bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adult Survivors of Pediatric Illness: The Impact on Pediatric Hospitals
Authors: Goodman Denise M. , Mendez Eduardo , Throop Cheri , Ogata Edward S. 
Published: August 2004

Context. Patients now live well into adulthood surviving diseases with pediatric onset. The size and financial impact of this growing population is unknown.Objective. To describe the demographics of adult inpatients in pediatric facilities and to assess the financial impact of providing care for these patients on freestanding children’s hospitals.Design and Data Sources. An observational study using the Pediatric Health Information System, a proprietary database available to Child Health Corporation of America member hospitals, covering years 1994–1999. These data reflect inpatient services and exclude outpatient encounters and adult patients transitioned to adult providers. National estimates of the number of adult survivors of pediatric illness and the financial impact of care were calculated.Hospitals with &gt;100 discharge events for patients ≥age 21 in 1999, and having both clinical and financial data in the dataset, assured an adequate sample size to discern resource utilization. Both 18 and 21 were used as lower limits of adult age to reflect common definitions of legal majority (age 18) and common pediatric practice (age 21). We truncated the data at age 64 to exclude patients eligible for Medicare.Results. Ten hospitals representing all geographic regions of the United States were used for an in-depth analysis of financial impact during 1999. Six of 10 had data for 1994–1999 to describe trends over time. The number of patients admitted over the 6-year period increased, as did average and total adjusted charges. In 1999, 3863 patients 18 to 64 years old incurred 5051 discharge episodes and total charges of $134.5 million. Of these, about half (1785) were ≥21 with charges of $66 million. Of the hospitals’ total discharges and financial charges, on average 2.1% and 3.1%, respectively, were from the inpatient care of patients 21 to 64 years old. Forty percent of patients receive public aid. Extrapolating from census data, up to 15 000 patients ≥21 years annually may seek inpatient care in part at children’s hospitals, with charges exceeding $500 million. The 3 most common diagnostic groups to be admitted were those with cystic fibrosis, mental retardation or cerebral palsy, and congenital heart disease.Conclusions. We describe a subset of adults who have survived diseases of pediatric onset. We focused on the portion of that population that obtains at least some inpatient care at a children’s hospital. The data reported here can be used to set a lower boundary for the size of this population, and thereby provide valuable data for health planners as well as clinicians. If one includes estimates of expenses across the continuum of care, the financial impact of this growing population is substantial. Public policy discussions should include the medical, psychological, social, and financial needs of this population.
Survival in Early- and Late-Term Infants With Congenital Diaphragmatic Hernia Treated With Extracorporeal Membrane Oxygenation
Authors: Stevens Timothy P. , Chess Patricia R. , McConnochie Kenneth M. , Sinkin Robert A. , Guillet Ronnie , Maniscalco William M. , Fisher Susan G. 
Published: August 2004

