bluuebunny/crossref_metadata_2025_split huggingface dataset:
What Is the Yield of Screening Echocardiography in Pediatric Syncope?
Authors: Ritter Saskia , Tani Lloyd Y. , Etheridge Susan P. , Williams Richard V. , Craig Janet E. , Minich L. LuAnn 
Published: August 2004

Objective.
To determine the yield of screening echocardiography in the evaluation of pediatric syncope.

Design.
All patients diagnosed with syncope from January 1993 to January 1999 were identified and their records were reviewed for age, weight, sex, year of presentation, personal and family history, physical examination, and cardiac diagnostic testing. Cardiac defects were identified by reviewing echocardiograms and reports.

Results.
The 480 patients (268 females) ranged in age from 1.5 to 18.0 years old and ranged in weight from 10.3 to 113.6 kg. Final diagnoses included noncardiac causes in 458, long QT syndrome in 14, arrhythmias in 6, and cardiomyopathy in 2. An abnormal history, physical examination, or electrocardiogram identified 21 of the 22 patients with a cardiac cause of syncope. Of the 322 (67%) echocardiograms performed, abnormalities were detected in 37. These abnormalities included 26 minor valve anomalies, 7 hemodynamically insignificant shunt lesions, 2 mildly decreased left ventricular shortening fractions, and 2 cardiomyopathies. Only the 2 cardiomyopathies were considered to be potential causes of syncope, and in both cases, the electrocardiogram was markedly abnormal. A similar percentage of echocardiograms were ordered during the first and last 3 years of the study (61% vs 71%).

Conclusion.
History, physical examination, and electrocardiography provide a screening protocol that allows the identification of a cardiac cause of syncope in the overwhelming majority of pediatric patients. In the absence of a positive screen result, the echocardiogram does not contribute to the evaluation of syncope in children. We speculate that primary care providers and pediatric cardiologists continue to use echocardiography because of the paucity of data regarding its value in pediatric syncope. However, this study shows little benefit of screening echocardiography and should discourage its routine use.
A Family With Extrinsic Allergic Alveolitis Caused by Wild City Pigeons: A Case Report
Authors: Sarvaas Gideon J. du Marchie , Merkus Peter J. F. M. , de Jongste Johan C. 
Published: August 2004

We describe a family in which the mother died of unresolved lung disease and whose 5 children, some of whom had previous signs of asthma, were subsequently affected by extrinsic allergic alveolitis caused by contact with wild city pigeon antigens. The children received systemic corticosteroids for 1 month and inhaled steroids for 24 months, while antigen exposure was reduced as much as feasible. This was followed by a quick clinical recovery and a slow normalization of chest radiographs and pulmonary function indices, especially of diffusion capacity, during a follow-up of 24 months.Because pigeon-breeder's lung caused by free-roaming city pigeons has not been previously described, it remains unclear whether this family developed the disease because of high antigen exposure or because of increased susceptibility. None of the supposedly high-risk human leukocyte antigen types were found in the children. Whether human leukocyte antigen B7 in 1 child played a role in the course of the illness remains speculative. It is unknown to what extent pigeon-breeder's lung caused by nondomestic birds remains undetected and misdiagnosed as difficult or steroid-resistant asthma. The question remains whether free-roaming city pigeons are indeed a public health risk. We suggest that atypical outdoor antigens be considered in all patients with nonresolving chest disease or therapy-resistant asthma.
Clinical Auscultation Skills in Pediatric Residents
Authors: Gaskin Peter R. A. , Owens Susan E. , Talner Norman S. , Sanders Stephen P. , Li Jennifer S. 
Published: August 2004

