bluuebunny/crossref_metadata_2025_split huggingface dataset:
Persistence of Benefits of Continuous Subcutaneous Insulin Infusion in Very Young Children With Type 1 Diabetes: A Follow-up Report
Authors: Weinzimer Stuart A. , Ahern JoAnn H. , Doyle Elizabeth A. , Vincent Miranda R. , Dziura James , Steffen Amy T. , Tamborlane William V. 
Published: December 2004

Objective. Use of continuous subcutaneous insulin infusion (CSII) has increased dramatically in recent years, and pump therapy has been shown to be a safe and effective alternative to multiple daily injections in adults and older pediatric patients with type 1 diabetes. Its use in very young children, however, has been limited, although this group might be expected to benefit the most from CSII. The objective of this study was to analyze the CSII efficacy and safety data in very young children with type 1 diabetes from our Diabetes Clinic database.Methods. Glycosylated hemoglobin (HbA1c), severe hypoglycemia (SH), and ketoacidosis (DKA) in the year before CSII were compared with corresponding values during pump treatment in all children who started CSII before age 7.Results. Sixty-five children (mean age: 4.5 y at CSII initiation; range: 1.4–6.9 years; 28 girls; 3 black, 1 Hispanic) were analyzed for &gt;162 patient-years of follow-up. Mean HbA1c (7.4 ± 1.0 prepump) decreased to 7.0 ± 0.9 after 12 months of CSII and continued to improve even after 4 years on CSII. The rate of SH was reduced by 53% (from 78 to 37/100 patient-years). Children who received daytime care from paid caregivers (n = 26) experienced significant reductions in HbA1c and hypoglycemia frequency. There were no episodes of DKA requiring emergency treatment in the year before CSII and 4 episodes (4 per 100 patient-years) after transition to pump.Conclusions. CSII is a durable and effective means of optimizing glycemic control in very young patients with type 1 diabetes and may be superior to multiple daily injections in minimizing the risk of severe hypoglycemia in this age group. Employment of paid caregivers does not preclude safe and effective use of CSII.
Increased Behavioral Morbidity in School-Aged Children With Sleep-Disordered Breathing
Authors: Rosen Carol L. , Storfer-Isser Amy , Taylor H. Gerry , Kirchner H. Lester , Emancipator Judith L. , Redline Susan 
Published: December 2004

Objective. To assess whether sleep-disordered breathing (SDB), ranging from primary snoring to obstructive sleep apnea (OSA), is associated with increased behavioral morbidity.Methods. A cross-sectional study was conducted of school-aged children in an urban, community-based cohort, stratified for term or preterm (&lt;37 weeks' gestation) birth status. A total of 829 children, 8 to 11 years old (50% female, 46% black, 46% former preterm birth) were recruited from a cohort study. All children had unattended in-home overnight cardiorespiratory recordings of airflow, respiratory effort, oximetry, and heart rate for measurement of the apnea hypopnea index (number of obstructive apneas and hypopneas per hour). SDB was defined by either parent-reported habitual snoring or objectively measured OSA. Functional outcomes were assessed with 2 well-validated parent ratings of behavior problems: the Child Behavioral Checklist and the Conners Parent Rating Scale–Revised:Long.Results. Forty (5%) children were classified as having OSA (median apnea hypopnea index: 7.1 per hour; interquartile range: 3.1–10.5), 122 (15%) had primary snoring without OSA, and the remaining 667 (80%) had neither snoring nor OSA. Children with SDB had significantly higher odds of elevated problem scores in the following domains: externalizing, hyperactive, emotional lability, oppositional, aggressive, internalizing, somatic complaints, and social problems.Conclusions. Children with relatively mild SDB, ranging from primary snoring to OSA, have a higher prevalence of problem behaviors, with the strongest, most consistent associations for externalizing, hyperactive-type behaviors.
Recognition and Management of Pediatric Fractures by Pediatric Residents
Authors: Ryan Leticia Manning , DePiero Andrew D. , Sadow Karin B. , Warmink Corwin A. , Chamberlain James M. , Teach Stephen J. , Johns Christina M. S. 
Published: December 2004

