bluuebunny/crossref_metadata_2025_split huggingface dataset:
Screening for Developmental Dysplasia of the Hip: From Theory to Practice
Authors: Baronciani Dante , Atti Giuseppe , Andiloro Francesco , Bartesaghi Angelo , Gagliardi Luigi , Passamonti Contardo , Petrone Massimo ,   Collaborative Group DDH Project
Published: August 2004

Objective. To evaluate an organizational model for neonatal population screening for developmental dysplasia of the hip.Methods. In 4648 neonates born in six hospitals of the Lombardy region, screening for developmental dysplasia of the hip was done using the Ortolani-Barlow maneuver and ultrasonography.Results. The frequency of positive results of clinical and ultrasound examinations carried out in the hospitals varied considerably as a result of difficulties in the Ortolani-Barlow test reproducibility and in the low sensitivity of the clinical examination when compared to ultrasonography. Neonatal screening results implied a large number of subjects with a IIa hip, according to Graf’s system; as these subjects require follow-up, the cost of this type of screening is high. Ultrasound findings were normal at 69 days of life in 88% and 75% of subjects, respectively, with unilateral and bilateral type IIa hip.Conclusion. This study evaluated various organizational models for screening (for different time periods and for selected populations) in relation to the cost-benefit ratio and demonstrated the different problems that still impede identification of a correct screening model. congenital dislocation of the hip, developmental dysplasia of the hip, clinical screening, newborn, reliability, ultrasonography.
Chorioamnionitis, Cortisol, and Acute Lung Disease in Very Low Birth Weight Infants
Authors: Watterberg Kristi L. , Scott Susan M. , Naeye Richard L. 
Published: August 2004

Objective. To explore the relationship between chorioamnionitis, postnatal cortisol concentrations, and acute respiratory distress in very low birth weight infants.Methods. Appropriate for gestational age infants weighing between 501 to 1500 g at birth were enrolled into this prospective, observational study, and data regarding respiratory distress on the first day of life were recorded. Serum cortisol concentrations were measured on (a) day 2, (b) day 3 or 4, and (c) day 5, 6, or 7 of life. On day (b) or (c), 3.5 μg/kg of cosyntropin (an adrenocorticotrophic hormone analog) was given, and a repeat specimen was drawn 30 minutes later. Chorioamnionitis was diagnosed by placental examination by one author (R.L.N.).Results. Forty-two infants exposed to chorioamnionitis and 37 infants not exposed were enrolled. Chorioamnionitis correlated inversely with gestational age, and was associated with decreased measures of acute respiratory support (exogenous surfactant, fraction of inspired oxygen, and ventilator support at 12 and 24 hours). Infants with chorioamnionitis had higher cortisol concentrations, both basal and stimulated. Gestational age was not significantly related to basal cortisol, but did correlate positively with stimulated values. Cortisol values from the 16 infants exposed to prenatal glucocorticoid therapy were excluded from these analyses.Conclusions. These results provide evidence that prenatal inflammation leads to adrenal stimulation, resulting in increased cortisol secretion and accelerated lung maturation. The enhanced response to cosyntropin stimulation seen in these infants may reflect an increased adrenal capacity to respond to postnatal stressors. Because of the apparent magnitude of the effect of chorioamnionitis on cortisol measures, this factor should be included in future investigations of adrenal function in very low birth weight newborns. chorioamnionitis, very low birth weight infants, respiratory distress syndrome, cortisol, adrenocorticotrophic hormone, adrenal gland, lung maturation.
Hepatitis B Vaccination and Hepatocellular Carcinoma in Taiwan
Authors: Lee Cheng-Liang , Ko Ying-Chin 
Published: August 2004

