bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Comparative Efficacy Trial in Germany in Infants Who Received Either the Lederle/Takeda Acellular Pertussis Component DTP (DTaP) Vaccine, the Lederle Whole-Cell Component DTP Vaccine, or DT Vaccine
Authors: Stehr Klemens , Cherry James D. , Heininger Ulrich , Schmitt-Grohé Sabina , Überall Michael , Laussucq Suzanne , Eckhardt Thomas , Meyer Martin , Engelhardt Rita , Christenson Peter ,   the Pertussis Vaccine Study Group
Published: August 2004

Background. The goal of the trial was to determine the efficacy of a multicomponent acellular pertussis vaccine against Bordetella illnesses in comparison with a whole-cell product and DT.Design. In a randomized, double-blind fashion, 2- to 4-month-old infants received 4 doses of either DTP or DTaP vaccine at 3, 4.5, 6, and 15 to 18 months of age. The controls received 3 doses (3, 4.5, 15 to 18 months of age) of DT vaccine. The DTP vaccine was Lederle adsorbed vaccine (licensed in the United States) and DTaP was Lederle/Takeda adsorbed vaccine. Follow-up for vaccine efficacy started 2 weeks after the third dose (DTP/DTaP) and at the same age (6.5 months) in DT recipients. Reactogenicity of all doses of all three vaccines was documented by standardized parent diary cards. In addition, all subjects were monitored for respiratory illnesses and serious adverse events by biweekly phone calls.Results. From May 1991 to January 1993, a total of 10 271 infants were enrolled: 8532 received either DTP or DTaP and 1739 received DT. Specific efficacy against B pertussisinfections with cough ≥7 days duration was 83% (95% confidence interval [CI]: 76–88) and 72% (95% CI: 62–79) for DTP and DTaP, respectively; results for DTP and DTaP based on ≥21 days of cough with either paroxysms, whoop or posttussive vomiting (PWV) were 93% (95% CI: 89–96) and 83% (95% CI: 76–88), respectively. For DTaP vaccine, efficacy was higher after the fourth dose as compared with its efficacy after the third dose (78% vs 62% for cough ≥7 days and 85% vs 76% for cough ≥21 days with PWV). For DTP vaccine, efficacy was less varied after the third and fourth dose (78% vs 85% for cough ≥7 days and 93% vs 93% for cough ≥21 days with PWV). In contrast with DTP, the DTaP vaccine had some efficacy against B parapertussisinfection (point estimate for cough ≥7 days: 31% [95% CI: −10–56]). All vaccines were generally well-tolerated. However, side reactions were significantly less after DTaP compared with DTP.Conclusions. Like other multicomponent acellular pertussis vaccines, the Lederle/Takeda DTaP vaccine demonstrated good efficacy against mild and typical pertussis due to B pertussisinfections. Interestingly, it also may have some efficacy againstB parapertussis. Based on the results of this trial, the vaccine was licensed in the United States in December 1996 for all 5 doses of the currently recommended immunization schedule in this country.
Severe Invasive Group A Streptococcal Infections: A Subject Review
Authors:   Committee on Infectious Diseases
Published: August 2004

This Policy Statement was retired October 2004.
The course of severe invasive group A β-hemolytic streptococcal (GABHS) infections is often precipitous, requiring prompt diagnosis and rapid initiation of appropriate therapy. Therefore, physicians must have a high index of suspicion of this disease, particularly in patients at increased risk (eg, those with varicella or diabetes mellitus). Although a relationship between the use of nonsteroidal antiinflammatory drugs and severe invasive GABHS infections has been suggested, at present data on which to base a clinical decision about the use or restriction of nonsteroidal antiinflammatory drugs in children with varicella are insufficient. When necrotizing fasciitis is suspected, prompt surgical drainage, debridement, fasciotomy, or amputation often is necessary. Many experts recommend intravenously administered penicillin G and clindamycin for the treatment of invasive GABHS infections on the basis of animal studies. Some evidence exists that intravenous immunoglobulin given in addition to appropriate antimicrobial and surgical therapy may be beneficial. Although chemoprophylaxis for household contacts of persons with invasive GABHS infections has been considered by some experts, the limited available data indicate that the risk of secondary cases is low (2.9 per 1000) and data about the effectiveness of any drug are insufficient to make recommendations. Because of the low risk of secondary cases of invasive GABHS infections in schools or child care facilities, chemoprophylaxis is not indicated in these settings. Routine immunization of all healthy children against varicella is recommended and is an effective means to decrease the risk of invasive GABHS infections.
Lead Levels in High-risk and Low-risk Young Children in the Minneapolis-St Paul Metropolitan Area
Authors: Nordin James , Rolnick Sharon , Ehlinger Ed , Nelson Andrew , Arneson Tom , Cherney-Stafford Linda , Griffin Joan 
Published: August 2004