Background. Competence in basic orthopedic assessment and interpretation of radiographs is important for pediatricians because appropriate initial management of fractures can expedite therapy and minimize morbidity. However, requirements for training in orthopedics and radiology are poorly defined in pediatric residency programs.
Objective. To assess the ability of pediatric residents to recognize and to manage appropriately pediatric fractures.
Methods. This study involved administration of a case-based questionnaire with radiographs to volunteer categorical pediatric residents in 3 geographically diverse training programs. The diagnosis and management of 8 orthopedic complaints were evaluated. Responses were scored according to the number of features identified accurately, including the presence or absence of a fracture. Residents who were able to identify a fracture were assessed with respect to their ability to classify the fracture and to provide initial management. The study was pretested with a group of pediatric emergency medicine attending physicians, to establish the suitability of the cases.
Results. Among the 3 residency sites, 102 of 190 eligible pediatric residents (53.7%) participated, yielding 95 completed questionnaires. The mean number of cases in which a resident correctly answered the question, “Is a fracture present?” and correctly identified the fractured bone (if a fracture was present) was 6.5 ± 1.2 of 8 cases (81.6%; 95% confidence interval: 78.5–84.7%). The diagnostic accuracy of Salter-Harris classification in cases in which such fractures were present was 40.9%. The mean score of correctly identified features for the resident group was 38.5 ± 9.4, of a possible 64 points (proportion correct: 60.1%; 95% confidence interval: 57.2-63%). There was a small but significant difference in mean correct responses between first-year residents (proportion correct: 55.4%; 95% confidence interval: 50.8- 60.3%) and third-year residents (proportion correct: 65.1%; 95% confidence interval: 60.7-69.5%). There was no association between the proportion of correct responses and whether or not residents had taken radiology or orthopedics elective courses in medical school. Overall, 43% of cases were both identified and managed correctly by the pediatric residents.
Conclusions. For residents from the participating training programs, skills in recognizing and managing pediatric fractures were suboptimal. Additional review of training requirements is necessary to identify more clearly areas of improvement for current curricula.
Trends in Risk Factors for Cardiovascular Disease Among Children and Adolescents in the United States
Authors: Ford Earl S. , Mokdad Ali H. , Ajani Umed A. 
Published: December 2004

Background. The increasing prevalence of obesity among children and adolescents in recent decades might have affected trends in obesity-associated risk factors for cardiovascular disease.
Participants and Methods. We used data for 12 665 children and adolescents, 2 to 17 years of age, from the Third National Health and Nutrition Examination Survey (1988–1994) and for 3611 children and adolescents from National Health and Nutrition Examination Survey 1999–2000.
Results. For participants 2 to 17 years of age, waist circumference increased 1.6 cm among male subjects and 2.4 cm among female subjects. Mean systolic blood pressure increased by 2.2 mm Hg among children and adolescents 8 to 17 years of age. There were significant decreases in concentrations of triglycerides (8.8 mg/dL) and glucose (2.5 mg/dL) among children and adolescents 12 to 17 years of age. Mean concentrations of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and glycosylated hemoglobin were relatively unchanged. Some changes in means of risk factors varied according to age.
Conclusions. The temporal trends for risk factors among children and adolescents during the 1990s exhibited different patterns. The effects of the increasing prevalence of obesity on the cardiovascular health of children and adolescents remain unclear.
Declining Diagnosis of Birth Asphyxia in California: 1991–2000
Authors: Wu Yvonne W. , Backstrand Kendall H. , Zhao Shoujun , Fullerton Heather J. , Johnston S. Claiborne 
Published: December 2004

