bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oral Health Risk Assessment Timing and Establishment of the Dental Home
Authors:   Section on Pediatric Dentistry
Published: August 2004

This Policy Statement was retired January 2015.
Early childhood dental caries has been reported by the Centers for Disease Control and Prevention to be perhaps the most prevalent infectious disease of our nation’s children. Early childhood dental caries occurs in all racial and socioeconomic groups; however, it tends to be more prevalent in low-income children, in whom it occurs in epidemic proportions. Dental caries results from an overgrowth of specific organisms that are a part of normally occurring human flora. Human dental flora is site specific, and an infant is not colonized until the eruption of the primary dentition at approximately 6 to 30 months of age. The most likely source of inoculation of an infant’s dental flora is the mother or another intimate care provider, through shared utensils, etc. Decreasing the level of cariogenic organisms in the mother’s dental flora at the time of colonization can significantly impact the child’s predisposition to caries. To prevent caries in children, high-risk individuals must be identified at an early age (preferably high-risk mothers during prenatal care), and aggressive strategies should be adopted, including anticipatory guidance, behavior modifications (oral hygiene and feeding practices), and establishment of a dental home by 1 year of age for children deemed at risk.
Health Services Use by Children of Migratory Agricultural Workers: Exploring the Role of Need for Care
Authors: Weathers Andrea , Minkovitz Cynthia , O’Campo Patricia , Diener-West Marie 
Published: August 2004

Objective. For migrant children: 1) to assess the determinants of health services use among users and nonusers of health services; 2) to evaluate the association between health status and health services use, while controlling for potential confounders.Design. A cross-sectional household survey using multistage, partially random sampling to identify migrant families in eastern North Carolina.Participants. Adult caretakers of 1 randomly selected child under 13 years old.Results. Forty-four percent of children (N = 300) visited a doctor in the preceding 3 months. Those visiting a doctor disproportionately reported having less than very good health (29% vs 10%), insurance (46% vs 11%), interpreters (45% vs 27%), a family member receiving Special Supplemental Nutrition Program for Women, Infants, and Children (50% vs 16%), and a legal caretaker (30% vs 18%). Compared with those without a doctor visit, a larger proportion of children visiting a doctor were 6 years or younger in age (71% vs 35%), born in the United States (51% vs 15%), female (64% vs 45%), and had not moved in 6 or more months (19% vs 10%). Controlling for enabling resource and sociodemographic confounders, children with less than very good health were 2.4 times more likely than those in very good health to have visited a doctor (95% confidence interval [1.1–5.2]).Conclusions. Migrant children using health services are distinct from nonusers with regards to sociodemographic factors, enabling resources, and need for care. Health services use is associated with less than very good perceived health, despite resource barriers and sociodemographic disadvantages. More efforts are needed to improve access to health care for migrant children.
Serious Bacterial Infections in Febrile Infants Younger Than 90 Days of Age: The Importance of Ampicillin-Resistant Pathogens
Authors: Byington Carrie L. , Rittichier Kristine K. , Bassett Kathlene E. , Castillo Heidi , Glasgow Tiffany S. , Daly Judy , Pavia Andrew T. 
Published: August 2004