Objectives. To determine distribution of lead levels among children in a low-risk area; to validate a prescreening questionnaire; and to determine if universal lead screening is necessary in children in this area.Design. Blood lead levels and questionnaires were obtained on eligible patients. Data were analyzed using stepwise regression analysis.Setting. Community clinics and a health maintenance organization (HMO) in the Minneapolis-St Paul metropolitan area.Patients. A total of 9603 children at well-child visits, age 6 months to 6 years at community clinics, and 6 months to 3 years at the HMO.Outcome Measures. Whole blood lead levels (WBLs) and questionnaires.Results. The total sample rate of WBLs at ≥10 μg/dL was 12%, at ≥15 μg/dL was 3½%, and at ≥20 μg/dL was 1.2%. At both 10 μg/dL and 15 μg/dL, the non-HMO group was at higher risk. For both groups, risk factors included living in the central cities, and living in housing built before 1950. For the non-HMO group a history of the child eating paint chips, or the child or a sibling having previous lead poisoning were also risk factors.Conclusions. Not all children need lead screening. Children living in the central cities, or with the risk factors of living in housing built before 1950 or a previous history of lead poisoning should be screened.
The Apgar Score and Its Components in the Preterm Infant
Authors: Hegyi Thomas , Carbone Tracy , Anwar Mujahid , Ostfeld Barbara , Hiatt Mark , Koons Anne , Pinto-Martin Jennifer , Paneth Nigel 
Published: August 2004

Objective. The Apgar score is well-characterized in full-term infants but not in premature infants. The objective of this study was to assess the Apgar score in preterm infants with respect to the relationships between the 1- and 5-minute scores, the correlation of the Apgar score with pH and with other variables, and the relationship among the individual Apgar components.Methodology. We recorded Apgar scores at 1 and 5 minutes in a population-based cohort of preterm infants (n = 1105) with birth weight &lt;2000 g, from three intensive care nurseries in central New Jersey. Linear correlation analysis was used to examine the relationship between 1- and 5-minute Apgar scores and between the individual components of the Apgar score. Multiple regression analysis was used to explore the relationship between various perinatal characteristics and the Apgar score, and between pH and Apgar score. Stepwise logistic regression analysis was used to assess the determinants of mortality.Results. The 1-minute Apgar score median (25%, 75%) was 6(4,8) and correlated with the 5-minute score of 8(7,9) atr = .78. Slight but significant differences were seen between male (n = 557) and female (n = 508) infants in the 1-minute (6[4,8] and 7[4,8]) Apgar scores. One- and 5-minute scores of white infants (7[4,8] and 8[7,9]; n = 713) were significantly higher than those of black infants (5[3,7] and 8[6,9]; n = 280). Birth weight and gestational age were both linearly related to both Apgar scores. Low Apgar score (&lt;3 at 1 minute and &lt;6 at 5 minutes) was significantly associated with birth weight, gestational age and mode of delivery. Low arterial blood pH (&lt;7.01) at birth was significantly related to low Apgar score. One hundred fifty-nine infants died; these infants were significantly smaller (983 ± 382 vs 1462 ± 369 g), less mature (27 vs 31 weeks), had lower arterial blood pH (7.20 ± 0.18 vs 7.31 ± 0.11), had lower 1- (3[2,6] vs 7[4,8]) and 5-minute Apgar scores (6[4,8] vs 8[7,9]), and a greater incidence of low Apgar score (32% vs 6%) than did survivors.Conclusions. Among the components of the Apgar score, respiratory effort, muscle tone, and reflex activity correlated well with one another; heart rate correlated less well; and color the least. Our data confirms the limited use of the Apgar score in preterm infants and demonstrates the different responses of the Apgar score's components.
Increasing Prevalence of Overweight Among US Low-income Preschool Children: The Centers for Disease Control and Prevention Pediatric Nutrition Surveillance, 1983 to 1995
Authors: Mei Zuguo , Scanlon Kelley S. , Grummer-Strawn Laurence M. , Freedman David S. , Yip Ray , Trowbridge Frederick L. 
Published: August 2004

