bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tubefeeding and Mortality in Children With Severe Disabilities and Mental Retardation
Authors: Strauss David , Kastner Theodore , Ashwal Stephen , White James 
Published: August 2004

Objective. To study the contribution of tubefeeding to mortality for children with severe disabilities and mental retardation. Previous research has suggested an association between tubefeeding and mortality. However, risk has never been determined using population-based data or defined in regard to patient variables.Methods. Retrospective analysis of a comprehensive statewide data set comprised of 4921 children with severe disabilities and mental retardation living in community and congregate care settings. The outcome measure was mortality; primary study variables included the presence of a feeding tube, measures of functional independence, type of residence, and medical comorbidity.Results. There were four findings. First, the use of a feeding tube was associated with virtually every disability. Second, when no study variables were controlled, statistically significant differences in mortality rates were noted between children who were tubefed and those who were not. The relative risk of mortality associated with use of a feeding tube was 2.1. Third, the use of a feeding tube was associated with a reduction in relative risk of mortality in children with tracheostomy (relative risk of mortality: .55). However, this association did not achieve statistical significance. Fourth, when study variables were controlled in a multivariate analysis, feeding tube use was associated with no identifiable increase in mortality among children with very severe disabilities, but was associated with an approximated doubled mortality rate among those with less severe disabilities.Conclusions. We hypothesize that the increased mortality associated with tubefeeding may be attributable to a differential increase in pulmonary disease secondary to overly vigorous nutritional maintenance and subsequent aspiration after tube placement. For children with tracheostomy this risk may be reduced. If tracheostomy proves to be associated with a relatively more favorable outcome for tubefeeding, we hypothesize that it would reflect the benefits of tracheostomy in allowing access to the airway for suctioning and ventilation. Given the observed higher mortality rates among the less severely disabled children who are tubefed and the substantial costs associated with tubefeeding, a prospective, controlled study may be clinically indicated, ethically justifiable, and economically warranted.
Epidemiology of Choanal Atresia With Special Reference to the CHARGE Association
Authors: Harris John , Robert Elisabeth , Källén Bengt 
Published: August 2004

Objective. To present epidemiologic data on the relatively rare malformation choanal atresia, based on a large collection of material and with special stress on the significance of the so-called CHARGE (coloboma, heart defect, choanal atresia, retarded growth and development, genital anomaly, and ear defect with deafness) association.Methods. Data from three large registries of congenital malformations were used. Based on more than 5 million births, 444 infants with choanal atresia were identified.Results. The average rate of choanal atresia is 0.82 per 10 000 and varies among programs. There is no statistically significant difference between races in rates, even though white infants have a higher rate than those of other races. The higher rate found in the California program is mainly attributable to unilateral, isolated cases. Unilateral atresia occurs equally often on the right and left. Among all cases of choanal atresia, the sex distribution is normal, a slightly increased risk at twinning exists, and no effect of maternal age or parity is seen. Chromosome anomalies are found in 6% of infants with choanal atresia, and 21 infants (5%) have monogenic syndromes or conditions. An analysis of associated malformations (present in 47% of the infants without chromosome anomalies) indicated that although a weak nonrandom association can be demonstrated between the malformations entering the so-called CHARGE complex, only a small proportion of infants with choanal atresia and other components of that condition probably represent this entity. The term CHARGE association seems to be overused in clinical practice.Conclusion. To be meaningful, the term CHARGE should be restricted to infants with multiple malformations and choanal atresia and/or coloboma combined with other cardinal malformations (heart, ear, and genital) and with a total of at least three cardinal malformations. Growth retardation should not be used in the definition.
Coagulopathy in Pediatric Abusive Head Trauma
Authors: Hymel Kent P. , Abshire Thomas C. , Luckey Dennis W. , Jenny Carole 
Published: August 2004

Objectives. Coagulopathy is a potential complication of head trauma that may be attributable to parenchymal brain damage. The objectives of this study were to assess the frequency of coagulation defects in pediatric abusivehead trauma and to analyze their relationship to parenchymal brain damage.
Methods. We reviewed the records of 265 pediatric patients hospitalized for head trauma. One hundred forty-seven patients met study inclusion criteria: (1) radiologic evidence of head trauma, (2) multidisciplinary validation that head trauma had been inflicted, and (3) coagulation screening performed within 2 days of presentation. Using nonparametric analysis, initial coagulation test results were compared between study patients without parenchymal brain damage and those with parenchymal brain damage.
Results. Mild prothrombin time (PT) prolongations (median 13.1) occurred in 54% of study patients with parenchymal brain damage and only 20% of study patients withoutparenchymal brain damage. Among pediatric abusive head trauma patients with parenchymal brain damage who died, 94% displayed PT prolongations (median 16.3) and 63% manifested evidence of activated coagulation.
Conclusions. PT prolongation and activated coagulation are common complications of pediatric abusive head trauma. In the presence of parenchymal brain damage, it is highly unlikely that these coagulation abnormalities reflect a preexisting hemorrhagic diathesis. These conclusions have diagnostic, prognostic, and legal significance.
Patterns of Cognitive Development in Very Low Birth Weight Children During the First Six Years of Life
Authors: Koller Helene , Lawson Katharine , Rose Susan A. , Wallace Ina , McCarton Cecelia 
Published: August 2004