Background. Congenital diaphragmatic hernia (CDH) is a malformation of the diaphragm that allows bowel to enter the thoracic cavity, resulting in pulmonary hypoplasia and pulmonary hypertension. Approximately 50% of CDH patients are treated with extracorporeal membrane oxygenation (ECMO). The optimal gestational age for delivery of term infants with CDH at high risk for requiring ECMO is not known. The goal of this study was to compare survival of infants with CDH receiving ECMO born early term (38 0/7–39 6/7 weeks’ gestation) with those born late term (40 0/7–41 6/7 weeks’ gestation). Changes in survival rates of term infants and the factors associated with these changes were assessed over the 25 years that ECMO has been available.Methods. Design. Retrospective cohort study of infants with CDH treated with ECMO.Data Sources. The Extracorporeal Life Support Organization registry of patients treated at active Extracorporeal Life Support Organization centers from April 1976 through June 2001.Analysis. Survival and clinical predictors of survival were compared between infants born early term (38 0/7–39 6/7 weeks’ gestation) and infants born late term (40 0/7–41 6/7 weeks’ gestation). Changes in survival rates over time and factors associated with survival were evaluated.Results. Among full-term infants with CDH treated with ECMO, late-term compared with early-term delivery was associated with improved survival (63% vs 53%). Among full-term survivors of ECMO, late-term infants spent less time on ECMO (181 vs 197 hours) and less time in the hospital (60 vs 67 days). In multivariate analysis, greater birth weight, higher 5-minute Apgar score, higher arterial pH and Pco2 &lt;50 torr before ECMO, and absence of a prenatal diagnosis of CDH were associated with survival.Since the late 1980s, survival of infants with CDH requiring ECMO decreased from 63% to 52%. The decreased survival rate was associated with increased rates of prenatal diagnosis, early-term delivery, lower birth weight, longer ECMO runs, and more frequent complications on ECMO.Conclusions. Among term infants with CDH receiving ECMO, late-term delivery compared with early-term delivery is associated with improved survival, shorter ECMO duration, shorter hospital length of stay, and fewer complications on ECMO. These data suggest that, at least for the ∼50% of CDH patients treated with ECMO, outcomes for infants with CDH may be improved by delay of elective delivery until 40 completed weeks of gestation.
Infant Feeding and Blood Cholesterol: A Study in Adolescents and a Systematic Review
Authors: Owen Christopher G. , Whincup Peter H. , Odoki Katherine , Gilg Julie A. , Cook Derek G. 
Published: August 2004

Objective. To examine the influence of infant feeding method on serum total cholesterol (TC) and low-density lipoprotein (LDL) cholesterol.Methods. A cross-sectional study of 13- to 16-year-olds and a systematic review of studies (all observational) on the effects of infant feeding on cholesterol in infancy (&lt;1 year), childhood or adolescence (1–16 years), and adulthood (≥17 years) were conducted using random effects models. Differences are presented as breastfed-bottle-fed. A total of 1532 individuals (92% white; 55% male; mean age: 15.1 years) in 10 British towns were studied, and 37 studies with 52 observations on TC (26 in infancy, 17 in childhood or adolescence, and 9 in adulthood; corresponding figures for LDL were 7, 4, and 6) were reviewed.Results. Mean TC in childhood or adolescence (including the new study) was not related to infant feeding pattern (mean TC difference = 0.00; 95% confidence interval [CI]: −0.07 to 0.07 mmol/L). However, in infancy, mean TC was higher among those breastfed (mean TC difference = 0.64; 95% CI: 0.50–0.79 mmol/L), whereas in adults, mean TC was lower among those breastfed (mean TC difference = −0.18; 95% CI: −0.30 to −0.06 mmol/L). Patterns for LDL were similar to those for TC throughout.Conclusions. Breastfeeding is associated with increased mean TC and LDL levels in infancy but lower levels in adulthood/adult life. These results suggest that breastfeeding may have long-term benefits for cardiovascular health and may have implications for the content of formula feed milks.
When Inflicted Skin Injuries Constitute Child Abuse
Authors:   Committee on Child Abuse and Neglect
Published: August 2004

This Policy Statement was retired October 2006.
Child abuse should be considered as the most likely explanation for inflicted skin injuries if they are nonaccidental and there is any injury beyond temporary reddening of the skin. Minor forms of abuse may lead to severe abuse unless abusive skin injuries are identified and labeled as such and interventions are made.
Distribution and Correlates of Non-High-Density Lipoprotein Cholesterol in Children: The Bogalusa Heart Study
Authors: Srinivasan Sathanur R. , Myers Leann , Berenson Gerald S. 
Published: August 2004