Background. Intrapartum antibiotic prophylaxis against group B Streptococcus (GBS) has reduced the occurrence of serious bacterial infections (SBI) in young infants caused by GBS. Recommendations for initial antibiotic therapy for the febrile infant 1 to 90 days old were developed when infections with GBS were common and antibiotic resistance was rare.Objective. To document the pathogens responsible for SBI in recent years in febrile infants 1 to 90 days old and the antibiotic susceptibility of these organisms.Methods. The results of bacterial cultures from infants 1 to 90 days old evaluated for fever at Primary Children’s Medical Center in Salt Lake City, Utah, between July 1999 and April 2002 were analyzed. Antibiotic susceptibility profiles were collected and patient records were reviewed to determine if initial antibiotic therapy was changed following the identification of the organism.Results. Of 1298 febrile infants enrolled from the Primary Children’s Medical Center emergency department, 105 (8%) had SBI. The mean age of the infants with SBI was 39 days (range 2–82 days) and 2 (2%) were &lt;7 days. SBI included urinary tract infection (UTI; 67%), bacteremia (16%), bacteremia and UTI (6%), bacteremia and meningitis (5%), meningitis (2%), abscess (2%), meningitis and UTI (1%), and meningitis and gastroenteritis (1%). Eighty-three (79%) of 105 episodes of SBI were caused by Gram-negative bacteria, including 92% of UTI, 54% of bacteremia, and 44% of meningitis cases. The most common pathogen was Escherichia coli (61%). Other Gram-negative pathogens were responsible for 19% of SBI. Staphylococcus aureus was the most common Gram-positive pathogen, causing 8% of SBI. GBS accounted for 6% of SBI.Of the 105 pathogens, 56 (53%) were resistant to ampicillin. Of the pathogens causing meningitis, UTI, and bacteremia, 78%, 53%, and 50%, respectively, were resistant to ampicillin. Antibiotic therapy was changed in 54% of cases of SBI following identification of the organism.Conclusions. In Utah, ampicillin-resistant Gram-negative bacteria are the most common cause of SBI in febrile infants &lt;90 days old. This finding impacts antibiotic selection, especially in cases of meningitis. Local surveillance of pathogens and antibiotic susceptibility patterns is critical to determine appropriate antibiotic therapy.
Extrauterine Growth Restriction Remains a Serious Problem in Prematurely Born Neonates
Authors: Clark Reese H. , Thomas Pam , Peabody Joyce 
Published: August 2004

Background. Poor growth is a common problem in premature neonates and may be associated with neurodevelopmental delay.
Objective. To evaluate the incidence of extrauterine growth restriction (growth values ≤10th percentile of intrauterine growth expectation based on estimated postmenstrual age in premature (23–34 weeks’ estimated gestational age) neonates at the time they are discharged from the hospital.
Design/Methods. Using a database formed from a computer-assisted tool that generates clinical progress notes and discharge summaries on neonatal intensive care unit admissions, we reviewed data on neonates discharged from 124 neonatal intensive care units between January 1, 1997, and December 31, 2000. We evaluated neonates who were born between 23 and 34 weeks’ estimated gestational age without congenital anomalies and who were cared for at and discharged from the same hospital. For each patient, we compared the discharge growth values to the expected values based on our intrauterine growth data and postmenstrual age on the day of discharge. We defined extrauterine growth restriction as having a measured growth value (weight, length or head circumference) that was ≤10th percentile of the predicted value. In each specific birth weight and estimated gestational age group, we counted the number of neonates ≤10th percentile for each growth parameter and calculated the percentage of patients who had values ≤10th percentile at discharge. Using logistic regression, we evaluated the factors associated with extrauterine growth restriction for weight, length, and head circumference.
Results. Our sample included 24 371 premature neonates. Data on discharge weight, length, and head circumference was available on 23 970, 17 203, and 20 885 neonates, respectively. The incidence of extrauterine growth restriction was common (28%, 34%, and 16% for weight, length, and head circumference, respectively). For each growth parameter, the incidence of extrauterine growth restriction increased with decreasing estimated gestational age and birth weight. Factors independently associated with extrauterine growth restriction were male gender, need for assisted ventilation on day 1 of life, a history of necrotizing enterocolitis, need for respiratory support at 28 days of age, and exposure to steroids during the hospital course.
Conclusions. Extrauterine growth restriction remains a serious problem in premature neonates especially for neonates who are small, immature, and critically ill.
Medication Use in the Treatment of Pediatric Insomnia: Results of a Survey of Community-Based Pediatricians
Authors: Owens Judith A. , Rosen Carol L. , Mindell Jodi A. 
Published: August 2004

