bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vitamin K Status of Premature Infants: Implications for Current Recommendations
Authors: Kumar Deepak , Greer Frank R. , Super Dennis M. , Suttie John W. , Moore John J. 
Published: August 2004

Objective.Newborn infants are vitamin K deficient. Vitamin K status in full-term infants after intramuscular vitamin K supplementation at birth has been described. Similar information in growing premature infants has not been reported. The objective of this study was to assess vitamin K status in premature infants by measuring plasma vitamin K and plasma protein-induced in vitamin K absence (PIVKA II) from birth until 40 weeks' postconceptional age.Methods.Premature infants (≤36 weeks' gestation) were divided at birth into groups by gestational age (group 1, ≤28 weeks; group 2, 29–32 weeks; group 3, 33–36 weeks). Supplemental vitamin K (1 mg intramuscularly) was administered at birth followed by 60 μg/day (weight &lt;1000 g) or 130 μg/day (weight ≥1000 g) via total parenteral nutrition. After hyperalimentation, most received vitamin K–fortified enteral feedings with the remainder receiving unfortified breast milk. Blood was obtained for PIVKA II in cord blood and for PIVKA II and vitamin K at 2 weeks and 6 weeks after birth and at 40 weeks' postconception.Results.Of the 44 infants enrolled, 10 infants in each gestational age group completed the study. The patient characteristics for groups 1, 2, and 3 were as follows: gestational age, 26.3 ± 1.7, 30.3 ± 1.3, and 33.9 ± 1.1 weeks; birth weight, 876 ± 176, 1365 ± 186, and 1906 ± 163 g; and days of hyperalimentation, 28.9 ± 16, 16.8 ± 12, and 4.3 ± 4 days, respectively. At 2 weeks of age, the vitamin K intake and plasma levels were highest in group 1 versus group 3 (intake: 71.2 ± 39.6 vs 13.4 ± 16.3 μg/kg/day; plasma levels: 130.7 ± 125.6 vs 27.2 ± 24.4 ng/mL). By 40 weeks' postconception, the vitamin K intake and plasma levels were similar in all 3 groups (group 1, 2, and 3: intake, 11.4 ± 2.5, 15.4 ± 6.0, and 10.0 ± 7.0 μg/kg/day; plasma level, 5.4 ± 3.8, 5.9 ± 3.9, and 9.3 ± 8.5 ng/mL). None of the postnatal plasma samples had any detectable PIVKA II.Conclusions.Premature infants at 2 weeks of age have high plasma vitamin K levels compared with those at 40 weeks' postconceptional age secondary to the parenteral administration of large amounts of vitamin K. By 40 weeks' postconception, these values are similar to those in term formula-fed infants. Confirming “adequate vitamin K status,” PIVKA II was undetectable by 2 weeks of life in all of the premature infants. With the potential for unforeseen consequences of high vitamin K levels, consideration should be given to reducing the amount of parenteral vitamin K supplementation in the first few weeks of life in premature infants.vitamin K, PIVKA II, premature, total parenteral nutrition, enteral nutrition.
Childhood Hepatitis B Virus Infections in the United States Before Hepatitis B Immunization
Authors: Armstrong Gregory L. , Mast Eric E. , Wojczynski Mary , Margolis Harold S. 
Published: August 2004

Objective.To estimate the number of hepatitis B virus (HBV) infections among US children younger than 10 years before implementation of routine childhood hepatitis B immunization.Methods.Incidence of HBV infection in children was modeled from existing prevalence data by means of regression analysis. Sources of data for the models included published and unpublished surveys that determined the prevalence of HBV infection in US-born children. The number of nonperinatal HBV infections in children younger than 10 years was estimated by applying these infection rates to 1991 population data according to maternal race, ethnicity, and birthplace.Results.Estimated annual rates of infection ranged from 24 per 100 000 in non-Asian children to 2580 per 100 000 in children of Southeast Asian immigrant mothers. These rates indicate that by the early 1990s, HBV was infecting 16 000 children who were younger than 10 years (8700 non-Asian children and 7300 Asian-American children) annually. The total estimate, not including perinatal infections, ranged from 12 000 (95% confidence interval: 5500–27 700) to 24 900 (95% confidence interval: 16 700–42 300) infections and depended on how the estimated rates were applied to the population data.Conclusion.Thousands of US children were infected each year with HBV before routine infant hepatitis B immunization, placing them at high risk of death from cirrhosis or hepatocellular carcinoma later in life.
Molecular Epidemiology of Antibiotic-Resistant Gram-Negative Bacilli in a Neonatal Intensive Care Unit During a Nonoutbreak Period
Authors: Toltzis Philip , Dul Michael J. , Hoyen Claudia , Salvator Ann , Walsh Michele , Zetts Laura , Toltzis Hasida 
Published: August 2004