Objective. To determine whether the prevalence of overweight in preschool children has increased among the US low-income population.
Design. Analysis using weight-for-height percentiles of surveillance data adjusted for age, sex, and race or ethnicity.
Setting. Data from 18 states and the District of Columbia were examined.a
Subjects. Low-income children &lt;5 years of age who were included in the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance System.
Results. The prevalence of overweight increased from 18.6% in 1983 to 21.6% in 1995 based on the 85th percentile cutoff point for weight-for-height, and from 8.5% to 10.2% for the same period based on the 95th percentile cutoff point. Analyses by single age, sex, and race or ethnic group (non-Hispanic white, non-Hispanic black, and Hispanic) all showed increases in the prevalence of overweight, although changes are greatest for older preschool children.
Conclusion. Overweight is an increasing public health problem among preschool children in the US low-income population. Additional research is needed to explore the cause of the trend observed and to find effective strategies for overweight prevention beginning in the preschool years.
Fluoride Supplement Prescribing and Dental Referral Patterns Among Academic Pediatricians
Authors: Roberts Michael W. , Keels Martha Ann , Sharp Michael C. , Lewis Jasper L. 
Published: August 2004

Objective. To determine how well the current fluoride supplementation schedule was known by academic pediatricians and to examine the fluoride supplement prescribing and dental referral practices among primary care faculty pediatricians at four medical centers.Setting. Four university medical centers in North Carolina.Subjects. Primary care faculty pediatricians.Method. A questionnaire pretested for clarity was distributed to all identified full-time primary care pediatric faculty (42 members).Results. A total of 40 completed questionnaires were returned. Thirty-seven (93%) primary care faculty pediatricians reported that they routinely addressed the need for fluoride supplements for their patients, but only 28 (70%) determined the fluoride content of the drinking water before prescribing supplements. Thirty-five (87.5%) began supplements at the correct age, but fewer knew the correct doses for children of various ages. Only 23 (58%) referred their patients for oral examination and preventive care before the age of 36 months, contrary to American Academy of Pediatrics recommendations.Conclusions. Pediatricians in an academic setting would be expected to be more knowledgeable of current recommendations than those in private practice. Failure to know and teach correct fluoride supplement recommendations and failure to recommend early professional dental involvement can result in less than optimum oral health.
Effect of Allopurinol on Postasphyxial Free Radical Formation, Cerebral Hemodynamics, and Electrical Brain Activity
Authors: Van Bel Frank , Shadid Majidah , Moison Ralf M. W. , Dorrepaal Caroline A. , Fontijn Jehudith , Monteiro Louisa , Van De Bor Margot , Berger Howard M. 
Published: August 2004

