bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inter-Neonatal Intensive Care Unit Variation in Discharge Timing: Influence of Apnea and Feeding Management
Authors: Eichenwald Eric C. , Blackwell Mary , Lloyd Janet S. , Tran Tai , Wilker Richard E. , Richardson Douglas K. 
Published: August 2004

Background.Premature infants need to attain both medical stability and maturational milestones (specifically, independent thermoregulation, resolution of apnea of prematurity, and the ability to feed by mouth) before safe discharge to home. Current practice also requires premature infants to be observed in hospital before discharge for several days (margin of safety) after physiologic maturity is recognized.Objective.To compare postmenstrual age (PMA) at discharge in a homogeneous population of premature infants cared for in different neonatal intensive care units (NICUs) and to assess the impact on hospital stay of the recognition and recording of physiologic maturity and the required margin of safety.Methods.We studied premature infants delivered at 30 to 34 6/7 weeks gestational age (GA), free of significant medical or surgical complications. Medical records of 30 eligible infants consecutively discharged from the hospital before July 1997 from each of 15 NICUs in Massachusetts (9 level 2 and 6 level 3) were reviewed.Results.A total of 435 infants were included in the study sample. Mean (± standard deviation) GA and birth weight of the study population were 33.2 ± 1.2 weeks and 2024 ± 389 g, respectively. Infants were discharged at a similar PMA regardless of GA at birth. Considerable variation in the PMA at discharge between hospital sites was observed (range, 35.2 ± 0.5 weeks to 36.5 ± 1.2 weeks). Despite the homogeneous study population, hospitals in which infants had the latest PMA at discharge also recorded mature cardiorespiratory and feeding behavior at an older age. Longer duration of pulse oximetry use was associated with later resolution of apnea. Differences in the duration of the margin of safety between sites did not contribute to variation in hospital stay.Conclusion.NICUs vary widely in length of hospital stay for healthy premature infants. We speculate that this variation results in part from differences in monitoring for and documentation of apnea of prematurity and feeding behavior.
Reactive Hyperemia and Interleukin 6, Interleukin 8, and Tumor Necrosis Factor-α in the Diagnosis of Early-Onset Neonatal Sepsis
Authors: Martin Helena , Olander Bodil , Norman Mikael 
Published: August 2004

Objective.To evaluate the diagnostic value of peripheral circulatory reactive hyperemia and serum levels of interleukin-6 (IL-6), IL-8, and tumor necrosis factor-α (TNF-α) in early-onset neonatal sepsis.Methods.Reactive hyperemia in the dorsal hand and serum levels of IL-6, IL-8, and TNF-α were studied in newborn infants (n = 32; gestational age 39 ± 3 weeks) who had been admitted to the neonatal unit because of suspected sepsis &lt;48 hours after birth. On admission, reactive hyperemia after a standardized arterial occlusion was measured with laser Doppler technique, and blood samples were taken for cytokine analyses. On the basis of predetermined criteria, the infants subsequently were classified as septic (n = 12) or not (n = 20).Results.The degree of reactive hyperemia was higher in the group with sepsis (median + 170% perfusion increase) than in that without (+37%). On admission, serum levels of IL-6, IL-8, and TNF-α all were higher in septic (median values: 1620, 331, and 22 pg/mL, respectively) than in nonseptic neonates (median values: 42, 63, and 13 pg/mL, respectively). In the group with sepsis, the degree of reactive hyperemia correlated to log IL-6 (r = 0.80) and log IL-8 values (r = 0.71).Conclusion.Newborn infants with septicemia have increased reactive hyperemia and elevated cytokine levels very early in their disease. Reactive hyperemia in skin can be analyzed at the bedside and noninvasively and therefore may serve as an additional diagnostic tool in neonatal sepsis.
Limb Deficiencies in Newborn Infants
Authors: McGuirk Caroline K. , Westgate Marie-Noel , Holmes Lewis B. 
Published: August 2004

Objective.
The prevalence rate of all types of limb reduction defects in general and those that potentially are caused by vascular disruption in particular is needed to provide a baseline for the evaluation of infants who are exposed in utero to teratogens that cause vascular disruption. The objective of this study was to determine this prevalence rate.