Objective.
Gram-negative organisms that are resistant to parenteral antibiotics are a growing threat to hospitalized patients. This study was conducted to define the epidemiologic characteristics of these organisms during a nonoutbreak period in a neonatal intensive care unit (NICU).

Methods.
Nasopharyngeal and rectal swab specimens were obtained 3 times a week from every infant in a tertiary care NICU during a 12-month period. Specimens were processed to identify aerobic Gram-negative species resistant to gentamicin, piperacillin-tazobactam, or ceftazidime. Selected clinical parameters were tested for their association with colonization with a resistant organism. Restriction endonuclease digests of genomic DNA were derived from isolates of the most frequently occurring species. The fragments were analyzed by pulsed-field gel electrophoresis (PFGE) to determine the genetic relatedness of the various isolates and thereby determine the length of colonization, the frequency of horizontal transmission, and the size and duration of clusters.

Results.
A total of 101 infants (8.6%) of 1180 admissions were colonized with at least 1 antibiotic-resistant bacillus before NICU discharge. Multiple parameters indicating a prolonged, complicated NICU course were associated with resistant colonization, including gestational age, length of stay, and exposure to several classes of antibiotics. Colonization with resistant bacilli occurred as early as the first NICU day, but acquisition continued throughout the infants' stay. A total of 436 isolates were analyzed by PFGE. On the basis of this molecular analysis, it was determined that duration of colonization was usually very short; the median for all species tested was &lt;1 week. In addition, cross-colonization occurred in only 12% of all PFGE-analyzed isolates. Most clusters of cross-colonized infants were small, with the majority involving only 2 patients.

Conclusions.
During endemic periods, acquisition of antibiotic-resistant Gram-negative bacilli in the NICU may occur very soon after admission, but colonization continues over many weeks of NICU stay. The duration of colonization with resistant bacilli is short, and horizontal transmission is unusual. These characteristics suggest a gradual but temporary incorporation of these organisms from the NICU environment into the nascent newborn microflora over time with little cross-colonization. These observations may aid the rational development of infection-control strategies to contain the reservoir of resistant Gram-negative organisms in the NICU.antibiotic resistance, Gram-negative bacilli, neonatal intensive care, antibiotic utilization, colonization, pulsed-field gel electrophoresis.
Prevalence of Autism in a United States Population: The Brick Township, New Jersey, Investigation
Authors: Bertrand Jacquelyn , Mars Audrey , Boyle Coleen , Bove Frank , Yeargin-Allsopp Marshalyn , Decoufle Pierre 
Published: August 2004

Objective.
This study determined the prevalence of autism for a defined community, Brick Township, New Jersey, using current diagnostic and epidemiologic methods.

Methods.
The target population was children who were 3 to 10 years of age in 1998, who were residents of Brick Township at any point during that year, and who had an autism spectrum disorder. Autism spectrum disorder was defined as autistic disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS), and Asperger disorder. The study used 4 sources for active case finding: special education records, records from local clinicians providing diagnosis or treatment for developmental or behavioral disabilities, lists of children from community parent groups, and families who volunteered for participation in the study in response to media attention. The autism diagnosis was verified (or ruled out) for 71% of the children through clinical assessment. The assessment included medical and developmental history, physical and neurologic evaluation, assessment of intellectual and behavioral functioning, and administration of the Autism Diagnostic Observation Schedule—Generic.

Results.
The prevalence of all autism spectrum disorders combined was 6.7 cases per 1000 children. The prevalence for children whose condition met full diagnostic criteria for autistic disorder was 4.0 cases per 1000 children, and the prevalence for PDD-NOS and Asperger disorder was 2.7 cases per 1000 children. Characteristics of children with autism in this study were similar to those in previous studies of autism.