Objective. Birth asphyxia is recognized as an important cause of neonatal morbidity and mortality. Whether advances in perinatal care have altered the incidence of birth asphyxia is unknown. We determined the incidence of birth asphyxia diagnoses made over a 10-year period in California.Methods. In a population-based retrospective cohort study of 5 364 663 live births, we determined the incidence and case fatality of birth asphyxia between 1991 and 2000. Using a statewide administrative hospital discharge database, we identified all newborn admissions that generated a diagnosis of birth asphyxia (International Classification of Diseases, Ninth Revision, Clinical Modification codes 768.5, 768.6, or 768.9) or a diagnosis that overlaps with birth asphyxia, such as congenital encephalopathy or fetal distress. We determined incidence and in-hospital case fatality rates adjusted for birth weight and demographic characteristics and stratified by associated perinatal complications.Results. The 24 330 newborns who received a diagnosis of birth asphyxia yielded a population incidence of 4.5 per 1000 live births. Black ethnicity (relative risk [RR]: 1.3; 95% confidence interval [CI]: 1.2–1.3), male gender (RR: 1.2; 95% CI: 1.1–1.2), and low socioeconomic status (RR: 1.2; 95% CI: 1.1–1.2) all were associated with increased risk. The diagnosis of birth asphyxia decreased by 91% from 14.8 to 1.3 per 1000 live births during the study years. This decrease could not be explained by an increased diagnosis of overlapping conditions. Overall case fatality was 4%, and the majority of deaths in infants &gt;2000 g occurred in the presence of congenital anomalies, cord abnormalities, or maternal hemorrhage. In newborns &lt;2000 g, case fatality was highest in the presence of chorioamnionitis (48%).Conclusion. The diagnosis of birth asphyxia has decreased dramatically in recent years. The factors that are responsible for this decline are unclear and deserve additional investigation.
Topical 4% Amethocaine Gel Reduces the Pain of Subcutaneous Measles-Mumps-Rubella Vaccination
Authors: O'Brien Lisa , Taddio Anna , Ipp Moshe , Goldbach Morton , Koren Gideon 
Published: December 2004

Objectives. Ametop gel (4% amethocaine) is a relatively new topical anesthetic that produces anesthesia within 30 to 45 minutes and therefore may be appropriate for use in busy outpatient settings. The objective of this study was to assess the efficacy and safety of 4% amethocaine in reducing the pain of subcutaneous measles-mumps-rubella vaccination in 1-year-old infants.Methods.A double-blind, randomized, placebo-controlled trial was conducted in pediatric outpatient clinics.Results.A total of 120 infants participated in the study; 60 were followed up for assessment of antibody titers after 1 month. Either 1 g of amethocaine or placebo was applied for 30 minutes before vaccination. The Modified Behavioral Pain Scale was used to assess pain; the mean (standard deviation) pain scores for the amethocaine group (n = 61) was 1.5 (1.6) versus 2.3 (2.2) for the placebo group (n = 59). The rate of vaccination success (88% and 87%) was not different between treatment groups.Conclusions.4% Amethocaine significantly reduces the pain of measles-mumps-rubella vaccination in infants when compared with placebo and does not seem to interfere with subsequent development of protective antibody levels. Because of its relatively short application time (30 minutes), 4% amethocaine may be suitable for busy clinics and emergency departments.
Epidemiologic Features of Kawasaki Disease in Taiwan, 1996–2002
Authors: Chang Luan-Yin , Chang I-Shou , Lu Chun-Yi , Chiang Bor-Luen , Lee Chin-Yun , Chen Pei-Jer , Wang Jin-Town , Ho Hong-Nerng , Chen Ding-Shinn , Huang Li-Min ,   and the Kawasaki Disease Research Group
Published: December 2004

Objective. Kawasaki disease (KD) is the most common acquired heart disease in children worldwide. The incidence of KD varies among different countries, with Asian countries supposedly having higher incidences than Western countries. However, the incidence of KD in Taiwan has not been well investigated.Methods. Since the implementation of Taiwan's National Health Insurance (NHI) in 1995, NHI has covered health care for &gt;96% its population. Using the NHI database from 1996 to 2002, we investigated epidemiologic features of KD (International Classification of Diseases, Ninth Revision, code 446.1), the rate of coronary artery aneurysm formation (International Classification of Diseases, Ninth Revision, code 414.11), and the change in incidence during the recent 7 years. We also compared the annual incidences in Taiwan with those reported by other countries.Results. During the 7-year study period, KD occurred most frequently in the summer and least frequently in winter. It is interesting that the highest peak occurred in the summer of 1998 at the same time that Taiwan's enterovirus 71 epidemic was occurring. Ninety-one percent of KD cases occurred in children who were &lt;5 years old, and the male-to-female ratio was 1.70:1. Recurrence of KD was found in 1.3% (94 of 7305) of these children, and coronary artery aneurysm was found in 7.3% (536 of 7305). The annual incidence per 100 000 children was 146 in children &lt;1 year old, 98 in 1-year-old children, 51 in 2-year-old children, 28 in 3-year-old children, 19 in 4-year-old children, and 5.3 in 5- to 9-year-old children; the incidence of KD decreased with increased age. The overall incidence was 66 cases per 100 000 children &lt;5 years old from 1996 to 2002 with the annual incidence not differing significantly during the 7-year study period.Conclusions. KD in Taiwan occurs more frequently in boys and in the summer months. During the 7-year study period, the annual KD incidence in Taiwan of 66/100000 in children &lt;5 years old was the second highest in the world after Japan.
Psychosocial and Academic Characteristics of Extremely Low Birth Weight (≤800 g) Adolescents Who Are Free of Major Impairment Compared With Term-Born Control Subjects
Authors: Grunau Ruth E. , Whitfield Michael F. , Fay Taryn B. 
Published: December 2004