Background. Cognitive development in very low birth weight (VLBW, ≤1500 g) infants typically has been reported based on mean endpoints in cross-sectional studies. These overall group means mask individual patterns of cognitive development. Given the heterogeneity of VLBW infants, it is important to identify individual patterns of development and the factors associated with the different patterns.Objective. We sought to determine individual patterns of cognitive development over the first 6 years in VLBW children and to examine the relative influence of selected biomedical and sociodemographic factors on these patterns.Method. VLBW infants (N = 203) were followed from birth to six years. Cognitive scores were obtained at four yearly intervals, and biomedical and social data were obtained beginning with the neonatal period. Cluster analysis was used to identify individual patterns of cognitive development.Results. Five developmental patterns were identified: average–stable (13% of the sample); average–declined to low average (24% of the sample); average–declined to below average (43% of the sample); very low–increased to low average (8% of the sample); and very low–stable (12% of the sample). The patterns could be differentiated by several biomedical factors, including birth weight, gestational age, neonatal health, and 1-year assessments of neurological status and head circumference, as well as by level of maternal education. In particular, abnormal neurological status at 1 year was associated with a pattern of very low stable scores, and a suspicious status was associated with a pattern of improving cognitive development. Maternal education was influential among children born at the upper end of the VLBW range, who had a more favorable set of biomedical factors.Conclusions. Biomedical factors are of major importance for the cognitive development of VLBW infants, and their influence increases as birth weight declines. Differences in neurological integrity at 1 year were an important indicator of different patterns of cognitive development, especially for infants at the lower end of the VLBW range.
Neuroradiographic Findings in the Newborn Period and Long-term Outcome in Children With Symptomatic Congenital Cytomegalovirus Infection
Authors: Boppana Suresh B. , Fowler Karen B. , Vaid Yoginder , Hedlund Gary , Stagno Sergio , Britt William J. , Pass Robert F. 
Published: August 2004

Objective. To determine whether newborn cranial computed tomographic (CT) scan abnormalities predict an adverse neurodevelopmental outcome in children with symptomatic congenital cytomegalovirus (CMV) infection and to examine the association between clinical findings at birth and imaging abnormalities.Methods. The data from 56 children with symptomatic congenital CMV infection who underwent cranial CT scans as newborns and were enrolled in a long-term follow-up study were analyzed. The incidence of sequelae was compared between the groups of children with normal and abnormal imaging studies. The relationship between CT scan results and other newborn findings was also examined.Results. Abnormal CT scans were noted in 70% of subjects; intracerebral calcification was the most frequent finding. Most of the children with an abnormal newborn CT scan (90%) developed at least one sequela, compared with 29% of those with a normal study. Only 1 child with a normal CT scan had an IQ &lt;70, in contrast to 59% of those with imaging abnormalities. In addition, almost half of the children with CT abnormalities had an IQ &lt;50 compared with none of those with a normal CT scan. Newborn CT abnormalities were also associated with an abnormal hearing screen at birth and hearing loss on follow-up. None of the neonatal neurologic findings were predictive of an abnormal CT scan.Conclusion. In neonates with symptomatic congenital CMV infection, a cranial CT scan is a good predictor of an adverse neurodevelopmental outcome. In addition, newborn clinical and laboratory findings did not predict neuroradiographic abnormalities in neonates with symptomatic congenital CMV infection.
Promoting Mealtime Communication Between Adolescent Mothers and Their Infants Through Videotape
Authors: Black Maureen M. , Teti Laureen O. 
Published: August 2004

