing, region of the country, and poverty.
Conclusions. The high prevalence of BLLs ≥5 μg/dL overall and within US subpopulations will be an important variable in any change in screening and intervention criteria. However, most children with BLLs ≥5 μg/dL are below the current intervention level of 10 μg/dL. Exposure to lead from multiple sources is suggested by the prevalence of BLLs ≥5 μg/dL but &lt;10 μg/dL among children with uncertain risk factors. The probable presence of one or more known risk factors for childhood lead poisoning increases as BLL increases.
Generalist-Subspecialist Communication for Children With Chronic Conditions: A Regional Physician Survey
Authors: Stille Christopher J. , Primack William A. , Savageau Judith A. 
Published: August 2004

Objective. To identify target areas for interventions to improve communication between pediatric generalists (PCPs) and pediatric subspecialists (SPs) in the outpatient care of children with chronic conditions.Methods. We constructed a 4-page mailed questionnaire probing communication practices, opinions about the role of communication in care, and perceived barriers and facilitators to PCP-SP communication in the care of children with chronic conditions. In the spring of 2001, we surveyed all 495 New England SPs who were members of the American Academy of Pediatrics (AAP) and/or SP societies and a random sample of 495 generalist AAP members in New England. Eligible were those actively providing outpatient care. Most items were rated on a 5-point scale.Results. Of those eligible, 48% (412/860) completed the questionnaire. Although 98% of respondents agreed that communication was important for good care, reported practices reflected large gaps in this area. Frequent receipt (&gt;60% of the time) of communication about an initial referral was reported by only 28% of SPs. Barriers reported as most important involved inefficiencies in telephone contact, transcription delay, and failure to keep all providers informed when &gt;1 specialist is involved. Important facilitators included letters or phone calls at or before the time of consultation, and clear and specific referral questions from PCPs. PCPs saw communication as more of a problem than did SPs (40% vs 28%), and reported several barriers as more important. Although 86% of respondents had access to e-mail in their practices, &lt;20% used it often.Conclusions. PCPs and SPs sharing care for children with chronic conditions are troubled by their frequent failure or inability to contact their colleagues by phone and letter. PCPs communicate less frequently than SPs yet perceive more problems with communication. Interventions to promote efficient contact between providers at or before the time of subspecialty visits can lead to improved coordination of care, which in turn may better meet the needs of families.
Impact of Television Viewing Patterns on Fruit and Vegetable Consumption Among Adolescents
Authors: Boynton-Jarrett Reneé , Thomas Tracy N. , Peterson Karen E. , Wiecha Jean , Sobol Arthur M. , Gortmaker Steven L. 
Published: August 2004

Background. National data indicate that children and youth do not meet Healthy People 2010 objectives for fruit and vegetable intake. Television viewing is hypothesized as a contributing factor because of its documented role in encouraging consumption of highly advertised foods that may lead to the replacement of fruits and vegetables.Methods. A sample of 548 ethnically diverse students (average age: 11.7 ± 0.8 years) from public schools in 4 Massachusetts communities were studied prospectively over a 19-month period from October 1995 to May 1997. We examined the associations between baseline and change in hours of television and video viewing per day (the predictor variables) and change in energy-adjusted intake of fruits and vegetables by using linear regression analyses to control for potentially confounding variables and the clustering of observations within schools.Findings. For each additional hour of television viewed per day, fruit and vegetable servings per day decreased (−0.14) after adjustment for anthropometric, demographic, dietary variables (including baseline percent energy from fat, sit-down dinner frequency, and baseline energy-adjusted fruit and vegetable intake), and physical activity. Baseline hours of television viewed per day was also independently associated with change in fruit and vegetable servings (−0.16).Conclusions. Television viewing is inversely associated with intake of fruit and vegetables among adolescents. These associations may be a result of the replacement of fruits and vegetables in youths’ diets by foods highly advertised on television.
Impact of Zinc Supplementation on Diarrheal Morbidity and Growth Pattern of Low Birth Weight Infants in Kolkata, India: A Randomized, Double-Blind, Placebo-Controlled, Community-Based Study
Authors: Sur Dipika , Gupta Dhirendra N. , Mondal Sujit K. , Ghosh Subrato , Manna Byomkesh , Rajendran Krishnan , Bhattacharya Sujit K. 
Published: August 2004