Objective. To compare academic and cognitive ability, attention, attitudes, and behavior of extremely low birth weight (ELBW) adolescents who are free of major impairments at 17 years of age with term-born control subjects.Methods. Between January 31, 1981, and February 9, 1986, 250 infants of ≤800 g were admitted for intensive care in British Columbia, 98 (39%) of whom survived to late adolescence. Teens with major sensorimotor handicaps and/or IQ &lt;70 were excluded (n = 19). Of the 79 eligible ELBW teens, 53 (67%) were assessed at 17.3 (16.3–19.7) years (birth weight: 720 [520–800g]; gestation: 26 [23–29] weeks). The test battery screened the following areas: cognitive (Wechsler Intelligence Scale for Adults Third Edition, 3 subtests), academic (Wide Range Achievement Test-3), attention (Connors' Continuous Performance Task), self-report (Harter Self-Perception Profile for Adolescents; Job Search Attitude Inventory), and parent report (Child Behavior Check List). A comparison group of term born control subjects (n = 31) were also assessed (birth weight: 3506 [3068–4196] g; gestation: 40 [39–42] weeks) at age 17.8 (16.5–19.0) years. Multivariate analysis of variance (group × gender) was conducted for each domain (cognitive, academic, self-report, and parent report).Results. The ELBW group showed lower cognitive scores (vocabulary, block design, and digit symbol) and academic skills (reading and arithmetic) compared with control subjects, with no gender differences. There were no differences in attention between the 2 groups using a repetitive computer task. ELBW teens reported lower scholastic, athletic, job competence, and romantic confidence and viewed themselves as more likely to need help from others in finding a job. In the behavioral domain, parents reported their ELBW teens to display more internalizing, more externalizing, and more total problems than the control teens, with ELBW boys showing more problems. ELBW teens showed a higher percentage of clinically significant behavior problems than control subjects.Conclusions. In a provincial cohort of unimpaired survivors of birth weight ≤800 g, psychosocial and educational vulnerabilities persist into late adolescence and may complicate the transition to adult life compared with their peers.
Prophylaxis of Early Adrenal Insufficiency to Prevent Bronchopulmonary Dysplasia: A Multicenter Trial
Authors: Watterberg Kristi L. , Gerdes Jeffrey S. , Cole Cynthia H. , Aucott Susan W. , Thilo Elizabeth H. , Mammel Mark C. , Couser Robert J. , Garland Jeffery S. , Rozycki Henry J. , Leach Corinne L. , Backstrom Conra , Shaffer Michele L. 
Published: December 2004

Background. Infants developing bronchopulmonary dysplasia (BPD) show decreased cortisol response to adrenocorticotropic hormone. A pilot study of low-dose hydrocortisone therapy for prophylaxis of early adrenal insufficiency showed improved survival without BPD at 36 weeks’ postmenstrual age, particularly in infants exposed to histologic chorioamnionitis.Methods. Mechanically ventilated infants with birth weights of 500 to 999 g were enrolled into this multicenter, randomized, masked trial between 12 and 48 hours of life. Patients received placebo or hydrocortisone, 1 mg/kg per day for 12 days, then 0.5 mg/kg per day for 3 days. BPD at 36 weeks’ postmenstrual age was defined clinically (receiving supplemental oxygen) and physiologically (supplemental oxygen required for O2 saturation ≥90%).Results. Patient enrollment was stopped at 360 patients because of an increase in spontaneous gastrointestinal perforation in the hydrocortisone-treated group. Survival without BPD was similar, defined clinically or physiologically, as were mortality, head circumference, and weight at 36 weeks. For patients exposed to histologic chorioamnionitis (n = 149), hydrocortisone treatment significantly decreased mortality and increased survival without BPD, defined clinically or physiologically. After treatment, cortisol values and response to adrenocorticotropic hormone were similar between groups. Hydrocortisone-treated infants receiving indomethacin had more gastrointestinal perforations than placebo-treated infants receiving indomethacin, suggesting an interactive effect.Conclusions. Prophylaxis of early adrenal insufficiency did not improve survival without BPD in the overall study population; however, treatment of chorioamnionitis-exposed infants significantly decreased mortality and improved survival without BPD. Low-dose hydrocortisone therapy did not suppress adrenal function or compromise short-term growth. The combination of indomethacin and hydrocortisone should be avoided.
Managed Care and Children With Special Health Care Needs
Authors: Kastner Theodore A. ,   and Committee on Children with Disabilities
Published: December 2004