Conclusions.
The prevalence of autism in Brick Township seems to be higher than that in other studies, particularly studies conducted in the United States, but within the range of a few recent studies in smaller populations that used more thorough case-finding methods.
Insulin Lispro Lowers Postprandial Glucose in Prepubertal Children With Diabetes
Authors: Deeb Larry C. , Holcombe John H. , Brunelle Rocco , Zalani Sunita , Brink Stuart , Jenner Morris , Kitson Hilary , Perlman Kusiel , Spencer Martha 
Published: August 2004

Objective.
This study compared the glucose-lowering effect of insulin lispro, given before or after meals, with regular human insulin given before meals in prepubertal children with diabetes.

Research Design and Methods.
A 3-way crossover, open-label study involving 61 prepubertal children (ages 2.9–11.4 years) with type 1 diabetes. The children were randomly assigned to receive regular human insulin 30 to 45 minutes before meals, insulin lispro within 15 minutes before or immediately after meals, combined with basal insulin. Each treatment lasted 3 months. Hemoglobin A1c levels and home glucose monitoring profiles were measured at the end of each treatment period.

Results.
Treatment with insulin lispro before breakfast resulted in lower 2-hour postprandial glucose values than regular human insulin (11.7 ± 4.4 mmol/L vs 15.0 ± 5.4 mmol/L). Similarly, insulin lispro given before dinner resulted in lower blood glucose values 2 hours postprandially (8.8 ± 5.0 mmol/L vs 10.8 ± 5.4 mmol/L) than regular human insulin. When insulin lispro was administered after meals, the 2-hour glucose levels were between those seen with either insulin lispro or regular human insulin given before meals. The number and types of adverse events, the rates of hypoglycemia, and the HbA1c levels did not differ among the 3 therapies.

Conclusions.
In prepubertal children, insulin lispro given before meals is safe and significantly lowers postprandial glucose levels after breakfast and dinner compared with regular human insulin, and insulin lispro given after the meal provides similar benefits as regular human insulin before the meal.
Glucose Monitoring With Long-Term Subcutaneous Microdialysis in Neonates
Authors: Baumeister Friedrich A. M. , Rolinski Boris , Busch Raymonde , Emmrich Peter 
Published: August 2004

Background.
Microdialysis is a new approach for continuous monitoring of small molecules in the extracellular space, and hypoglycemia is a common problem in neonatal intensive care. The objective of this study was to evaluate subcutaneous microdialysis for long-term glucose monitoring in neonatal intensive care. We determined the relative recovery of the microdialysis system in vitro and in vivo, the stability of the relative recovery in vivo during long-term microdialysis, and the correlation between blood and dialysate concentrations of glucose and urea. Furthermore, we evaluated the sensitivity and specificy of subcutaneous microdialysis for the diagnosis of hypoglycemia.

Patient and Methods.
Thirteen infants (10 neonates) with gestational ages of 30.2 to 45.6 weeks were investigated by microdialysis of subcutaneous adipose tissue and blood sampling. Subcutaneous microdialysis was performed for a median (range) duration of 9 (4–16) days.

Results.
The application was safe, even in extremely low birth weight infants (&lt;1000 g) with scanty subcutaneous adipose tissue.
The mean ± standard deviation of the relative recovery in vitro was 101 ± 3% for glucose and 100 ± 2% for urea. Using urea as the internal standard, the mean relative recovery in vivo was 96.4 ± 12.7% at the beginning and remained constant up to 16 days.
The correlation between microdialysate and blood was significant for glucose (r = 0.88) and urea (r= 0.98). Subcutaneous microdialysis allowed the detection of asymptomatic hypoglycemias. The diagnostic sensitivity of a dialysate glucose ≤2.9 mM to predict a blood glucose level ≤2.8 mM was 92.3%, with 88.1% specificy. The positive predictive value with a 13.4% prevalence of a blood glucose ≤2.8 mM was 54.5%, with a negative predictive value of 98.7% and an accuracy of 88.7%.