Objective. Serum non–high-density lipoprotein (HDL) cholesterol (total cholesterol minus HDL cholesterol) is considered a better screening tool than low-density lipoprotein (LDL) cholesterol for the assessment of coronary artery disease (CAD) risk in adults because it includes all classes of atherogenic lipoproteins. Although population frequency distribution and clinically useful cutpoints for this variable in adults have been reported recently, such information is lacking in children. Therefore, this study sought to provide population-based data on the distribution and correlates of non-HDL cholesterol in biracial (black–white) children.Methods. The study sample consisted of 2843 5- to 17-year-olds (57% white, 50% female) who participated in a cross-sectional screening of cardiovascular risk factors as part of the Bogalusa Heart Study.Results. Non-HDL cholesterol levels were similar in black and white children, and higher in girls than in boys, especially among the younger (5–11 years) age group. Age was inversely related to both non-HDL cholesterol and LDL cholesterol. Body fatness as measured by body mass index and waist circumference was positively associated with non-HDL cholesterol. The magnitude of correlation with triglycerides was relatively higher for non-HDL cholesterol versus LDL cholesterol. Non-HDL cholesterol showed an inverse relation to HDL cholesterol. In a multivariate analysis, body mass index, age, gender, waist circumference, and cigarette smoking accounted for 7.7% of the variance in non-HDL cholesterol. Non-HDL cholesterol levels equivalent to currently recommended LDL cutpoints (110, 130, 160, and 190 mg/dL) for CAD risk assessment were 123, 144, 176, and 207 mg/dL.Conclusion. Population-based data on non-HDL cholesterol are now available for children, which may help improve the CAD risk assessment and intervention.
Ambiguous Genitalia With Perineoscrotal Hypospadias in 46,XY Individuals: Long-Term Medical, Surgical, and Psychosexual Outcome
Authors: Migeon Claude J. , Wisniewski Amy B. , Gearhart John P. , Meyer-Bahlburg Heino F.L. , Rock John A. , Brown Terry R. , Casella Samuel J. , Maret Alexander , Ngai Ka Ming , Money John , Berkovitz Gary D. 
Published: August 2004

Objectives. To identify and study adults (21 years or older) who have a 46,XY karyotype and presented as infants or children with genital ambiguity, including a small phallus and perineoscrotal hypospadias, reared male or female.
Methods. Participants were classified according to the cause underlying their intersex condition based on review of medical and surgical records. Long-term medical and surgical outcome was assessed with a written questionnaire and physical examination. Long-term psychosexual development was assessed with a written questionnaire and semistructured interview.
Results. Thirty-nine (72%) of 54 eligible patients participated. The cause underlying genital ambiguity of participants included partial androgen insensitivity syndrome (n = 14; 5 men and 9 women), partial gonadal dysgenesis (n = 11; 7 men and 4 women), and other intersex conditions. Men had significantly more genital surgeries (mean: 5.8) than women (mean: 2.1), and physician-rated cosmetic appearance of the genitalia was significantly worse for men than for women. The majority of participants were satisfied with their body image, and men and women did not differ on this measure. Most men (90%) and women (83%) had sexual experience with a partner. Men and women did not differ in their satisfaction with their sexual function. The majority of participants were exclusively heterosexual, and men considered themselves to be masculine and women considered themselves to be feminine. Finally, 23% of participants (5 men and 4 women) were dissatisfied with their sex of rearing determined by their parents and physicians.
Conclusions. Either male or female sex of rearing can lead to successful long-term outcome for the majority of cases of severe genital ambiguity in 46,XY individuals. We discuss factors that should be considered by parents and physicians when deciding on a sex of rearing for such infants.
46,XY Intersex Individuals: Phenotypic and Etiologic Classification, Knowledge of Condition, and Satisfaction With Knowledge in Adulthood
Authors: Migeon Claude J. , Wisniewski Amy B. , Brown Terry R. , Rock John A. , Meyer-Bahlburg Heino F. L. , Money John , Berkovitz Gary D. 
Published: August 2004