Objectives. To examine clinical practice patterns, beliefs, and attitudes regarding the use of both nonprescription and prescription medications by community-based pediatricians for children with significant difficulties in initiating and/or maintaining sleep.
Methods. A survey was mailed to 3424 American Academy of Pediatrics members in 6 US cities.
Results. The final sample (n = 671) consisted of practitioners who identified themselves as primary care pediatricians. Three percent ± 7% of visits in the respondents’ practices were for pediatric insomnia, although there was a wide range in the numbers of children identified during a typical 6-month practice period. More than 75% of practitioners had recommended nonprescription medications, and &gt;50% had prescribed a sleep medication. Specific clinical circumstances in which medications were most commonly used were acute pain and travel, followed by children with special needs (mental retardation, autism, and attention-deficit/hyperactivity disorder). Antihistamines were the most commonly reported nonprescription medications for sleep. Melatonin or herbal remedies had been recommended by approximately 15% of the respondents. α-agonists were the most frequently prescribed sleep medications (31%). The likelihood of prescribing medication for sleep was 2- to 4-fold greater in respondents who treated children with attention-deficit/hyperactivity disorder for daytime behavioral problems or nocturnal sleep problems, respectively. Practitioners expressed a range of concerns about sleep medication appropriateness, safety, tolerance, and side effects in children.
Conclusions. The practice of prescribing or recommending sedatives and hypnotics for pediatric insomnia is common among community-based pediatricians, especially among special needs patients. An empirically based approach to the use of these medications is needed.
Economic Analysis of Promotion of Hepatitis B Vaccinations Among Vietnamese-American Children and Adolescents in Houston and Dallas
Authors: Zhou Fangjun , Euler Gary L. , McPhee Stephen J. , Nguyen Thoa , Lam Tram , Wong Ching , Mock Jeremiah 
Published: August 2004

Objective. To ascertain the cost-effectiveness and benefit-cost ratios of 2 public health campaigns conducted in Dallas and Houston in 1998–2000 for “catch-up” hepatitis B vaccination of Vietnamese-Americans born 1984–1993.Design. Program evaluation.Setting. Houston and Dallas, Texas.Participants. A total of 14 349 Vietnamese-American children and adolescents.Interventions. Media-led information and education campaign in Houston, and community mobilization strategy in Dallas. Outcomes were compared with a control site: Washington, DC.Main outcome measures. Receipt of 1, 2, or 3 doses of hepatitis B vaccine before and after the interventions, costs of interventions, cost-effectiveness ratios for intermediate outcomes, intervention cost per discounted year of life saved, and benefit-cost ratio of the interventions.Results. The number of children who completed the series of 3 hepatitis B vaccine doses increased by 1176 at a total cost of $313 904 for media intervention, and by 390 and at $169 561 for community mobilization. Costs per child receiving any dose, per dose, and per completed series were $363, $101, and $267 for media intervention and $387, $136, and $434 for community mobilization, respectively. For media intervention, the intervention cost per discounted year of life saved was $9954 and 131 years of life were saved; for community mobilization, estimates were $11 759 and 60 years of life. The benefit-cost ratio was 5.26:1 for media intervention and 4.47:1 for community mobilization.Conclusion. Although the increases in the number of children who completed series of 3 doses were modest for both the Houston and Dallas areas, both media education and, to a lesser degree, community mobilization interventions proved cost-effective and cost-beneficial.
Occult Head Injury in High-Risk Abused Children
Authors: Rubin David M. , Christian Cindy W. , Bilaniuk Larissa T. , Zazyczny Kelly Ann , Durbin Dennis R. 
Published: August 2004