Objective. To assess the impact of zinc supplementation on diarrheal morbidity and growth pattern of low birth weight (LBW) infants.
Methodology. In a randomized, double-blind, placebo-controlled, community-based study conducted in the Tiljala slum of eastern Kolkata, India, between 1999 and 2001, a birth cohort of 100 LBW infants was randomly allocated into either an intervention group receiving 1 mL daily dose of 5 mg of elemental zinc as zinc sulfate in vitamin B complex-based syrup or a placebo group receiving an identical placebo of 1 mL of vitamin-based syrup from birth up to 1 completed year of age. Active weekly surveillance was conducted for detection of diarrhea. Anthropometric measurements of each child were recorded once every month as close to the child’s birth date as possible. Data were analyzed by using statistical software packages SPSSPC+ 4.0 (SPSS, Inc, Chicago, IL) and Epi Info 6.0 (Centers for Disease Control and Prevention, Atlanta, GA).
Results. Among the zinc-supplemented group, diarrheal incidence of 1.36 episodes per child per year were observed, whereas it was 1.93 episodes per child per year among the placebo group, giving a relative risk of 1.4 (95% confidence interval: 1.02-2.00). Linear growth and weight for age showed significant differences between the supplemented and placebo groups only at the end of 1 year. Interestingly, the impact of zinc supplementation was masked to a large extent by the protective action of breastfeeding.
Conclusions. The study showed that zinc supplementation had a beneficial impact on the incidence of diarrhea and also weight gain among LBW infants.
Corrected End-Tidal Carbon Monoxide Closely Correlates With the Corrected Reticulocyte Count in Coombs’ Test-Positive Term Neonates
Authors: Javier Maria Cristina , Krauss Alfred , Nesin Mirjana 
Published: August 2004

Objective. To evaluate clinical usefulness of corrected end-tidal carbon monoxide (ETCOc) measurements in healthy, term, Coombs’ test-positive neonates and correlate it to the corrected reticulocyte count (RC).Methods. ETCOc and RC were determined (at 36 ± 12 hours of age) in 50 Coombs’ test-positive neonates and compared with the ETCOc values of 50 Coombs’ test-negative neonates.Results. Fifty percent of Coombs’ test-positive infants had RCs &lt;5% (within a normal range for a healthy newborn) and ETCOc = 1.8 ± 0.34 parts per million (ppm) and likely did not exhibit hemolysis. Among infants with elevated RCs, 72% had RCs between 5% and 8% and ETCOc = 2.77 ± 0.68 ppm, and 28% had RCs &gt;8% and ETCOc = 4.52 ± 0.83 ppm. There was an almost linear correlation (r = 0.86) between the RC and the ETCOc among Coombs’ test-positive infants. The 50 Coombs’ test-negative infants had ETCOc = 1.6 ± 0.45 ppm. Serial ETCOc measurements were performed in 14 Coombs’ test-positive infants: in all but 1 infant ETCOc values declined over time.Conclusions. There is a good correlation between ETCOc and RC in Coombs’ test-positive infants. ETCOc &gt;2.5 ppm predicts a significant elevation of RC in 90% of Coombs’ test-positive infants.
Not Only a Matter of Epilepsy: Early Problems of Cognition and Behavior in Children With “Epilepsy Only”—A Prospective, Longitudinal, Controlled Study Starting at Diagnosis
Authors: Oostrom Kim J. , Smeets-Schouten Anneke , Kruitwagen Cas L. J. J. , Peters A. C. Boudewyn , Jennekens-Schinkel Aagje ,   for the Dutch Study Group of Epilepsy in Childhood (DuSECh)
Published: August 2004

Objective. To understand early educational and behavioral predicament in childhood “epilepsy only.”Methods. A multicenter, prospective, longitudinal study was conducted of 51 outpatient schoolchildren with newly diagnosed idiopathic or cryptogenic epilepsy and 48 sex-matched classmate control subjects. All children underwent neuropsychological assessment 3 times within the first year after diagnosis; parents and teachers completed behavior questionnaires, and patients’ parents were interviewed to inventory contextual adversity. Principal components analysis of cognition and behavior disclosed 6 major components that were related with the interview data (repeated measures analysis of variance).Results. Despite similar intelligence and educational background, significantly more patients (51%) than control subjects (27%) required special educational assistance. Patients obtained worse scores across components of cognition and behavior. Parents and teachers perceived patients to have more behavioral problems. Differences between groups existed at pretreatment baseline. Over time, notwithstanding stable percentages of poor scores in both groups, nonpersistence of poor scores was impressive (each time other children scored poorly in other domains). Rather than epilepsy characteristics, contextual adversities were significant risk factors.Conclusion. Already in the earliest stage of the illness, children with epilepsy are liable to vicissitudes in cognitive and behavioral functioning. Contextual variables are all-important.
Long-Term Results of Pediatric Cardiac Surgery in Finland: Education, Employment, Marital Status, and Parenthood
Authors: Nieminen Heta , Sairanen Heikki , Tikanoja Tero , Leskinen Markku , Ekblad Henrik , Galambosi Päivi , Jokinen Eero 
Published: August 2004