Objectives. The objective of this study was to identify and study adults who have a 46,XY karyotype and presented as infants or children with variable degrees of undermasculinization of their genitalia (female genitalia, ambiguous genitalia, or micropenis). Participants’ knowledge of their condition, satisfaction with their knowledge, and desire for additional education about their intersex condition were assessed.
Methods. Participants were classified according to the cause underlying their intersex condition based on review of medical and surgical records. Knowledge of medical condition, satisfaction with that knowledge, and desire for additional education were assessed with a written questionnaire and a semistructured interview.
Results. Patients were ineligible for recruitment because of death (9%), because of developmental delay (12%), or because they were not located (27%). Among the 96 eligible patients, 78% participated. Approximately half of the men (53%) and women (54%) exhibited a good understanding of their history. Fewer women who have a 46,XY chromosome complement and were born with female genitalia were informed about their intersex condition (36% with complete androgen insensitivity syndrome) than were women who were born with masculinized genitalia such as micropenis (80%) or ambiguous genitalia (72%). More women (66%) than men (38%) were satisfied with their knowledge of their medical and surgical history.
Conclusions. Almost half of the patients, reared male or female, were neither well informed about their medical and surgical history nor satisfied with their knowledge.
Maternal Adherence to the Zidovudine Regimen for HIV-Exposed Infants to Prevent HIV Infection: A Preliminary Study
Authors: Demas Penelope A. , Webber Mayris P. , Schoenbaum Ellie E. , Weedon Jeremy , McWayne Janis , Enriquez Elizabeth , Bamji Mahrukh , Lambert Genevieve , Thea Donald M. 
Published: August 2004

Objective. To describe the extent of adherence to the recommended neonatal zidovudine (ZDV) regimen administered to infants who have been exposed to the human immunodeficiency virus (HIV) to prevent mother-to-child transmission of HIV and to determine which maternal factors are associated with compliance.
Methods. HIV-infected women (n = 87) who were participating in a larger study of perinatal transmission at 3 inner-city New York City hospitals were interviewed 2 to 6 weeks’ postpartum to assess adherence to neonatal prophylaxis, social support, social network factors, and depression. In addition, plasma samples of 45 of their infants were assayed for ZDV levels.
Results. A majority of women (71%) administered all of the prescribed 4 daily doses in the previous week, as measured by interview; self-reported adherence was not associated with any maternal characteristics. In contrast, poor adherence, as measured by lower infant ZDV plasma levels, was associated with asymptomatic HIV illness in the mother and having 2 or more other children; good adherence, as indicated by higher ZDV levels, was associated with the presence of a maternal social support network, disclosure of HIV infection, and mothers’ adherence to their own ZDV regimens during pregnancy. In multivariate regression analyses, maternal asymptomatic status (β = −0.40) was associated with lower infant ZDV levels, and maternal adherence during pregnancy (β = 0.37) was associated with higher levels.
Conclusions. Women who are HIV asymptomatic and lack a social support network are more likely not to comply with the recommended neonatal prophylactic regimen of antiretroviral therapy. Future studies should address the prenatal period and social network factors, such as disclosure of serostatus, and the custody of other children.
Factors Associated With HIV Testing Among HIV-Positive and HIV-Negative High-Risk Adolescents: The REACH Study
Authors: Murphy Debra A. , Mitchell Rick , Vermund Sten H. , Futterman Donna ,   for the Adolescent Medicine HIV/AIDS Research Network
Published: August 2004