Conclusions.
Subcutaneous microdialysis is a safe method, well suited for long-term glucose monitoring in neonates during intensive care. Subcutaneous microdialysis can be used to reduce blood loss and painful stress resulting from diagnostic blood sampling in high-risk neonates.
Varicella in a Pediatric Heart Transplant Population on Nonsteroid Maintenance Immunosuppression
Authors: Dodd Debra A. , Burger Judy , Edwards Kathryn M. , Dummer J. Stephen 
Published: August 2004

Objective.Varicella-zoster virus has been reported to produce serious, often life-threatening, disease in immunosuppressed patients with a variety of diagnoses. The impact of this virus on the young child after heart transplantation has not been reported.Methods.We reviewed the charts of 28 children who were &lt;10 years of age at heart transplantation and had at least 1 year of follow-up. The median follow-up period was 7 years (1.4–13.0 years). All were seronegative for varicella-zoster virus before transplantation. Fourteen (50%) developed varicella at a median time posttransplantation of 3.3 years. The first 7 were admitted for intravenous acyclovir for 3 days followed by oral acyclovir for 7 days. The last 7 were treated as outpatients with oral valacyclovir for 7 days (n = 6) or with oral acyclovir for 10 days (n = 1).Results.Intravenous and oral regimens both were well tolerated and were without complications. No patient was receiving steroids at the time that they developed their initial episode of varicella. One patient was receiving steroids for therapy of posttransplantation lymphoproliferative disease when she developed recurrent varicella or generalized zoster. No episodes of rejection were attributed to the varicella-zoster virus infection. There were no episodes of localized zoster. All patients experienced seroconversion from undetectable to detectable antibody titers early after varicella, and 12 of the 14 patients continued to have persistent detectable titers in late follow-up. Two of the 14 who received chemotherapy or enhanced immunosuppression after retransplantation transiently lost detectable varicella-zoster virus antibodies but currently have detectable titers.Conclusions.Primary varicella-zoster infection was well tolerated in our young pediatric heart transplant recipients, with no serious complications. We now reserve inpatient/intravenous therapy for those who are unable to tolerate oral medications or those who are receiving enhanced immunosuppression.
Atomoxetine in the Treatment of Children and Adolescents With Attention-Deficit/Hyperactivity Disorder: A Randomized, Placebo-Controlled, Dose-Response Study
Authors: Michelson David , Faries Douglas , Wernicke Joachim , Kelsey Douglas , Kendrick Katherine , Sallee F. Randy , Spencer Thomas ,   the Atomoxetine ADHD Study Group
Published: August 2004

Objective.Atomoxetine is an investigational, nonstimulant pharmacotherapy being studied as potential treatment for attention-deficit/hyperactivity disorder (ADHD). It is thought to act via blockade of the presynaptic norepinephrine transporter in the brain. We assessed the efficacy of 3 doses of atomoxetine compared with placebo in children and adolescents with ADHD.Methods.A total of 297 children and adolescents who were 8 to 18 years of age and had ADHD as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, were randomized to placebo or atomoxetine dosed on a weight-adjusted basis at 0.5 mg/kg/day, 1.2 mg/kg/day, or 1.8 mg/kg/day for an 8-week period. ADHD symptoms, affective symptoms, and social and family functioning were assessed using parent and investigator rating scales.Results.Approximately 71% of children enrolled were male, approximately 67% met criteria for mixed subtype (both inattentive and hyperactive/impulsive symptoms), and the only common psychiatric comorbidity was oppositional defiant disorder (approximately 38% of the sample). At baseline, symptom severity was rated as moderate to severe for most children. At endpoint, atomoxetine 1.2 mg/kg/day and 1.8 mg/kg/day were consistently associated with superior outcomes in ADHD symptoms compared with placebo and were not different from each other. The dose of 0.5 mg/kg/day was associated with intermediate efficacy between placebo and the 2 higher doses, suggesting a graded dose-response. Social and family functioning also were improved in the atomoxetine groups compared with placebo with statistically significant improvements in measures of children's ability to meet psychosocial role expectations and parental impact. Discontinuations as a result of adverse events were &lt;5% for all groups.Conclusion.Among children and adolescents aged 8 to 18, atomoxetine was superior to placebo in reducing ADHD symptoms and in improving social and family functioning symptoms. Atomoxetine was associated with a graded dose-response, and 1.2 mg/kg/day seems to be as effective as 1.8 mg/kg/day and is likely to be the appropriate initial target dose for most patients. Treatment with atomoxetine was safe and well tolerated.
Treadmill Training of Infants With Down Syndrome: Evidence-Based Developmental Outcomes
Authors: Ulrich Dale A. , Ulrich Beverly D. , Angulo-Kinzler Rosa M. , Yun Joonkoo 
Published: August 2004

Objective.
On average, infants with Down syndrome (DS) learn to walk about 1 year later than nondisabled (ND) infants. The purpose of this study was to determine if practice stepping on a motorized treadmill could help reduce the delay in walking onset normally experienced by these infants.