Objective. In 1984, Taiwan started a large-scale hepatitis B vaccination program, enabling us to test the hypothesis that prevention of hepatitis B virus infection eventually decreases the incidence of hepatocellular carcinoma.Methods. Groups aged 0 to 9 years and 10 to 100 years in each calendar year were defined as the study group and the reference group, respectively. The percentage of children vaccinated in the study group increased during recent years. The study group and the reference group were divided into 5-year age strata (0 to 4, 5 to 9, … , 80 to 84, and 85 and over). Poisson regression was used to estimate age- and gender-adjusted liver carcinoma mortality rate ratios for 1974 through 1993, relative to 1974.Results. The adjusted mortality rate ratios of liver carcinoma in the study group decreased significantly for 1992 and 1993, whereas in the reference group it did not show the same result. A significantly declining trend of liver carcinoma mortality rate ratios was observed in the study group after 1984, whereas the same trend was not found in the reference group.Conclusions. Our results support the hypothesis that hepatitis B vaccination can decrease the incidence of hepatocellular carcinoma.
Megestrol Acetate Treatment of Growth Failure in Children Infected With Human Immunodeficiency Virus
Authors: Clarick Robert H. , Hanekom Willem A. , Yogev Ram , Chadwick Ellen Gould 
Published: August 2004

Objective. To evaluate the effect of megestrol acetate on weight gain and linear growth in human immunodeficiency virus-infected children with growth failure.Methods. All human immunodeficiency virus-infected children with growth failure treated with megestrol acetate at our institution were evaluated retrospectively. Weight, height, and weight:height ratio were documented from 6 months before initiation of megestrol acetate until 6 months after treatment was discontinued. Measurements were corrected for age and sex by conversion toz-scores. Incremental growth was determined before, during, and after treatment. The potential effects of CD4+ T-lymphocyte count and percentage, antiretroviral therapy, and intercurrent illnesses on growth were evaluated.Results. Nineteen patients were treated with a total of 27 courses of megestrol acetate. The median duration of therapy was 7 months (range, 3 to 11 months), and the median megestrol acetate dose was 7.91 mg/kg/day (range, 4.06 to 8.56 mg/kg/day). From 6 months and 3 months before treatment to the onset of therapy, median changes in weight z-scores were −.27 and −.15, respectively. During megestrol acetate treatment, median changes in weightz-scores were +.29 after 1 month of therapy, +.40 after 3 months, and +.57 after 6 months. After megestrol acetate therapy was discontinued, poor weight gain and weight loss resumed. Median 6-month growth velocities for weight were less than the 10th percentile before megestrol acetate, greater than the 97th percentile during treatment, and less than the 3rd percentile after treatment was discontinued. Megestrol acetate therapy was not associated with changes in linear growth. Antiretroviral therapy, CD4+ T-lymphocyte count or percentage, or intercurrent illnesses were not associated with statistically significant differences in response to megestrol acetate therapy.Conclusions. Megestrol acetate treatment of growth failure in pediatric human immunodeficiency virus disease is associated with weight gain, without affecting linear growth.
Treatment of Pyogenic Granuloma in Children With the Flashlamp-pumped Pulsed Dye Laser
Authors: Tay Yong-Kwang , Weston William L. , Morelli Joseph G. 
Published: August 2004

Objective. Pyogenic granuloma is a common, acquired, vascular tumor of the skin in children, often ulcerates or bleeds, and is commonly localized to the face. The treatment of choice has been surgical removal, either by excision or shave, followed by electrocautery. The site, young age of the patient, and the inherent nature of surgical removal or electrocautery often make this procedure a traumatic experience. Also, surgical treatment usually leads to permanent scarring. Owing to the pulsed dye laser's ability to cause selective destruction of superficial capillary-sized cutaneous blood vessels, its ease of operation, and its lack of scarring, we evaluated its use in the treatment of pyogenic granuloma in children.
Methods. Twenty-two children with solitary pyogenic granulomas were treated with a vascular-specific (585 nm), pulsed (450 microseconds) dye laser using a 5-mm spot size with a laser energy of 6 to 7 J/cm2 without anesthesia. Retreatments were administered every 2 weeks if necessary until the lesion cleared. Posttreatment care consisted of twice-a-day application of bacitracin ointment.
Results. In 20 patients (91%), laser treatment was successful. Five patients (25%) required one treatment for resolution, eight patients (40%) required two treatments, and six patients (30%) required three treatments for clearing. One patient required six treatments before the lesion resolved. There was no correlation with the duration, or site of the lesion, with respect to the number of laser treatments required. Lesions in all 20 children healed without scarring and with excellent cosmetic results. In two patients (9%), laser treatment failed in that there was no response to the initial laser treatment on follow-up 2 weeks later. Both had large pyogenic granulomas (1 cm and .5 cm in diameter, respectively) which were elevated over .5 cm above the surface of the skin. These lesions were surgically removed. None of the patients had a recurrence during the follow-up period of 6 months to 3 years.
Conclusion. Pulsed dye lasers are effective and safe for the treatment of small pyogenic granulomas in children and should be considered a treatment option.
Epidemiology of Biliary Atresia: A Population-based Study
Authors: Yoon Paula W. , Bresee Joseph S. , Olney Richard S. , James Levy M. , Khoury Muin J. 
Published: August 2004