Objective. To use social learning theory to develop and examine the effectiveness of a 15-minute, culturally sensitive videotape in altering mealtime communication and attitudes among African-American adolescent mothers.Design. Randomized clinical trial with baseline and follow-up evaluations.Setting. High schools, WIC (Women, Infants, and Children) Clinics, and Family Support Centers serving low-income families.Participants. Fifty-nine first-time, African-American adolescent mothers of infants.Intervention. Intervention group viewed and received a copy of a videotape titled “Feeding Your Baby With Love.” The messages, title, music, and setting were designed by an advisory group of six African-American adolescent mothers who were filmed feeding their infants in their homes.Measurements and Results. During baseline and follow-up evaluations, mothers were videotaped feeding their baby and completed a questionnaire on attitudes toward mealtime behavior. Analysis of covariance with repeated measures indicated changes in both behavior and attitudes. At follow-up, intervention mothers were more involved with their infant and reported more favorable attitudes toward feeding and communication than control mothers.Conclusions. Brief culturally sensitive videotapes may be effective strategies to promote parenting skills and to prevent social and health problems among adolescents.
Revised Guidelines for Prevention of Early-onset Group B Streptococcal (GBS) Infection
Authors:   Committee on Infectious Diseases and Committee on Fetus and Newborn
Published: August 2004

This Policy Statement was retired October 2002.
In 1992, the Committee on Infectious Diseases and Committee on Fetus and Newborn of the American Academy of Pediatrics provided guidelines for prevention of early-onset group B streptococcal (GBS) disease through intrapartum chemoprophylaxis of selected maternal GBS carriers.1 The guidelines were based on demonstrated efficacy in randomized, controlled clinical trials and selected only women with GBS colonization who had an obstetric risk factor.2 The guidelines were controversial34and their implementation incomplete.5 Since 1992, additional data have become available, and experience with the guidelines has been gained in numerous medical centers. Recently, consensus guidelines were developed by obstetricians, pediatricians, family practitioners, and public health authorities and published by the Centers for Disease Control and Prevention.6 These recommendations are supported by the American College of Obstetricians and Gynecologists7 and the American Academy of Pediatrics. This statement reviews the selection of pregnant women for chemoprophylaxis and provides an algorithm for management of their newborns.
Childhood Burn Injuries Related to Gasoline Can Home Storage
Authors: Kennedy Christopher S. , Knapp Jane F. 
Published: August 2004

Objective. To examine the risks associated with home storage of gasoline and to outline prevention strategies to avoid further injury and death.
Design. Case series.
Patients and Other Participants. Twenty-five patients less than 6 years old were selected for study (3 by presentation to a tertiary care Children’s Hospital Emergency Department, and 22 from the National Electronic Injury Surveillance System Data during the same calendar year).
Main Outcome Measures. Data collected included child’s age; burn injury, either percent body surface area or minor, moderate, or major burn classification; mortality; circumstances related to ignition of gasoline, such as behaviors, and if can was opened or closed; and flame source.
Results. Boys were involved in 95% of cases. Mean age was 2.7 years. The source of ignition was a pilot light in 100% of cases. Forty-four percent of patients died. Only vapors were ignited in 56% of cases. The gasoline can was described as closed in 64% of cases.
Conclusion. Gasoline is dangerous. The rectangular red metal gasoline can is not safe either. National building codes and can specifications are needed to prevent serious injury and deaths among young children. gasoline storage, pediatric burn injuries, fire safety.
Clinical Features and Virological Findings in Children With Primary Human Herpesvirus 7 Infection
Authors: Suga Sadao , Yoshikawa Tetsushi , Nagai Takao , Asano Yoshizo 
Published: August 2004

Objective. To elucidate clinical features of patients with primary human herpesvirus 7 (HHV-7) infection and serologic and virologic findings between HHV-7 and human herpesvirus 6 (HHV-6).Materials and Methods. During a 19-month observation period, 71 infants and children (35 boys and 36 girls with a mean age of 14.5 months [range, 1 month to 48 months]) who had acute febrile respiratory illness with or without skin rash were examined clinically and virologically. Heparinized blood samples were used for isolation of HHV-6 and HHV-7 and detection of both virus DNA sequences by a nested polymerase chain reaction amplification. Both virus antibody activities were measured by an indirect immunofluorescent assay.Results. HHV-7 infection was observed in 15 (6 boys and 9 girls with a mean age of 12.9 months [range, 7 months to 27 months]), 1 of 10 with upper respiratory infection and 14 (28%) of 50 with febrile exanthem, whereas HHV-6 infection was in 22 (44%) of the 50. Fever (37.5°C) was observed in all 15, with an average maximum body temperature of 38.7°C (range, 37.6°C to 39.8°C), which persisted for 2.9 days (range, 1 to 5 days). Papular, macular, or maculopapular rash was observed in 14 (93%) of the 15, which appeared on day 2.9 of fever (range, days 2 to 5) on the face, trunk, and extremities and persisted for 2.7 days (range, 1 to 5 days). A convulsive seizure that persisted for a few minutes developed in 1 patient on the first day of elevation of fever. HHV-6 antibody was demonstrated in 13 (87%), and a simultaneous significant increase to HHV-6 antibody titers was observed in 8 (53%) of the 15 during primary HHV-7 infection. HHV-7 and HHV-6 DNAs were almost always detected in mononuclear cells (MNCs) during acute and convalescent phases, whereas HHV-7 DNA was positive in some plasma samples obtained during the acute phase of the disease.Conclusions. Primary HHV-7 infection occurred somewhat later than HHV-6, which was confirmed by the isolation of HHV-7 from blood and/or seroconversion to the virus. Clinical features of a virologically confirmed patient with primary HHV-7 infection were comparable with those of primary HHV-6 infection. Preexisting HHV-6 antibody increased significantly in the half of patients with primary HHV-7 infection. HHV-7 DNA was detected in peripheral blood MNCs and plasma in the acute phase and persisted in MNCs thereafter. human herpesvirus 7, human herpesvirus 6, exanthem subitum, roseola infantum, polymerase chain reaction.
Juvenile Delinquency and Adolescent Trauma: How Strong Is the Connection?
Authors: Conseur Amy , Rivara Frederick P. , Emanuel Irvin 
Published: August 2004