This Clinical Report was retired May 2011.The implementation of managed care for children with special health care needs is often associated with apprehension regarding new barriers to health care services. At times, these barriers may overshadow opportunities for improvement. This statement discusses such opportunities, identifies challenges, and proposes active roles for pediatricians and families to improve managed care for children with special health care needs.
Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Statement for Health Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association
Authors: Newburger Jane W. , Takahashi Masato , Gerber Michael A. , Gewitz Michael H. , Tani Lloyd Y. , Burns Jane C. , Shulman Stanford T. , Bolger Ann F. , Ferrieri Patricia , Baltimore Robert S. , Wilson Walter R. , Baddour Larry M. , Levison Matthew E. , Pallasch Thomas J. , Falace Donald A. , Taubert Kathryn A. 
Published: December 2004

Background. Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in ∼15% to 25% of untreated children and may lead to ischemic heart disease or sudden death.Methods and Results. A multidisciplinary committee of experts was convened to revise the American Heart Association recommendations for diagnosis, treatment, and long-term management of Kawasaki disease. The writing group proposes a new algorithm to aid clinicians in deciding which children with fever for ≥5 days and ≤4 classic criteria should undergo electrocardiography, receive intravenous gamma globulin (IVIG) treatment, or both for Kawasaki disease. The writing group reviews the available data regarding the initial treatment for children with acute Kawasaki disease, as well for those who have persistent or recrudescent fever despite initial therapy with IVIG, including IVIG retreatment and treatment with corticosteroids, tumor necrosis factor-α antagonists, and abciximab. Long-term management of patients with Kawasaki disease is tailored to the degree of coronary involvement; recommendations regarding antiplatelet and anticoagulant therapy, physical activity, follow-up assessment, and the appropriate diagnostic procedures to evaluate cardiac disease are classified according to risk strata.Conclusions. Recommendations for the initial evaluation, treatment in the acute phase, and long-term management of patients with Kawasaki disease are intended to assist physicians in understanding the range of acceptable approaches for caring for patients with Kawasaki disease. The ultimate decisions for case management must be made by physicians in light of the particular conditions presented by individual patients.
Elimination of Organic Compounds of Sewage or Sewage Fractions in Sandy Soil below Leaking Sewers
Authors: Hua Jianmin , An Pinglin , Winter Josef , Gallert Claudia 
Published: December 2004

AbstractTo determine the purification effect of a sandy underground for pollutants from leaky sewers, raw sewage, clarified sewage and the resuspended solids fraction of sewage were trickled through sand columns of 1.25 m length.On average 79 % of the chemical oxygen demand (COD) of raw sewage from dry weather seasons and 62 % of the COD of raw sewage from wet seasons were eliminated during trickling through the sand. During trickling of the soluble sewage fraction 61 % of the COD were eliminated, whereas the COD of the hydrolysed portion of the particulate fraction was eliminated to an extent of 85 %. The non‐hydrolysed residues (26 % of the COD of sewage) remained as a discrete sludge layer on top and in the first 5 cm of the sand, not causing colmation during one year.The mean hydraulic residence time (HRT) of sewage in the sand columns was determined by spiking with potassium chloride and conductivity measurement. It was 24 h initially and after a trickling time of more than 8 months 32 h for the soluble fraction of sewage or 35 h for raw sewage. The increasing HRT of the soluble sewage fraction in the sand columns with trickling time indicated the formation of a water‐retaining biofilm on the sand particles in the columns, which was more pronounced when a greater portion of degradable COD was supplied with the raw sewage as compared to clarified sewage. The HRT of all columns was drastically shorter at flow rates of more than 6.4 L d—1, presumably by preferential, non‐restricted wastewater flow through large pores.