Objective. Biliary atresia is the leading cause of extrahepatic obstructive jaundice in the newborn and is the single most frequent indication for liver transplantation in children. The cause of biliary atresia is unknown, although several mechanisms have been postulated to explain the inflammatory process that obliterates the bile ducts. Most interest has been directed toward viral infections. Information about the epidemiologic characteristics of biliary atresia in well-defined populations is lacking but is essential for developing and addressing hypotheses of causation for the disease.Methods. Infants with biliary atresia were identified in metropolitan Atlanta from 1968 through 1993 by a population-based birth defects surveillance system that ascertains infants with serious birth defects in the first year of life using active case ascertainment. Birth prevalence rates were analyzed for spatial and temporal clustering and effects attributable to county of residence, sex, race, maternal age, parity, and birth weight. Logistic regression was used to study the independent effects of the risk factors and to look for interactions.Results. Fifty-seven infants with biliary atresia were identified, for a rate of 0.73 per 10 000 live births. There was significant seasonal clustering of the disease, with rates three times higher from December through March compared with rates from April through July. Rates were significantly higher among nonwhite infants compared with white infants (0.96 vs 0.44 per 10 000 live births) and infants born at term with low birth weights (&lt;2500 g) compared with infants born at term with normal birth weights (≥2500 g) (2.62 vs 0.75 per 10 000 live births).Conclusions. Our study is the first in the United States to describe the epidemiologic characteristics of biliary atresia using a population-based approach. The demonstration of significant seasonal clustering provides support for theories that biliary atresia may be caused by environmental exposure (consistent with a viral cause) during the perinatal period.
Additive Impact of In-hospital Cardiac Arrest on the Functioning of Children With Heart Disease
Authors: Bloom Audrey A. , Wright Jean A. , Morris Robin D. , Campbell Robert M. , Krawiecki Nicolas S. 
Published: August 2004

Objective. This study examined the impact of a sudden cardiac arrest (CA) on the neurodevelopmental and adaptive functioning of young children with congenital heart disease (CHD).
Methodology. Sixteen children with CHD who had sustained an in-hospital CA were compared with a medically similar group of children with CHD who had not incurred a CA. The contribution of CA, disease severity, and family socioeconomic status on the prediction of developmental outcome variables was evaluated.
Results. Children in the CA group displayed more impairments in general cognitive, motor, and adaptive behavior functioning as well as greater disease severity as measured by a cumulative medical risk index. With respect to all children in the study, a higher socioeconomic status was related to higher scores on cognitive functioning, lower levels of child maladjustment, and lower levels of stress within the parent-child relationship. Although the occurrence of a CA alone did not contribute to the prediction of outcome measures, a significant interactional effect between CA and cumulative medical risk index was found. Specifically, among children who had incurred a CA, as disease severity increased, decrements in abilities were observed. Few significant correlations between specific CA-related variables (eg, length of CA) and outcome indices were found.
Conclusions. Results from this study indicate that the impact of cardiac arrest on neuropsychological functioning may be mediated by the child's overall disease severity. These findings have implications for the identification of CA survivors at greatest risk for developmental difficulties.
Iguanas and Salmonella Marina Infection in Children: A Reflection of the Increasing Incidence of Reptile-associated Salmonellosis in the United States
Authors: Mermin Jonathan , Hoar Bruce , Angulo Frederick J. 
Published: August 2004