Methods.
All infants with any limb deficiency among 161 252 liveborn and stillborn infants and elective terminations were identified in a hospital-based Active Malformations Surveillance Program in Boston in the years 1972 to 1974 and 1979 to 1994. An extensive search was made to identify infants who were missed by the Surveillance Program; an additional 8 infants (7.3% of total) were identified. The limb reduction defects were classified in 3 ways: 1) by the anatomic location of the defect, that is longitudinal, terminal, intercalary, etc; 2) for infants with absence/hypoplasia of fingers or toes, a tabulation of which digit or digits were affected; and 3) by apparent cause.

Results.
The prevalence rate for all types of limb deficiency was 0.69/1000. The apparent causes included single mutant genes, familial occurrence, and known syndromes (24%); chromosome abnormalities (6%); teratogens (4%); vascular disruption (35%); and unknown cause (32%).

Conclusions.
A hospital-based surveillance program can be used to establish the prevalence of limb reduction defects, if ascertainment is extended to include elective terminations for fetal abnormalities. An apparent cause can be established for most limb defects when the clinical findings are used rather than reliance only on the International Classification of Diseases, Ninth Revision, codes of the discharge diagnoses. The prevalence rate of limb reduction defects as a result of presumed vascular disruption was 0.22/1000.
Breastfeeding and Early Weaning Practices in Northeast Brazil: A Longitudinal Study
Authors: Marques Neusa M. , Lira Pedro I. C. , Lima Marilia C. , da Silva Nara Lacerda , Filho Malaquias Batista , Huttly Sharon R.A. , Ashworth Ann 
Published: August 2004

Objectives.
To describe breastfeeding practices from 0 to 12 months of age in 4 small towns that are representative of urban northeast Brazil and to identify factors associated with introduction of other milk in the first month of life.

Methods.
From January to August 1998, 364 mothers were interviewed at delivery to ascertain antenatal care; delivery room practices; and their intentions regarding breastfeeding, pacifiers, and introduction of water, teas, and other milk. Their perceptions of home support and the advantages of breastfeeding also were assessed. Thereafter, daily information about feeding practices was collected at twice-weekly home visits. When other milk was started, a second interview was conducted to ascertain initial and current breastfeeding problems and use of a pacifier. Reasons for starting other milk were investigated using 5-point Likert scales.

Results.
Mothers were positive toward breastfeeding, and 99% breastfed their new infant. Few intended to breastfeed exclusively, and in the first week 80% gave water/tea and 56% used a pacifier. The median duration of exclusive breastfeeding was 0 days, and the median age for starting other milk was 24 days. The median duration of breastfeeding was 65 days for mothers who started other milk within 1 month and 165 days for other mothers. After adjustment for confounding variables, the main factors associated with introduction of other milk within 1 month were pacifier use in the first week (odds ratio [OR], 4.01; 95% confidence interval [CI]: 2.07–7.78), intention to start other milk in the first month (OR, 3.79; 95% CI: 1.74–8.24), giving water/tea in the first week (OR, 3.07; 95% CI: 1.56–6.03), and leaving the maternity ward before breastfeeding was started (OR, 2.59; 95% CI: 1.34–5.04).

Conclusion.
Although breastfeeding is common in this community, it rarely is exclusive and takes place for a relatively short duration. Identification of risk factors for early introduction of other milk offers potential avenues for future intervention, including improvement of breastfeeding support in antenatal and maternity services.
Exclusive Breastfeeding Reduces Acute Respiratory Infection and Diarrhea Deaths Among Infants in Dhaka Slums
Authors: Arifeen Shams , Black Robert E. , Antelman Gretchen , Baqui Abdullah , Caulfield Laura , Becker Stan 
Published: August 2004