Objective. Head injury is the leading cause of death in abused children under 2 years of age. Evidence for establishing guidelines regarding screening for occult head injury in a neurologically asymptomatic child with other evidence of abuse is lacking. This is particularly important given that many children with acute inflicted head injury have evidence of old injury when they are diagnosed. The primary aim of this study was to estimate the prevalence of occult head injury in a high-risk sample of abused children with normal neurologic examinations. The secondary aim was to describe characteristics of this population.Methods. Children under 2 years of age admitted to an urban children’s hospital between January 1998 and December 2001 with injuries suspicious for child abuse were eligible for this study if they had a normal neurologic examination on admission. Subjects were selected if they met 1 of the following “high-risk” criteria: rib fractures, multiple fractures, facial injury, or age &lt;6 months. Subjects were excluded if they had a history of neurologic dysfunction, seizures, respiratory arrest, or if their initial physical examination revealed scalp injury.Results. Of the 65 patients who met these criteria, 51 (78.5%) had a head computed tomography or magnetic resonance imaging in addition to skeletal survey. Of these 51 patients, 19 (37.3%, 95% confidence interval 24.2–50.4%) had an occult head injury. Injuries included scalp swelling (74%), skull fracture (74%), and intracranial injury (53%). All except 3 of the head-injured patients had at least a skull fracture or intracranial injury. Skeletal survey alone missed 26% (5/19) of the cases. Head-injured children were younger than non-head-injured children (median age 2.5 vs 5.1 months); all but 1 head-injured child was &lt;1 year of age. Among the head-injured children, 72% came from single parent households, 37% had mothers whose age was &lt;21 years, and 26% had a history of prior child welfare involvement in their families. Ophthalmologic examination was performed in 14 of the 19 cases; no retinal hemorrhages were noted.Conclusions. Our results support a recommendation for universal screening in neurologically asymptomatic abused children with any of the high-risk criteria used in this study, particularly if that child is under 1 year of age. Ophthalmologic examination is a poor screening method for occult head injury, and one should proceed directly to computed tomography or magnetic resonance imaging. Given the high prevalence of occult head injury detected in this study, further study is warranted to estimate the prevalence of occult head injury in lower risk populations of abused children.
Differential Influence of Family History of Hypertension and Premature Myocardial Infarction on Systolic Blood Pressure and Left Ventricular Mass Trajectories in Youth
Authors: Dekkers J. Caroline , Treiber Frank A. , Kapuku Gaston , Snieder Harold 
Published: August 2004

Objective. To examine the influence of genetic susceptibility to essential hypertension (EH) and the genetic susceptibility to premature myocardial infarction (MI) on longitudinal development of systolic blood pressure (SBP) and left ventricular mass (LVM) in youth.Methods. Individual SBP and LVM growth curves across age were created for a sample of 745 subjects (age range: 4.9–27.5 years) and a sample of 687 subjects (age range: 8.2–27.5 years), respectively. Each sample had an approximately equal proportion of African American and European American males and females, with annual assessments over a 10-year period. Family history (FH) of EH and FH of premature MI were used as measures of genetic susceptibility to EH and to premature MI, respectively. Positive FH (FH+) of EH and of premature MI were defined, respectively, as verified EH in 1 or both biological parents, and verified MI in any biological parent or grandparent before 55 years of age.Results. Subjects with an FH+ of EH had higher SBP levels and stronger increases in SBP over time than subjects with a negative FH (FH−) of EH. Subjects with an FH+ of EH also showed higher LVM levels than subjects with an FH− of EH. In addition, the effect of an FH+ of EH on LVM was stronger in females than males. The effects of FH of EH on SBP and LVM could not be explained by differences in socioeconomic status, but the effect on LVM was no longer significant after adjustment for BMI. FH of MI had no significant effects on SBP or LVM.Conclusions. Effects of genetic susceptibility to EH on SBP and LVM trajectories were observed in childhood, whereas no such effects were found for FH of MI. Genetic markers of EH may improve the understanding of individual differences in susceptibility to develop hypertension and LV hypertrophy.
National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Chronic Kidney Disease in Children and Adolescents: Evaluation, Classification, and Stratification
Authors: Hogg Ronald J. , Furth Susan , Lemley Kevin V. , Portman Ronald , Schwartz George J. , Coresh Josef , Balk Ethan , Lau Joseph , Levin Adeera , Kausz Annamaria T. , Eknoyan Garabed , Levey Andrew S. 
Published: August 2004