Objective. To investigate clinical aspects and risk factors for Salmonella serotype Marina infection in the United States.
Methods. We identified all isolates of SMarina reported in 1994 to the NationalSalmonella Surveillance System. Patients were interviewed about demographic information, clinical course, diet, travel history, and contact with reptiles before illness.
Results. Twenty-six (81%) of 32 patients were infants (&lt;1 year of age) and 24 (75%) were male. This differs from otherSalmonella isolates reported to the Centers for Disease Control and Prevention in 1994, of which 14% were from infants and 49% from male patients. Eleven patients (34%) were hospitalized for a median of 3.5 days (range: 2 to 21 days), and 1 died. Of 28 patients (88%) with reported iguana exposure, only 4 (14%) touched the reptile, and only 12 respondents (43%) realized that it might have been the source of infection. Seven (32%) of 22 families who owned an iguana at the time of illness continued to own an iguana when contacted a median of 28 weeks later. Persons who thought that the iguana was the source of infection were more likely to have given away or sold the pet than those who did not. Four isolates (13%) were from blood. Bacteremia was associated with taking antibiotics during the 30 days before S Marina infection (odds ratio: 24; 95% confidence interval: 1.2–1309).
Conclusion. S Marina infection is a potentially serious illness associated with iguana exposure, and it reflects the larger problem of reptile-associated salmonellosis. Many parents do not know that owning an iguana puts their children at risk forSalmonella infection. Pediatricians, veterinarians, and pet store owners should inform their patients and customers of the potential risks of owning reptiles and provide appropriate preventive education.
Epidural Analgesia, Intrapartum Fever, and Neonatal Sepsis Evaluation
Authors: Lieberman Ellice , Lang Janet M. , Frigoletto Fredric , Richardson Douglas K. , Ringer Steven A. , Cohen Amy 
Published: August 2004

Objective. Although several studies have documented an increase in maternal temperature associated with use of epidural analgesia during labor, none have investigated the impact of epidural use on the rate of intrapartum fever or the consequences for the fetus and newborn of this elevated maternal temperature. This study evaluates the impact of epidural analgesia use during labor on the rate of intrapartum fever and the performance of neonatal sepsis evaluations and treatment with antibiotics.
Methods. We studied 1657 nulliparous women with term pregnancies and singleton vertex fetuses who were afebrile at admission for delivery. The rates of maternal intrapartum fever &gt;100.4°F, neonatal sepsis evaluation, and neonatal antibiotic treatment according to use of epidural analgesia during labor were determined. Rate ratios and 95% confidence intervals (CI) were calculated. Multiple logistic regression was used to examine associations while controlling for confounding factors.
Results. Intrapartum fever &gt;100.4°F occurred in 14.5% of women receiving an epidural but only 1.0% of women not receiving an epidural (adjusted odds ratio (OR) = 14.5, 95% CI = 6.3, 33.2). Without epidural, the rate of fever remained low regardless of length of labor; with epidural, the rate of fever increased from 7% for labors ≤6 hours to 36% for labors &gt;18 hours. Neonates whose mothers received epidurals were more often evaluated for sepsis (34.0% vs 9.8%; adjusted OR = 4.3, 95% CI = 3.2, 5.9) and treated with antibiotics (15.4% vs 3.8%; adjusted OR = 3.9, 95% CI = 2.1, 6.1). Although 63% of women received epidurals, 96.2% of intrapartum fevers, 85.6% of neonatal sepsis evaluations, and 87.5% of neonatal antibiotic treatment occurred in the epidural group.
Conclusions. Use of epidural analgesia during labor is strongly associated with the occurrence of maternal intrapartum fever, neonatal sepsis evaluations, and neonatal antibiotic treatment.
Secular Increases in Relative Weight and Adiposity Among Children Over Two Decades: The Bogalusa Heart Study
Authors: Freedman David S. , Srinivasan Sathanur R. , Valdez Rodolfo A. , Williamson David F. , Berenson Gerald S. 
Published: August 2004