Objective. Free radical-induced postasphyxial reperfusion injury has been recognized as an important cause of brain tissue damage. We investigated the effect of high-dose allopurinol (ALLO; 40 mg/kg), a xanthine-oxidase inhibitor and free radical scavenger, on free radical status in severely asphyxiated newborns and on postasphyxial cerebral perfusion and electrical brain activity.Methods. Free radical status was assessed by serial plasma determination of nonprotein-bound iron (μm), antioxidative capacity, and malondialdehyde (MDA; μm). Cerebral perfusion was investigated by monitoring changes in cerebral blood volume (ΔCBV; mL/100 g brain tissue) with near infrared spectroscopy; electrocortical brain activity (ECBA) was assessed in microvolts by cerebral function monitor. Eleven infants received 40 mg/kg ALLO intravenously, and 11 infants served as controls (CONT). Plasma nonprotein-bound iron, antioxidative capacity, and MDA were measured before 4 hours, between 16 and 20 hours, and at the second and third days of age. Changes in CBV and ECBA were monitored between 4 and 8, 16 and 20, 58 and 62, and 104 and 110 hours of age.Results. Six CONT and two ALLO infants died after neurologic deterioration. No toxic side effects of ALLO were detected. Nonprotein-bound iron (mean ± SEM) in the CONT group showed an initial rise (18.7 ± 4.6 μm to 21.3 ± 3.4 μm) but dropped to 7.4 ± 3.5 μm at day 3; in the ALLO group it dropped from 15.5 ± 4.6 μm to 0 μm at day 3. Uric acid was significantly lower in ALLO-treated infants from 16 hours of life on. MDA remained stable in the ALLO group, but increased in the CONT group at 8 to 16 hours versus &lt;4 hours (mean ± SEM; 0.83 ± 0.31 μm vs 0.50 ± 0.14 μm). During 4 to 8 hours, ΔCBV–CONT showed a larger drop than ΔCBV–ALLO from baseline. During the subsequent registrations CBV remained stable in both groups. ECBA–CONT decreased, but ECBA–ALLO remained stable during 4 to 8 hours of age. Neonates who died had the largest drops in CBV and ECBA.Conclusion. This study suggests a beneficial effect of ALLO treatment on free radical formation, CBV, and electrical brain activity, without toxic side effects.
Modulation of the Immune System by Human Milk and Infant Formula Containing Nucleotides
Authors: Pickering Larry K. , Granoff Dan M. , Erickson Julie Reed , Masor Marc L. , Cordle Christopher T. , Schaller Joseph P. , Winship Timothy R. , Paule Charles L. , Hilty Milo D. 
Published: August 2004

Objective. To determine whether human milk and nucleotides added to infant formula at levels present in human milk enhance development of the immune system during infancy.Methods. A 12-month, controlled, randomized and blinded, multisite feeding trial was conducted on two infant formulas: iron-fortified, milk-based control formula (Control) or the same formula fortified with nucleotides (Nucleotide). The level (72 mg/L) and ratio of individual nucleotides selected were patterned after those available in human milk. A third group fed human milk exclusively for 2 months and then human milk or Similac with iron until 12 months of age also was studied. Response to immunizations was chosen to assess development of the immune system. Infants followed the immunization schedule recommended by the American Academy of Pediatrics in 1991.Outcome Variables. Antibody responses were determined at 6, 7, and 12 months of age to Haemophilus influenzae type b polysaccharide (Hib), to diphtheria and tetanus toxoids, and to oral polio virus (OPV) immunizations.Results. Of 370 full-term, healthy infants enrolled, 311 completed the study (107 Control, 101 Nucleotide, 103 human milk/Similac with iron). Intake, tolerance, and growth of infants were similar in all three groups. Compared with the Control group 1 month after the third immunization (7 months of age), the Nucleotide group had a significantly higher Hib antibody concentration (geometric mean concentrations of 7.24 vs 4.05 μg/mL, respectively), and a significantly higher diphtheria antibody concentration (geometric mean of 1.77 vs 1.38 U/mL). The significantly higher Hib antibody response in the Nucleotide group persisted at 12 months. The antibody responses to tetanus and OPV were not enhanced by nucleotide fortification. There also was an effect of breastfeeding on immune response. Infants who breastfed had significantly higher neutralizing antibody titers to polio virus than either formula-fed group (1:346 vs 1:169 and 1:192 in the Control and Nucleotide groups, respectively) at 6 months of age.Conclusion. Infant formula fortified with nucleotides enhanced H influenzae type b and diphtheria humoral antibody responses. Feeding human milk enhanced antibody response to OPV. Dietary factors play a role in the antibody response of infants to immunization.
Safety of Hospitalized Ventilator-dependent Children Outside of the Intensive Care Unit
Authors: Ambrosio Iris U. , Woo Marlyn S. , Jansen Mary T. , Keens Thomas G. 
Published: August 2004