Objective. This population-based study was designed to examine the psychosocial outcome of Finnish patients who had been operated on for congenital heart disease during childhood.
Methods. A questionnaire was mailed to 3789 adult patients who had been operated on for congenital heart defects in Finland. Of these, 2896 (76%) answered the questionnaire. The mean age of patients was 33 years (range: 18–59 years), and they had had their first operation 9 to 46 years earlier.
Results. The patients had coped well with their defects when compared with the general Finnish population. The educational level of patients was comparable to and employment level was higher than expected (70% vs 66%, respectively). They were living in a steady relationship as often as the general population, but the number of parents among the patients was lower than that expected (47% vs 49%, respectively). The incidence of congenital heart disease among the 2697 children of the patients was 2.4%.
Conclusion. Our results confirm that in addition to high survival rate, the long-term psychosocial outcome of patients with surgically treated congenital heart defects is good if they do not have any additional syndromes that cause mental retardation.
Cost-Effectiveness of Inhaled Nitric Oxide in the Treatment of Neonatal Respiratory Failure in the United States
Authors: Angus Derek C. , Clermont Gilles , Watson R. Scott , Linde-Zwirble Walter T. , Clark Reese H. , Roberts Mark S. 
Published: August 2004

Objective. Two recent randomized controlled trials (RCTs) reported that inhaled nitric oxide (iNO) decreased the incidence of extracorporeal membrane oxygenation (ECMO) or death in term and near-term newborns with hypoxic respiratory failure. Our objective was to estimate the cost-effectiveness ratio of iNO in this population.Methods. We studied 1000 simulation cohorts (n = 483 for each cohort) of term/near-term newborns with hypoxemic respiratory failure. We conducted our study following US Public Health Service Panel on Cost-Effectiveness in Health and Medicine guidelines, adopting the US societal perspective. We constructed a decision tree reflecting iNO use, subsequent ECMO use, death, and long-term neurologic and respiratory morbidity in survivors, as determined from the combined outcomes of the 2 RCTs (n = 483). We estimated costs on the basis of length-of-stay data for the initial episode of care from 1 of the RCTs, unit costs from administrative data sets, and current pricing for iNO. We ran a Monte Carlo simulation to generate estimates of differences in costs and effects at 1 year, along with the stochastic uncertainty around these estimates. We expressed effects as quality-adjusted survival, assuming quality of life = 1 with no comorbidity, 0.7 with 1 comorbidity, and 0.49 (0.7 × 0.7) with 2 comorbidities. We constructed a base case, in which iNO was initiated at tertiary care ECMO centers (mimicking the RCTs) and a Public Health Service Panel on Cost-effectiveness in Health and Medicine reference case, in which iNO was initiated at the local hospital before transfer (mimicking real-world practice). We exposed our assumptions to a sensitivity analysis.Results. Direct application of the trial results (base case) suggested that iNO was both more effective and cheaper (cost savings of $1880 per case despite acquisition costs of $5150, predominantly as a result of decreased need for ECMO), with 84.6% probability that the cost-effectiveness ratio was better than $100 000 per quality-adjusted life-year. Under the reference case, iNO was also more effective (though slightly less so) and was even cheaper (cost savings of $4400 per case), with 71.6% probability that iNO was cheaper and more effective and 91.6% probability that the cost effectiveness ratio was better than $100 000 per quality-adjusted life-year. Sensitivity analyses showed these estimates to be sensitive to patient selection and the price of iNO but insensitive to assumptions regarding quality of life.Conclusions. From a US societal perspective, iNO has a favorable cost-effectiveness profile when initiated either at ECMO centers or at local hospitals in term/near-term neonates with hypoxemic respiratory failure.
A Novel Mutation in the Anion Exchanger 1 Gene Is Associated With Familial Distal Renal Tubular Acidosis and Nephrocalcinosis
Authors: Cheidde Lara , Vieira Teresa Cristina , Lima Paulo Roberto Moura , Saad Sara Teresinha Ollala , Heilberg Ita Pfeferman 
Published: August 2004

Objective. The anion exchanger gene (AE1) or band 3 encodes a chloride-bicarbonate (Cl−/HCO3−) exchanger expressed in the erythrocyte and in the renal α-intercalated cells involved in urine acidification. The purpose of the present study was to screen for mutations in the AE1 gene in 2 brothers (10 and 15 years of age) with familial distal renal tubular acidosis (dRTA), nephrocalcinosis, and failure to thrive.
Methods. AE1 mutations were screened by single-strand conformation polymorphism, cloning, and sequencing.
Results. A complete form of dRTA was confirmed in the 2 affected brothers and an incomplete form in their father. All 3 were heterozygous for a novel 20-bp deletion in exon 20 of the AE1 gene. This deletion resulted in 1 mutation in codon 888 (Ala-888→Leu) followed by a premature termination codon at position 889, truncating the protein by 23 amino acids. As band 3 deficiency might lead to spherocytic hemolytic anemia or ovalocytosis, erythrocyte abnormalities were also investigated, but no morphologic changes in erythrocyte membrane were found and the osmotic fragility test was normal.
Conclusions. A novel mutation in the AE1 gene was identified in association with autosomal dominant dRTA. We suggest that RTA be considered a diagnostic possibility in all children with failure to thrive and nephrocalcinosis.