Objective. To examine trends in relative weight and obesity among 5- to 24-year-olds between 1973 and 1994.Design. A panel design consisting of seven cross-sectional surveys of schoolchildren and three surveys of post-high-school subjects. Anthropometric measurements included height, weight, and subscapular and triceps skinfolds.Study Population. All schoolchildren residing in Ward 4 of Washington Parish, Louisiana, a biracial community, were considered eligible; participation rates were &gt;80%. Young adults were eligible if they had participated previously as schoolchildren. A total of 26 371 examinations were performed on 11 564 persons.Results. During the study period, substantial increases in mean levels of weight (0.2 kg/y) and skinfold thickness (0.15 mm/y) were observed; these changes were independent of height, age, and other covariates. The prevalence of overweight, defined by the 85th percentile of weight-for-height in 1973 to 1974, increased approximately twofold by 1994. Although secular increases were seen both among boys and girls and among blacks and whites, the largest increases were seen among 19- to 24-year-olds. Furthermore, the yearly increases in relative weight and obesity during the latter part of the study period (1983 through 1994) were ∼50% greater than those between 1973 and 1982.Conclusions. The increasing prevalence of obesity in early life indicates a need for primary prevention. Additional study is needed to determine whether these trends are continuing to accelerate and to examine possible explanations, such as diet and physical activity, for these changes.
Efficacy and Safety of Intravenous Midazolam and Ketamine as Sedation for Therapeutic and Diagnostic Procedures in Children
Authors: Parker Robert I. , Mahan Rosemary A. , Giugliano Debra , Parker Margaret M. 
Published: August 2004

Objective. We have used the combination of midazolam, a short-acting benzodiazepine, and ketamine, a “dissociative anesthetic,” to provide conscious sedation for invasive or lengthy procedures.Methods. A total of 350 procedures (74 lumbar punctures, 97 bone marrow aspirations or biopsies, 84 radiotherapy sessions, and 95 imaging studies) were performed on 68 children, 4 months to 17 years of age, in both inpatient and ambulatory settings. All patients had an intravenous line in place and were monitored for heart rate and O2 saturation by pulse oximetry for the duration of the procedure and recovery time. Blood pressure was monitored periodically (every 5 to 30 minutes). Oxygen and suction equipment was available during the procedure. In addition to the individual performing the procedure, a second staff member trained in airway management (eg, physician, nurse practitioner, or registered nurse) was present to monitor vital signs and respiratory status. Patients were sedated initially with midazolam (0.05 to 0.1 mg/kg intravenously; maximum single dose of 2 mg, maximum total dose of 4 mg), followed by ketamine (1 to 2 mg/kg intravenously). During lengthy procedures, additional doses of ketamine (0.5 to 1 mg/kg) were given as necessary. Effectiveness of the sedation, recovery time, and adverse events associated with the sedative regimen were documented.Results. All patients were effectively sedated with this regimen. Four patients experienced transient decrease in O2saturation (&lt;85%) requiring temporary interruption of the procedure and oxygen by blow-by; the procedure was subsequently completed without incident in each case. Two patients experienced significant agitation during recovery from sedation. This side effect resolved spontaneously after 5 to 10 minutes in one patient and was effectively treated with diphenhydramine hydrochloride in the other. Twenty-four lumbar punctures were associated with transient decrease in O2saturation (88% to 92%), which improved by relief of neck flexion and/or blow-by oxygen. No hypotension, bradycardia, or respiratory depression requiring respiratory support or reversal of sedation was noted. Anesthesia recovery time ranged from &lt;15 minutes to 120 minutes with &gt;70% of patients recovering within 30 minutes. Most patients demonstrated an increase in oral secretions requiring occasional suctioning. Transient sleep disturbances were reported in only two patients.Conclusions. This sedative regimen of intravenous midazolam and ketamine was found to be safe and effective. Its use has greatly reduced patient and parent anxiety for diagnostic and therapeutic procedures.