Objectives. To determine whether youth convicted of juvenile offenses have a greater risk of injury resulting in hospitalization compared with nonoffending adolescents.
Design. A statewide hospital discharge database was linked to juvenile justice records to identify all hospitalizations occurring at ages 13 to 17 years for juvenile offenders and nonoffenders.
Subjects. Juvenile offenders and nonoffenders in Washington State during 1989 through 1992.
Main Outcome Measures. Incidence of hospitalizations attributable to injury, analyzed by cause of injury and intent.
Results. The prevalence of delinquency was 19.1% of male and 9.5% of female adolescents. Hospitalization for injury was 2.7-fold greater for male and 1.6-fold greater for female offenders compared with nonoffenders. The greatest risk of hospitalization was for intentional injury, especially that attributable to firearms, and for drug overdoses.
Conclusions. Juvenile offenders are much more likely to be hospitalized for an injury than nonoffenders. Admission to the hospital for trauma may serve as an opportunity for health providers to intervene with youth exhibiting high-risk behavior. delinquency, injuries, trauma, hospitalization.
PICNIC (Pediatric Investigators Collaborative Network on Infections in Canada) Study of the Role of Age and Respiratory Syncytial Virus Neutralizing Antibody on Respiratory Syncytial Virus Illness in Patients With Underlying Heart or Lung Disease
Authors: Wang Elaine E. L. , Law Barbara J. , Robinson Joan L. , Dobson Simon , al Jumaah Suliman , Stephens Derek , Boucher François D. , McDonald Jane , Mitchell Ian , MacDonald Noni E. 
Published: August 2004

Objective. To determine the effects of age and respiratory syncytial virus (RSV) antibody status on frequency and severity of RSV infections in children with underlying heart or lung disease.
Design. Cohort study conducted during two consecutive RSV seasons.
Setting. Ambulatory patients at eight Canadian pediatric tertiary care centers.
Methods. Subjects under 3 years old with underlying heart disease who were digoxin-dependent or had not received corrective cardiac surgery or with underlying lung disease were enrolled. Demographic information and an acute sera for RSV neutralizing antibody was obtained on enrollment. Weekly telephone follow-up consisting of a respiratory illness questionnaire was followed with a home visit to obtain a nasopharyngeal aspirate when there was new onset of respiratory symptoms. The specimen was used to detect RSV antigen. RSV illnesses were grouped as upper or lower respiratory tract infection (LRI) based on clinical and radiographic findings. RSV hospitalizations were considered to be those RSV infections that resulted in hospitalization.
Results. Of 427 enrolled subjects, 160 had underlying lung disease only, 253 had underlying heart disease only, and 14 had both. Eleven percent and 12% of lung and heart disease groups, respectively, had an RSV LRI. Three percent and 6% of lung and heart disease groups, respectively, were hospitalized with RSV infection. A significant decrease in frequency of RSV LRI and RSV hospitalization occurred with increasing age, with a major drop in those older than 1 year vs those younger than 1 year. Acute sera were available from 422 subjects. Geometric mean RSV antibody titers demonstrated a U-shaped distribution with increasing age. The trend to lower antibody concentrations in premature infants did not reach statistical significance. The frequency of RSV infection and RSV LRI was lower in patients with antibody at a titer more than 100, although the difference for RSV hospitalization was not statistically significant. These differences remained significant after age adjustment.
Conclusion. Both age and RSV antibody status impact on RSV illness and LRI. Reduction in illness frequency with increasing age may lead to more informed targeting of those children most likely to benefit from RSV immune globulin prophylaxis. respiratory syncytial virus, cohort study, passive prophylaxis, neutralizing antibody.