Objective.The aim of this study is to determine the level of clinical auscultation skills in pediatric residents at Duke University Medical Center.Methods.Forty-seven residents from pediatrics and joint medicine/pediatrics training programs at Duke University Medical Center were enrolled in this study. They were asked to examine the cardiovascular patient simulator, Harvey, and report their findings. Five common conditions seen in the pediatric population were presented: ventricular septal defect, atrial septal defect, pulmonary valve stenosis, combined aortic valve stenosis and insufficiency, and innocent systolic ejection murmur. The responses were scored by the number of features and diagnoses accurately reported. Five pediatric cardiologists and cardiologists in training were also asked to participate in a manner similar to the trainees.Results.The mean score of features identified for the resident group was 11.4 ± 2.6 of a possible 19. The diagnostic accuracy was 33%. There was no significant difference between residents by year of training or by type of residency program, although there was a trend toward improved performance with more training. The difference in performance between the pediatric cardiology group and the residents group was striking. The condition that was most frequently misdiagnosed was the innocent systolic ejection murmur.Conclusions.The clinical auscultation skills of pediatric residents in this study were suboptimal. There was a trend toward improvement as training progressed, although not statistically significant. These skills are likely to improve further with increased exposure to patients with cardiovascular disease especially in the ambulatory care setting.
Medication Use Among Children With Asthma in East Harlem
Authors: Diaz Theresa , Sturm Toni , Matte Thomas , Bindra Monisha , Lawler Kate , Findley Sally , Maylahn Chris 
Published: August 2004

Purpose.To examine daily use of antiinflammatory medication among children with asthma in East Harlem, where hospitalization rates for asthma are among the highest in the United States.Methods.We analyzed parent/guardian reports of medications used by children with current asthma (defined as physician diagnosis and wheezing during the previous 12 months) identified from a cross-sectional survey conducted in 2 elementary schools.Results.From an overall sample of 1319 children, 298 with current asthma were included in this analysis. Most of those with asthma were Puerto Rican (136 [46%]) or black (98 [33%]), 168 (57%) were boys, and the median age was 8 years old. Overall, 65 (22%) were using antiinflammatory medication on a daily basis. A subgroup of 107 children with asthma had been hospitalized during the previous 12 months or had used β2-agonist on a daily basis, suggesting persistent or severe asthma. Of these 107 children, 42 (39%) were taking antiinflammatory medication on a daily basis. Multivariate analysis of these 107 children revealed that daily use of antiinflammatory medication was associated with using a spacer tube (adjusted odds ratio [AOR]: 3.08; 95% confidence interval [CI]: 1.27,7.47) and having seen a physician in the past 6 months (AOR: 3.46; CI: 1.01,11.9). Compared with Puerto Ricans, blacks (AOR: .32; CI: .12,.89) or children of other races/ethnicities (AOR: .27; CI: .09,.85) were less likely to use antiinflammatory medication on a daily basis.Conclusion.Daily use of antiinflammatory medication for children with persistent or severe asthma in East Harlem was underused. Differences in access to care may explain some findings; however, reasons for ethnic differences in use remain unclear. Both community interventions and additional provider education are needed.
Do Clinical Markers of Barotrauma and Oxygen Toxicity Explain Interhospital Variation in Rates of Chronic Lung Disease?
Authors: Van Marter Linda J. , Allred Elizabeth N. , Pagano Marcello , Sanocka Ulana , Parad Richard , Moore Marianne , Susser Mervyn , Paneth Nigel , Leviton Alan ,   the Neonatology Committeefor the Developmental Epidemiology Network
Published: August 2004