Objective. Hospitalization of clinically stable ventilator-dependent children in an intensive care unit (ICU) remains the standard in most pediatric centers. The aim of this study was to determine whether chronically ventilator-dependent children could be hospitalized safely in a non-ICU setting.
Methods. All ventilator-dependent children who were hospitalized on the pediatric wards at Childrens Hospital Los Angeles from December 1992 through June 1996 were reviewed retrospectively (N = 63) and compared with the general pediatric ward population hospitalized during the same period. Data collected included the number of unexpected ICU transfers from the pediatric ward and the number of deaths that occurred on the ward.
Results. The ventilator-dependent children on the pediatric wards had 11 emergency readmissions to the ICU for unexpected deterioration. This represented an unexpected ICU transfer rate of 2.7 per 1000 patient-days on the wards. The general pediatric ward population had an unexpected ICU transfer rate of 3.3 per 1000 patient-days, which was not significantly different from that of ventilator-dependent children on the wards. There were three ward deaths among the ventilator-dependent children, but all of these patients had advance directive status (do not resuscitate). This represented a rate of seven deaths per 10 000 patient-days on the wards, which was not significantly different from those of nonventilator-dependent ward patients (eight deaths per 10 000 patient-days).
Conclusions. We conclude that ventilator-dependent children hospitalized outside of the ICU do not have an increased incidence of deaths and unexpected ICU admissions compared with nonventilator-dependent inpatients. We speculate that hospital care of stable ventilator-dependent children can be provided safely outside of an ICU and at lower cost.
Mutation Screening of the BTK Gene in 56 Families With X-Linked Agammaglobulinemia (XLA): 47 Unique Mutations Without Correlation to Clinical Course
Authors: Holinski-Feder Elke , Weiss Michael , Brandau Oliver , Jedele Kerry B. , Nore Beston , Bäckesjö C. Magnus , Vihinen Mauno , Hubbard Stevan R. , Belohradsky Bernd H. , Smith C.I. Edvard , Meindl Alfons 
Published: August 2004

Objectives. To determine the utility of single-stranded conformation polymorphism (SSCP) analysis for mutation screening in the BTK (Bruton's tyrosine kinase) gene, we investigated 56 X-linked agammaglobulinemia (XLA) families. To obtain genotype/phenotype correlations, predicted protein aberrations were correlated with the clinical course of the disease.Patients. This study included 56 patients with XLA, with or without a positive family history, who were diagnosed on the basis of their clinical features, low peripheral B-cell count, and low immunoglobulin levels. Ten patients with isolated hypogammaglobulinemia and 50 healthy males served as controls.Methods. SSCP analysis was performed for the entire BTK gene, including the exon–intron boundaries and the promoter region. Structural implications of the missense mutations were investigated by molecular modeling, and the functional consequences of some mutations also were evaluated by in vitro kinase assays and Western blot analysis.Results. We report the largest series of patients with XLA to date. All but 5 of the 56 index patients with XLA screened with SSCP analysis showed BTK gene abnormalities, and in 2 of the 5 SSCP-negative patients, no BTK protein was found by Western blot analysis. There were 51 mutations, including 37 novel ones, distributed across the entire gene. This report contains the first promoter mutation as well as 14 novel missense mutations with the first ones described for the Tec homology domain and the glycine-rich motif in the SH1 domain. Each index patient had a different mutation, except for four mutations, each in two unrelated individuals. This result supports the strong tendency for private mutations in this disease. No mutations were found in the controls.Conclusions. Our results demonstrate that molecular genetic testing by SSCP analysis provides an accurate tool for the definitive diagnosis of XLA and the discrimination of borderline cases, such as certain hypogammaglobulinemia or common variable immunodeficiency patients with overlapping clinical features. Genotype/phenotype correlations are not currently possible, making prediction of the clinical course based on molecular genetic data infeasible.
Surveillance of Pediatric HIV Infection
Authors:   Committee on Pediatric AIDS
Published: August 2004

This Policy Statement was retired December 2015.
Pediatric human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) surveillance should expand to include perinatal HIV exposure and HIV infection as well as AIDS to delineate completely the extent and impact of HIV infection on children and families, accurately assess the resources necessary to provide services to this population, evaluate the efficacy of public health recommendations, and determine any potential long-term consequences of interventions to prevent perinatal transmission to children ultimately determined to be uninfected as well as for those who become infected. Ensuring the confidentiality of information collected in the process of surveillance is critical. In addition, expansion of surveillance must not compromise the established, ongoing surveillance system for pediatric AIDS. An expanded pediatric HIV surveillance program provides an important counterpart to existing American Academy of Pediatrics and American College of Obstetricians and Gynecologists recommendations for HIV counseling and testing in the prenatal setting.