Objectives.To describe breastfeeding practices and investigate the influence of exclusive breastfeeding in early infancy on the risk of infant deaths, especially those attributable to respiratory infections (ARI) and diarrhea.Methods.A prospective observational study was conducted on a birth cohort of 1677 infants who were born in slum areas of Dhaka in Bangladesh and followed from birth to 12 months of age. After enrollment at birth, the infants were visited 5 more times by 12 months of age. Verbal autopsy, based on a structured questionnaire, was used to assign a cause to the 180 reported deaths. Proportional hazards regression models were used to estimate the effect of breastfeeding practices, introduced as a time-varying variable, after accounting for other variables, including birth weight. Overall neonatal, postneonatal and infant mortality, and mortality attributable to ARI and diarrhea were measured.Results.The proportion of infants who were breastfed exclusively was only 6% at enrollment, increasing to 53% at 1 month and then gradually declining to 5% at 6 months of age. Predominant breastfeeding declined from 66% at enrollment to 4% at 12 months of age. Very few infants were not breastfed, whereas the proportion of partially breastfed infants increased with age. Breastfeeding practices did not differ between low and normal birth weight infants at any age. The overall infant mortality rate was 114 deaths per 1000 live births. Compared with exclusive breastfeeding in the first few months of life, partial or no breastfeeding was associated with a 2.23-fold higher risk of infant deaths resulting from all causes and 2.40- and 3.94-fold higher risk of deaths attributable to ARI and diarrhea, respectively.Conclusion.The important role of appropriate breastfeeding practices in the survival of infants is clear from this analysis. The reduction of ARI deaths underscores the broad-based beneficial effect of exclusive breastfeeding in prevention of infectious diseases beyond its role in reducing exposure to contaminated food, which may have contributed to the strong protection against diarrhea deaths.
Effect of a Single-Use Sterile Catheter for Each Void on the Frequency of Bacteriuria in Children With Neurogenic Bladder on Intermittent Catheterization for Bladder Emptying
Authors: Schlager Theresa A. , Clark Maureen , Anderson Susan 
Published: August 2004

Objective.
The frequency of bacteriuria is high in children with neurogenic bladder on intermittent catheterization for bladder emptying. In an effort to decrease bacteriuria, we examined whether the method of catheter care was responsible for the high rate of bacteriuria. For this, the frequency of bacteriuria was examined in the same patient on single-use sterile catheters and on reused clean catheters.

Methods.
A prospective, randomized, crossover trial was conducted with 10 patients who were randomized to 4 months of a new, sterile catheter for intermittent catheterization and 4 months of reuse of a clean catheter for intermittent catheterization. Each week, a urine sample was collected and symptoms of infection and medication use were recorded.

Results.
A total of 158 urine samples were collected during 164 patient-weeks on the new catheter method for each void; 115 (73%) were positive for a pathogen. Of the 161 samples collected during 169 patient-weeks on the standard, reuse method for voiding, 123 (76%) were positive (115 [73%] of 158 vs 123 [76%] of 161). Escherichia coli was the most common pathogen detected during both method periods.

Conclusion.
A new, sterile catheter for each void did not decrease the high frequency of bacteriuria in patients with neurogenic bladder on intermittent catheterization.
A Randomized, Controlled Trial of Kangaroo Mother Care: Results of Follow-Up at 1 Year of Corrected Age
Authors: Charpak Nathalie , Ruiz-Peláez Juan G. , Figueroa de C. Zita , Charpak Yves 
Published: August 2004

Objective.
To assess the effectiveness and safety of Kangaroo Mother Care (KMC) for infants of low birth weight.

Methods.
An open, randomized, controlled trial of a Colombian social security referral hospital was conducted. A total of 1084 consecutive infants who were born at ≤2000 g were followed, and 746 newborns were randomized when eligible for minimal care, with 382 to KMC and 364 to “traditional” care. Information on vital status was available for 693 infants (93%) at 12 months of corrected age. KMC consisted of skin-to-skin contact on the mother's chest 24 hours/day, nearly exclusive breastfeeding, and early discharge, with close ambulatory monitoring. Control infants remained in incubators until the usual discharge criteria were met. Both groups were followed at term and at 3, 6, 9, and 12 months of corrected age. The main outcomes measured were morbidity, mortality, growth, development, breastfeeding, hospital stay, and sequelae.

Results.
Baseline variables were evenly distributed, except for weight at recruitment (KMC: 1678 g; control participants: 1713 g). The risk for death was lower among infants who were given KMC, although the difference was not significant (KMC: 11 [3.1%] of 339; control participants: 19 [5.5%] of 324; relative risk: 0.57; 95% confidence interval: 0.17–1.18). The growth index of head circumference was statistically significantly greater in the group given KMC, but the developmental indices of the 2 groups were similar. Infants who weighed ≤1500 g at birth and were given KMC spent less time in the hospital than those who were given standard care. The number of infections was similar in the 2 groups, but the severity was less among infants who received KMC. More of these infants were breastfed until 3 months of corrected age.