Objective.To explore the hypothesis that variation in respiratory management among newborn intensive care units (NICUs) explains differences in chronic lung disease (CLD) rates.Design.Case–cohort study.Setting.NICUs at 1 medical center in New York (Babies' and Children's Hospital [Babies']) and 2 in Boston (Beth Israel Hospital and Brigham and Women's Hospital [Boston]).Study Population.Four hundred fifty-two infants born at 500 to 1500 g birth weight between January 1991 and December 1993, who were enrolled in an epidemiologic study of neonatal intracranial white matter disorders.Case Definition.Supplemental oxygen required at 36 weeks' postmenstrual age.Results.The prevalence rates of CLD differed substantially between the centers: 4% at Babies' and 22% at the 2 Boston hospitals, despite similar mortality rates. Initial respiratory management at Boston was more likely than at Babies' to include mechanical ventilation (75% vs 29%) and surfactant treatment (45% vs 10%). Case and control infants at Babies' were more likely than were those at Boston to have higher partial pressure of carbon dioxide and lower pH values on arterial blood gases. However, measures of oxygenation and ventilator settings among case and control infants were similar at the 2 medical centers in time-oriented logistic regression analyses. In multivariate logistic regression analyses, the initiation of mechanical ventilation was associated with increased risk of CLD: after adjusting for other potential confounding factors, the odds ratios for mechanical ventilation were 13.4 on day of birth, 9.6 on days 1 to 3, and 6.3 on days 4 to 7. Among ventilated infants, CLD risk was elevated for maximum peak inspiratory pressure &gt;25 and maximum fraction of inspired oxygen = 1.0 on the day of birth, lowest peak inspiratory pressure &gt;20 and maximum partial pressure of carbon dioxide &gt;50 on days 1 to 3, and lowest white blood count &lt;8 K on days 4 to 7. Even after adjusting for white blood count &lt;8 K and the 4 respiratory care variables, infants in Boston continued to be at increased risk of CLD, compared with premature infants at Babies' Hospital.Conclusion.In multivariate analyses, a number of specific measures of respiratory care practice during the first postnatal week were associated with the risk of a very low birth weight infant developing CLD. However, after adjusting for baseline risk, most of the increased risk of CLD among very low birth weight infants hospitalized at 2 Boston NICUs, compared with those at Babies' Hospital, was explained simply by the initiation of mechanical ventilation.
Thrombopoietin in the Thrombocytopenic Term and Preterm Newborn
Authors: Albert Timothy S. E. , Meng Y. Gloria , Simms Paul , Cohen Robert L. , Phibbs Roderic H. 
Published: August 2004

Objectives.
Neonatal thrombocytopenia occurs commonly in neonatal intensive care units. The role of the thrombopoietin (Tpo) system in normal neonatal platelet regulation and neonatal thrombocytopenia is not well understood. The purpose of our study was to: 1) determine the normal Tpo level at birth in healthy nonthrombocytopenic term (NTT) and nonthrombocytopenic preterm (NTP) infants and in infants born to women with preeclampsia; and 2) measure Tpo levels in infants during and after the resolution of thrombocytopenia. Characterizing Tpo levels in the healthy and thrombocytopenic newborn is an important step in furthering our understanding of the pathophysiology of neonatal thrombocytopenia.

Methods.
This study is comprised of 2 parts. For the first part, cord blood was obtained at birth from both term (gestational age [GA]: 38–42 weeks) and preterm (GA: 25–36 weeks) infants. If birth platelet levels were ≥140 × 103/μL and the infant fit criteria for being normal, or if the infant was born to a women with preeclampsia, Tpo levels were measured. For the second part, serial Tpo levels and concomitant platelet counts (Plts) were measured in both preterm and term infants during a period of marked thromboctyopenia (Plt &lt; 100 × 103/μL) until its resolution (Plt ≥ 140 × 103/μL).

Results.
Median cord blood Tpo levels from NTP infants (n = 35) were higher than those of NTT infants (n = 32; 95 pg/mL vs 48 pg/mL, respectively). In addition, preterm infants born to women with preeclampsia (n = 11) had lower Tpo levels than NTP infants with a similar GA (&lt;41 pg/mL vs 95 pg/mL). For infants with marked thrombocytopenia, median Tpo levels during thrombocytopenia were similar between term (n = 12) and preterm (n = 14) groups (223 pg/mL and 179 pg/mL, respectively), with the majority of individuals showing a decrease in Tpo with resolution of thrombocytopenia. Within each group, there was large variability in the Tpo response to thrombocytopenia.