Methods.
Thirty families of infants with DS were randomly assigned to the intervention or control group. All infants were karyotyped trisomy 21 and began participation in the study when they could sit alone for 30 seconds (Bayley Scales of Infant Development, Second Edition 1993, item 34). Infants received traditional physical therapy at least every other week. In addition, intervention infants received practice stepping on a small, motorized treadmill, 5 days per week, for 8 minutes a day, in their own homes. Parents were trained to support their infants on these specially engineered miniature treadmills. Every 2 weeks research staff went into the homes and tested infants' overall motor progress by administering the Bayley Scales of Infant Development, Second Edition,1 monitored growth status via a battery of 11 anthropometric measures, and checked parents' compliance with physical therapy and treadmill intervention. The primary measures of the intervention's effectiveness were comparisons between the groups on the length of time elapsed between sitting for 30 seconds (entry into the study) and 1) raising self to stand; 2) walking with help; and 3) walking independently.

Results.
The experimental group learned to walk with help and to walk independently significantly faster (73.8 days and 101 days, respectively) than the control group, both of which also produced large effect size statistics for the group differences. The groups were not statistically different for rate of learning to raise self to stand but there was a moderate effect size statistic suggesting that the groups were meaningfully different in favor of the experimental group.

Conclusions.
These results provide evidence that, with training and support, parents can use these treadmills in their homes to help their infants with DS learn to walk earlier than they normally would. Current research is aimed at 1) improving the protocol to maximize outcome; 2) determining the impact of treadmill practice on walking gait patterns; 3) testing the application to other populations with a history of delays in walking; and 4) determining the long-term benefits that may accrue from this form of activity. motor development, Down syndrome, early intervention, walking.
A Prospective Study of Psychological Distress and Sexual Risk Behavior Among Black Adolescent Females
Authors: DiClemente Ralph J. , Wingood Gina M. , Crosby Richard A. , Sionean Catlainn , Brown Larry K. , Rothbaum Barbara , Zimand Elana , Cobb Brenda K. , Harrington Kathy , Davies Susan 
Published: August 2004

Objective.
The purpose of the study was to examine the association between adolescents' psychological distress and their sexually transmitted disease/human immunodeficiency virus (STD/HIV)-associated sexual behaviors and attitudes.

Method.
Sexually active black adolescent females (N = 522) completed, at baseline and again 6 months later, a self-administered questionnaire that assessed sexual health attitudes and emotional distress symptoms (using standardized measures, α = .84), a structured interview that assessed STD/HIV-associated sexual risk behaviors, and a urine screen for pregnancy.

Results.
In multivariate analyses, controlling for observed covariates, adolescents with significant distress at baseline were more likely than their peers, after 6 months, to be pregnant (adjusted odds ratio [AOR]: = 2.0), have had unprotected vaginal sex (AOR = 2.1), have nonmonogamous sex partners (AOR = 1.7), and not use any form of contraception (AOR = 1.5). Additionally, they were also more likely to: perceive barriers to condom use (AOR = 2.2), be fearful of the adverse consequences of negotiating condom use (AOR = 2.0), perceive less control in their relationship (AOR = 2.0), have experienced dating violence (AOR = 2.4), feel less efficacious in negotiating condom use with a new sex partner (AOR = 1.6), and have norms nonsupportive of a healthy sexual relationship (AOR = 1.7).

Discussion.
The findings suggest that psychological distress is predictive over a 6-month period of a spectrum of STD/HIV-associated sexual behaviors and high-risk attitudes. Brief screening to detect distress or depressive symptoms among adolescent females can alert the clinician to the need to conduct a sexual health history, initiate STD/HIV-preventive counseling, and refer for comprehensive psychological assessment and appropriate treatment. Among adolescents receiving STD treatment, those with even moderate emotional distress may be at heightened risk for further unhealthy outcomes. STD/HIV interventions should also consider psychological distress as one potential risk factor that may impact program efficacy.