Conclusion.
These results support earlier findings of the beneficial effects of KMC on mortality and growth. Use of this technique would humanize the practice of neonatology, promote breastfeeding, and shorten the neonatal hospital stay without compromising survival, growth, or development.
Maternal Epidural Use and Neonatal Sepsis Evaluation in Afebrile Mothers
Authors: Goetzl Laura , Cohen Amy , Frigoletto Fredric , Ringer Steven A. , Lang Janet M. , Lieberman Ellice 
Published: August 2004

Objective.
Epidural use has been associated with a higher rate of neonatal sepsis evaluation. Epidural-related fever explains some of the increase but not the excess of neonatal sepsis evaluations in afebrile women

Methods.
We studied 1109 women who had singleton term pregnancies and who presented in spontaneous labor and were afebrile during labor (&lt;100.4°F). Neonatal sepsis evaluation generally was performed on the basis of the presence of 1 major or 2 minor criteria. Major criteria included rupture of membranes for &gt;24 hours or sustained fetal heart rate of &gt;160 beats per minute. Minor criteria included a maternal temperature of 99.6°F to 100.4°F, rupture of membranes for 12 to 24 hours, maternal admission white blood cell count of &gt;15 000 cells/mL3, or an Apgar score of &lt;7 at 5 minutes.

Results.
Infants of afebrile women with epidural analgesia were more likely to be evaluated for sepsis than infants of women without epidural (20.4% vs 8.9%), although not more likely to have neonatal sepsis. An increased risk of sepsis evaluation persisted in regression analysis (odds ratio: 3.1; 95% confidence interval: 2.0, 4.7) after controlling for confounders and was not explained by longer labors with epidural. Women with epidural were significantly more likely to have major and minor criteria for sepsis evaluation, including fetal tachycardia (4.4% vs 0.4%), rupture of membranes for &gt;24 hours (6.2% vs 3.4%), low-grade fever of 99.6°F to 100.4°F (24.3% vs 5.2%), and rupture of membranes for 12 to 24 hours (21.4% vs 5.2%) than women without epidural.

Conclusions.
Epidural analgesia is associated with increased rates of major and minor criteria for neonatal sepsis evaluations in afebrile women.
Differences in Brain Temperature and Cerebral Blood Flow During Selective Head Versus Whole-Body Cooling
Authors: Laptook Abbot R. , Shalak Lina , Corbett Ron J. T. 
Published: August 2004

Objective.
To compare brain temperature and cerebral blood flow (CBF) during head and body cooling, with and without systemic hypoxemia.

Methods.
Seventeen newborn swine were studied for either measurement of brain temperature alone (n = 9) or measurement of brain temperature and CBF (n = 8). All animals were ventilated and instrumented, and temperature probes were inserted into the rectum, into the brain at depths of 2 and 1 cm from the cortical surface, and on the dural surface. Blood flow was measured with microspheres. The protocol consisted of a control period, an interval of either head or body cooling, and cooling with 15 minutes of superimposed hypoxia. After a 1-hour recovery period, animals were exposed to the same sequence except that the alternate mode of cooling was evaluated.

Results.
Head cooling with a constant rectal temperature resulted in an increase in the temperature gradient across the brain from the warmer central structures to the cooler periphery (brain 2 cm − dura temperature: 1.3 ± 1.1°C at control to 7.5 ± 3.5°C during cooling). Hypoxia superimposed on head cooling decreased the temperature gradient by at least 50%. In contrast, body cooling was associated with an unchanged temperature gradient across the brain (brain 2 cm − dura temperature: 1.5 ± 1.2°C at control to 1.1 ± 0.9°C during cooling). Hypoxia superimposed on body cooling did not change brain temperature. Both modes of brain cooling resulted in similar reductions of global CBF (∼40%) and O2 uptake.