Impression.
These data show that the Tpo system is intact in NTP and NTT neonates. Preeclampsia may be an example of a disorder that perturbs this system. The great variability in Tpo levels seen in infants during thrombocytopenia may be related to the mechanism of thrombocytopenia. The finding that, in general, Tpo levels decreased with resolution of thrombocytopenia is consistent with what has been described in adults and children.
Health of Children Adopted From China
Authors: Miller Laurie C. , Hendrie Nancy W. 
Published: August 2004

Objective.Since 1989, American parents have adopted 18 846 Chinese children. This study assesses the health and developmental status of these children after their arrival in the United States.Patients and Methods.A total of 452 children (443 girls) in 2 groups were evaluated. The clinic group children (n = 192) included all Chinese adoptees seen in an international adoption clinic between 1991 and 1998. The travel group comprised 260 of 325 Chinese children placed by a single Massachusetts adoption agency between 1991 and 1996 whose adoptive parents and American physicians responded to mailed questionnaires. One hundred ninety-one of the travel group children were cared for by 1 of us (N.W.H.) during the adoption process in China.Results.Growth and developmental delays were frequent in the clinic group. Z scores ≤−2 were found in 39% of children for height, 18% for weight, and 24% for head circumference. The duration of orphanage confinement was inversely proportional to the linear height lag (r = .9), with a loss of 1 month of height age for every 2.86 months in the orphanage. Of the children, 75% had significant developmental delay in at least 1 domain: gross motor in 55%, fine motor in 49%, cognitive in 32%, language in 43%, social–emotional in 28%, activities of daily living in 30%, and global delays in 44%.The incidence of medical problems was similar in both groups of children (travel group and clinic group). Overall, among the 452 children, elevated lead levels were found in 14%, anemia in 35%, abnormal thyroid function tests in 10%, hepatitis B surface antigen in 6%, hepatitis B surface antibody in 22%, intestinal parasites (usually Giardia) in 9%, and positive skin test results for tuberculosis in 3.5%. One child each had hepatitis C exposure and congenital syphilis. No child had human immunodeficiency virus infection. Unsuspected significant medical diagnoses, including hearing loss, orthopedic problems, and congenital anomalies, were found in 18% (81/452) of the children.Conclusions.Chinese adoptees display a similar pattern of growth and developmental delays and medical problems as seen in other groups of internationally adopted children. An exception is the increased incidence of elevated lead levels (overall 14%). Although serious medical and developmental issues were found among the children, overall their condition was better than expected based on recent publicity about conditions in the Chinese orphanages. The long-term outcome of these children remains unknown. China, adoption, orphanage, institutionalized child.
Mycobacterium bovis as a Significant Cause of Tuberculosis in Children Residing Along the United States–Mexico Border in the Baja California Region
Authors: Dankner Wayne M. , Davis Charles E. 
Published: August 2004

Objective.
To determine the role ofMycobacterium bovis in active pediatric tuberculosis (TB) in a United States–Mexico border region.

Method.
We reviewed all new cases of pediatric (&lt;15 years old) TB presenting to San Diego hospitals and clinics from 1980 to 1997. Patients were categorized by age, ethnicity, country of origin, culture results, and disease manifestations. Case definitions were similar to those used by the Centers for Disease Control and Prevention. M bovis was distinguished fromMycobacterium tuberculosis by standard biochemical tests.

Results.
The median age of the 563 identified patients was 4.1 years old. The yearly incidence began rising in 1989 and peaked in the mid-1990s. Hispanics constituted 78.9% of the patients, but they were less likely to be foreign-born (21.6%) than were black children and Asian/Pacific Islanders. Overall, M boviscaused 10.8% of all TB during this period. Of the 180 patients with positive culture results, however, M bovis accounted for 33.9% and M tuberculosis 66.1%. This high percentage of M bovis infections was largely attributable to its contribution to extrapulmonary TB (55.2% of all culture-positive specimens). M bovis patients were also even more likely to be Hispanic (90.2%), to present with extrapulmonary disease (95.1%), and to be older than 12 months (96.8%).