Objective. To describe human immunodeficiency virus (HIV) testing patterns among high-risk, uninfected adolescents and HIV-infected adolescents, and factors associated with testing.Methods. HIV-infected adolescents (N = 246) and high-risk, uninfected adolescents (N = 141) at 15 sites nationwide were asked about the number of times they were tested for HIV, the type of agency at which testing occurred, and reasons for testing.Results. The majority of participants reported being influenced to obtain testing by health care providers (53.1% of the HIV-infected group and 66.1% of the HIV-uninfected group, respectively). Female participants were somewhat more likely to have used a confidential or anonymous site for the most recent test, compared with male participants (73.5% and 67.5%, respectively). Among the HIV-infected group, feeling sick was the only factor associated with number of tests. Among the HIV-uninfected group, having more male partners, marijuana use in the past 3 months, white race, and having had same-gender partners in their lifetime (males only) were associated with number of tests. Multivariate analyses identified 2 significant models. Modeling the probability of having been tested 3 or more times, black participants were less likely to be tested than white participants (odds ratio [OR] = 0.4), and participants who felt sick were more likely to be tested than those who did not (OR = 1.7). Modeling the probability that the last test would be positive, black participants were more likely than white participants to test positive (OR = 2.3); those who were tested because they thought they might have gotten HIV from sex (OR = 3.0) or they felt sick (OR = 3.9) were more likely to test positive; participants who were tested because a health care professional recommended it were actually less likely (OR = 0.5) to test positive.Conclusions. Overall, these findings highlight the importance of making HIV testing more routinely available to sexually active adolescents. More work needs to be done to normalize HIV testing among adolescents, and more innovative approaches need to be implemented on a wide scale.
Outcomes of Primary Image-Guided Drainage of Parapneumonic Effusions in Children
Authors: Mitri Ragheed K. , Brown Stephen D. , Zurakowski David , Chung Kee Y. , Konez Orhan , Burrows Patricia E. , Colin Andrew A. 
Published: August 2004

Objective. To assess the outcome of image-guided needle aspiration when compared with image-guided percutaneous catheter drainage in the management of parapneumonic effusions in children.
Methods. A retrospective chart review was conducted of the medical records, microbiology, and radiology reports of 67 children who presented with parapneumonic effusions and underwent primary image-guided drainage between April 1, 1995, and April 1, 2000.
Results. Thirty-four patients had aspiration only, and 33 patients had pigtail catheters placed. The 2 drainage methods had similar median length of stay and complication rates. The reintervention rate in this study was 27% (18 patients). Children who underwent primary aspiration without catheter placement had significantly higher rates of reintervention. Method of drainage, pH lower than 7.2, and loculation of the fluid collection were independent predictors of reintervention. A low glucose level was an additive predictor of reintervention when the pH was low.
Conclusions. Aspiration and catheter drainage of parapneumonic effusions had similar complication rates and lengths of stay, but children who underwent primary aspiration had significantly higher reintervention rates, particularly when pH and glucose levels were low. Therefore, primary catheter placement for parapneumonic effusions should be considered in children who undergo diagnostic thoracentesis. The decision regarding tube placement could be facilitated by the on-site availability of a pH meter and a glucometer.
Nebulized Morphine as a Treatment for Dyspnea in a Child With Cystic Fibrosis
Authors: Cohen Steven P. , Dawson Timothy C. 
Published: August 2004

Objective. To shed light on nebulized morphine, a new treatment for dyspnea in children with terminal lung disease.
Methods. A clinical case study was conducted on a patient in a tertiary care medical center.
Results. Nebulized morphine was administered in incremental doses ranging from 2.5 mg to 12.5 mg in a 10-year-old, 20-kg boy with end-stage cystic fibrosis. Before the nebulized morphine treatments were started, a dose of nebulized lidocaine failed to provide the patient with any relief. After each dose of morphine, the following parameters were recorded: visual analog “dyspnea” scores, vital signs, venous blood gases, and blood levels of morphine. The nebulized morphine was found to have a modest effect on the patient’s dyspnea, with no significant differences found between the varying doses. Venous carbon dioxide tension levels increased &lt;4 mm Hg for all doses except 12.5 mg, for which there was a 9-mm Hg increase. Systemic blood levels of morphine were &lt;10 ng/mL at all doses. The nebulized morphine did not cause any significant changes in blood pressure or heart rate for doses &lt;12.5 mg.
Conclusions. Inhaled morphine was associated with a mild, beneficial effect on dyspnea, with minimal differences found between the lowest and highest doses. This “ceiling” effect may be the result of saturation of opioid receptors in the lung, the variable bioavailability of inhaled morphine, or a placebo response. More studies are needed to determine what, if any, the optimum dose of nebulized morphine is for children.