Conclusion.
Brain hypothermia achieved through head or body cooling results in different brain temperature gradients. Alterations in systemic variables (ie, hypoxemia) alters brain temperature differently in these 2 modes of brain cooling. The mode of brain cooling may affect the efficacy of modest hypothermia as a neuroprotective therapy.
Treatment of Extensive Toxic Epidermal Necrolysis in Children
Authors: Spies Marcus , Sanford Arthur P. , Low J. F. Aili , Wolf Steven E. , Herndon David N. 
Published: August 2004

Objective.
Toxic epidermal necrolysis (TEN) is a rare but life-threatening disease of the skin and mucous membranes. We report our experience in the treatment of pediatric TEN patients with early debridement of necrotic skin and coverage with human allograft skin.

Methods.
From 1984 to 2000, 15 children (6 girls, 9 boys, 7.2 ± 1.5 years) with a histologic diagnosis of TEN and involvement of &gt;30% total body surface area were treated at the Shriners Hospitals for Children in Galveston. All were treated in a specialized pediatric burn intensive care unit after our standard treatment protocol, including operative debridement of sloughing skin and allografting within 24 hours of admission. Outcome parameters were mortality, length of hospital stay, wound healing, clinical complications, causative drugs, corticosteroid use, and delay in referral to a burn center.

Results.
Taking a new medication (antibiotics, anticonvulsive drugs) was associated with all cases of TEN. Patients who were treated with early debridement and coverage with allograft skin showed no wound infection, and overall mortality was 7%. Total length of hospital stay was 26 ± 3 days. Long-term sequelae were changes in skin pigmentation (100%), ophthalmologic problems (40%), and diffuse itching early after wound healing (53%).

Conclusion.
Although a rare disease in children, TEN was managed successfully in a burn center environment, using early debridement and wound coverage with allograft skin as a biological dressing. The use of corticosteroids and referral patterns seems unchanged during the past 2 decades, indicating an additional need for information and education about the disease.
Unexplained Reduced Microbiological Efficacy of Intramuscular Benzathine Penicillin G and of Oral Penicillin V in Eradication of Group A Streptococci From Children With Acute Pharyngitis
Authors: Kaplan Edward L. , Johnson Dwight R. 
Published: August 2004

Objective.To evaluate the efficacy of oral penicillin V and intramuscular benzathine penicillin G (BPG) in eradicating group A streptococci from the upper respiratory tract.Methodology.Two randomized, single-blind, multicenter antibiotic efficacy trials in children using recommended doses of either oral penicillin V or intramuscular BPG for treatment of acute-onset pharyngitis associated with isolation of group A streptococci were conducted. Throat examinations and cultures were obtained at enrollment and on days 5 to 8, 10 to 14, and 29 to 31.Results.Thirty-five percent of 284 evaluable patients treated with oral penicillin V and 37% of BPG-treated patients were microbiologic treatment failures at either 10 to 14 or 29 to 31 days.Conclusions.Although these findings do not provide sufficient evidence to change current treatment recommendations or public health policy, important questions are raised about currently recommended penicillin doses, about the role of the carrier state, and possibly about adequate bioavailability of intramuscular BPG. These findings require confirmation.
Acute Helicobacter pylori Infection Is Followed by an Increase in Diarrheal Disease Among Peruvian Children
Authors: Passaro Douglas J. , Taylor David N. , Meza Rina , Cabrera Lilia , Gilman Robert H. , Parsonnet Julie 
Published: August 2004

Background.
Cohort and case-crossover studies were conducted to evaluate whether new Helicobacter pylori infections are followed by increased diarrhea.

Methods.
Participants were 6-month-old to 12-year-old shantytown residents living near Lima, Peru. Baseline data were collected from community households. Health interviews were completed daily, and sera, drawn every 4 months, were tested for H pylori immunoglobulin G. Diarrhea rates among newly H pylori-infected (seroconverting) children were compared with rates among persistently uninfected and infected children using cohort and case-crossover analyses.

Results.
Sera were obtained from 345 children from January 1, 1995, through September 1, 1997. H pylori incidence was 12% per year (36 H pylori infections in 109 866 seronegative days). In adjusted cohort analyses, seroconverters had more diarrhea days (rate ratio: 2.0; 95% confidence interval: 1.6–2.4), episodes, and sick days in the year after infection than did uninfected children; and more diarrhea days and sick days than did persistently infected children. This effect was strongest in the first 2 months. Case-crossover analyses supported these findings.

Conclusion.
Preventing H pylori infection may help reduce pediatric diarrheal disease.