Conclusion.
These data demonstrate the dramatic impact of this underappreciated cause of zoonotic TB on US children at the Mexican border and underscore the need for cross-collaboration to enforce existing Mexican pasteurization laws.
Assessment of Stress in Mothers of Children With Severe Breath-Holding Spells
Authors: Mattie-Luksic Michele , Javornisky Gregory , DiMario Francis J. , MD Jr, 
Published: August 2004

Background.
Severe breath-holding spells (BHS) in children consist of a stereotypical sequence of provocation to cry, noiseless expiration, color change, and loss of consciousness. Parenting a child who exhibits BHS is likely more stressful than parenting a healthy child, owing to this additional medical concern. It is also likely more stressful than parenting a child with a convulsive seizure disorder (SD), because it is often not recognized or misdiagnosed as behavioral rather than medical. Mothers of children with BHS were hypothesized to suffer significantly greater stress than mothers of children with SD or mothers of children without any significant medical conditions.

Objectives.
To examine maternal stress in parenting a child who exhibits BHS, and to identify the specific areas of stress impact, compared with mothers of children with a convulsive SD and mothers of control children.

Methods.
The Parenting Stress Index and questions regarding how mothers coped were individually administered to 34 mothers of children with BHS, 16 mothers of children with SD, and 16 mothers of children with no medical conditions (controls).

Results.
Mothers of children with BHS or SD experience more overall stress and disruption in their attachment or understanding of their child, compared with control mothers. These groups of mothers (BHS and SD) also perceived their child as more distractible/hyperactive, less adaptive, and more demanding than did control mothers. However, mothers of the BHS group alone showed significant disruption in their sense of competence as a parent, maintaining self-identity, and receiving positive reinforcement from their child. Mothers of children with SD showed a similar trend, but it was not significant. These findings were not related to maternal health or feelings of depression/isolation, insufficient spousal support, child's mood, or other life stresses.

Conclusion.
Parenting a child with BHS or SD impacts a greater degree of life stress on mothers of these children than does parenting control children, although the stress is greater for the BHS group than for the SD group.
New Immunoassay in Stool Provides an Accurate Noninvasive Diagnostic Method forHelicobacter pyloriScreening in Children
Authors: Braden Barbara , Posselt Hans-Georg , Ahrens Peter , Kitz Richard , Dietrich C. F. , Caspary Wolfgang F. 
Published: August 2004

Objective.The noninvasive13C-urea breath test (UBT) is a reliable diagnostic method for detection of Helicobacter pylori infection in children, and it avoids invasive gastrointestinal endoscopy. In this study, we compared a noninvasive, newly developed fecal H pylori antigen test with the UBT.Methodology.One hundred sixty-two children (76 girls and 86 boys) were tested for H pylori infection using the UBT and a new antigen test in stool samples. The H pylori stool test is based on a sandwich enzyme immunoassay with antigen detection.Results.Twenty-four of the children (14.8%) with dyspepsia tested positive for H pylori according to the breath test results. In 22 of the 24 patients, H pyloriantigen could be detected in the stool (sensitivity: 91.6%). Of 138 patients with negative UBT results, 136 were H pylori-negative in the stool test (specificity: 98.6%).Conclusions.The new, noninvasive, low-cost H pylori antigen test in stool can replace the UBT for detection of H pylori infection in children with comparable reliability and accuracy.
Identification and Care of HIV-Exposed and HIV-Infected Infants, Children, and Adolescents in Foster Care
Authors:   Committee on Pediatric AIDS
Published: August 2004

This Policy Statement was retired August 2021.
As a consequence of the expanding human immunodeficiency virus (HIV) epidemic and major advances in medical management of HIV-exposed and HIV-infected persons, revised recommendations are provided for HIV testing of infants, children, and adolescents in foster care. Updated recommendations also are provided for the care of HIV-exposed and HIV-infected persons who are in foster care.
Intensive Training and Sports Specialization in Young Athletes
Authors:   Committee on Sports Medicine and Fitness
Published: August 2004

Children involved in sports should be encouraged to participate in a variety of different activities and develop a wide range of skills. Young athletes who specialize in just one sport may be denied the benefits of varied activity while facing additional physical, physiologic, and psychologic demands from intense training and competition.This statement reviews the potential risks of high-intensity training and sports specialization in young athletes. Pediatricians who recognize these risks can have a key role in monitoring the health of these young athletes and helping reduce risks associated with high-level sports participation.