Objectives. A series of new guidelines has been developed by the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative to improve the detection and management of chronic kidney disease (CKD). In most instances of CKD, the earliest manifestations of the disorder may be identified by relatively simple tests. Unfortunately, CKD is often “underdiagnosed,” in part because of the absence of a common definition of CKD and a classification of the stages in its progression. The Kidney Disease Outcomes Quality Initiative clinical practice guidelines for CKD evaluation, classification, and stratification provide a basis to remedy these deficits. The specific goals of the guidelines described in this review are to provide: 1) an overview of the clinical practice guidelines as they pertain to children and adolescents, 2) a simple classification of the stages of CKD, and 3) a practical approach to the laboratory assessment of kidney disease in children and adolescents.Methods. The guidelines were developed as part of an evidence-based evaluation of CKD and its consequences in patients of all ages. The data that were used to generate the guidelines in this article were extracted from a structured analysis of articles that reported on children with CKD.Results and Conclusions. This review presents the definition and 5-stage classification system of CKD developed by the work group assigned to develop the guidelines, and summarizes the major recommendations regarding the early detection of CKD. Major emphasis is placed on the identification of children and adolescents with CKD by measuring the protein-to-creatinine ratio in spot urine specimens and by estimating the glomerular filtration rate from serum creatinine using prediction equations.
Fatal Malignant Hyperthermia-Like Syndrome With Rhabdomyolysis Complicating the Presentation of Diabetes Mellitus in Adolescent Males
Authors: Hollander Abby S. , Olney Robert C. , Blackett Piers R. , Marshall Bess A. 
Published: August 2004

Objective. This report describes a new fatal syndrome observed in adolescent males at the initial presentation of diabetes mellitus. The features include hyperglycemic hyperosmolar coma complicated by a malignant hyperthermia-like picture with fever, rhabdomyolysis, and severe cardiovascular instability.
Design. Case series.
Setting. Pediatric intensive care units of 3 tertiary care facilities in the United States.
Patients. Six adolescent males, 5/6 obese with acanthosis nigricans, 4/6 black.
Results. Four of 6 patients died. Four of 6 patients did not have significant ketosis. Six of 6 patients had increased temperature after the administration of insulin.
Conclusions. The underlying etiology of this syndrome remains unclear. Possibilities include an underlying metabolic disorder such as a fatty acid oxidation defect, an unrecognized infection, exposure to an unknown toxin, or a genetic predisposition to malignant hyperthermia. Evaluation for all these possibilities and empiric treatment with dantrolene should be considered for this type of patient until this syndrome is better characterized.
Postexposure Prophylaxis in Children and Adolescents for Nonoccupational Exposure to Human Immunodeficiency Virus
Authors: Havens Peter L. ,   Committee on Pediatric AIDS
Published: August 2004

This Clinical Report was retired July 2017.
Exposure to human immunodeficiency virus (HIV) can occur in a number of situations unique to, or more common among, children and adolescents. Guidelines for postexposure prophylaxis (PEP) for occupational and nonoccupational (eg, sexual, needle-sharing) exposures to HIV have been published by the US Public Health Service, but they do not directly address nonoccupational HIV exposures unique to children (such as accidental exposure to human milk from a woman infected with HIV or a puncture wound from a discarded needle on a playground), and they do not provide antiretroviral drug information relevant to PEP in children.
This clinical report reviews issues of potential exposure of children and adolescents to HIV and gives recommendations for PEP in those situations. The risk of HIV transmission from nonoccupational, nonperinatal exposure is generally low. Transmission risk is modified by factors related to the source and extent of exposure. Determination of the HIV infection status of the exposure source may not be possible, and data on transmission risk by exposure type may not exist. Except in the setting of perinatal transmission, no studies have demonstrated the safety and efficacy of postexposure use of antiretroviral drugs for the prevention of HIV transmission in nonoccupational settings. Antiretroviral therapy used for PEP is associated with significant toxicity. The decision to initiate prophylaxis needs to be made in consultation with the patient, the family, and a clinician with experience in treatment of persons with HIV infection. If instituted, therapy should be started as soon as possible after an exposure—no later than 72 hours—and continued for 28 days. Many clinicians would use 3 drugs for PEP regimens, although 2 drugs may be considered in certain circumstances. Instruction for avoiding secondary transmission should be given. Careful follow-up is needed for psychologic support, encouragement of medication adherence, toxicity monitoring, and serial HIV antibody testing.