bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neonatal Circumcision and Pain Relief: Current Training Practices
Authors: Howard Cynthia R. , Howard Fred M. , Garfunkel Lynn C. , de Blieck Elisabeth A. , Weitzman Michael 
Published: August 2004

Objective. We conducted a national survey of pediatric, family practice, and obstetrics and gynecology residency program directors to determine the curriculum content and predominant practices in US training programs with regard to neonatal circumcision and anesthesia/analgesia for the procedure.Methods. Residency directors of accredited programs were surveyed in two mailings of a forced response and short answer survey (response rate: 680/914, 74%; pediatrics 83%; family practice 72%; obstetrics 71%).Results. Pediatric residents were less likely than family practice [odds ratio (OR), 0.04; 95% confidence interval (CI), 0.02–0.08] or obstetrical (OR, 0.14; 95% CI, 0.08–0.23) residents to be taught circumcision. Training and local custom were rated as important determinants of medical responsibility for neonatal circumcision. Pediatric residents training in programs in which community pediatricians perform circumcisions were more likely to learn circumcision (OR, 39.0; 95% CI, 14.3–110.6) as were obstetric residents (OR, 79.0; 95% CI, 22.4–306.4) training in programs in which community obstetricians perform circumcision. In programs that teach circumcision, pediatric (84%; OR, 3.4; 95% CI, 1.7–7.1) and family practice (80%; OR, 2.7; 95% CI, 1.7–4.2) programs were more likely than obstetric programs (60%) to teach analgesia/anesthesia techniques to relieve procedural pain. Overall, 26% of programs that taught circumcision failed to provide instruction in anesthesia/analgesia for the procedure. Significant regional variations in training in circumcision and analgesia/anesthesia techniques were noted within and across medical specialties.Conclusions. Residency training standards are not consistent for pediatric, family practice, and obstetrical residents with regard to neonatal circumcision or instruction in analgesia/anesthesia for the procedure. Training with regard to pain relief is clearly inadequate for what remains a common surgical procedure in the United States. Given the overwhelming evidence that neonatal circumcision is painful and the existence of safe and effective anesthesia/analgesia methods, residency training in neonatal circumcision should include instruction in pain relief techniques.
Plasma Leptin in Infants: Relations to Birth Weight and Weight Loss
Authors: Marchini Giovanna , Fried Gabriel , Östlund Eva , Hagenäs Lars 
Published: August 2004

Background. The hormone leptin, produced in the adipose tissue, is involved in the regulation of body weight. The release of the hormone is increased in obese adults and decreased after fasting in human adults. This study investigated whether the plasma leptin level was related to the infant's birth weight and whether the level was reduced in connection with the physiological weight loss during the neonatal period.Methods. We measured the plasma leptin level in cord blood from infants who were large for gestational age (LGA) (n = 15), small for gestational age (SGA) (n = 16), and appropriate for gestational age (AGA) (n = 38). AGA infants (n = 120), who were exclusively breastfed, were also studied during their first 4 postnatal days in a cross-sectional method. One blood sample was collected before breastfeeding from each infant. Plasma leptin concentrations were determined by radioimmunoassay.Results. The median (range) concentration of leptin from cord blood was increased in LGA infants and decreased in SGA infants compared with the level in AGA infants. There was a positive correlation between the log of the plasma leptin level in cord blood and both the infant's birth weight (r = 0.76; n = 69) and the body mass index (r = 0.63; n = 69). The normal 3% to 6% weight reduction that occurs during the first 4 postnatal days was associated with a 26% decrease in the plasma leptin level in healthy breastfed infants.Conclusions. The plasma leptin level is highly correlated to the size of adipose tissue mass and decreases in connection with the initial physiological weight loss in newborn infants. These data provide evidence that leptin is highly related to the nutritional status already during the fetal and neonatal periods.
Before Viability: A Geographically Based Outcome Study of Infants Weighing 500 Grams or Less at Birth
Authors: Sauve Reg S. , Robertson Charlene , Etches Philip , Byrne Paul J. , Dayer-Zamora Véronique 
Published: August 2004

Objective. The primary objective of this study was to determine the likelihood of long-term survival and avoidance of disabilities in a geographically based population of infants born at 20 weeks gestation or more and weighing 500 g or less at birth.Study Design. This was a 12-year historical cohort follow-up study of all infants born in this gestational age and birth weight category in the Province of Alberta, Canada, between 1983 and 1994. Data were collected from certificates of live births or stillbirths, death certificates, hospital records, and longitudinal multidisciplinary follow-up examinations.Results. One thousand one hundred ninety-three infants were of 20 weeks gestation or more, weighed 500 g or less, and were born between 1983 and 1994. Eight hundred eleven (68.0%) were stillborn and 382 (32.0%) were born alive. Among the latter, neonatal intensive care was provided in 113 (29.6%) and withheld in 269 (70.4%). The infants receiving intensive care were of heavier birth weight, later gestational age, higher antenatal risk scores, were more likely to be born in a level III center, to have received antenatal steroids, and to have been delivered by cesarean section. Of the infants receiving intensive care, 95 (84.1%) died and 18 (15.9%) were discharged alive, but 5 of these died after discharge because of respiratory complications. The infants discharged alive had later gestational age, were more likely to be small for gestational age, singletons, treated with antenatal steroids, and to have been delivered by cesarean section. Maternal indications were described in the majority of cesarean sections done for live-born infants. The 13 infants who were long-term survivors were followed at ages 12 and 36 months adjusted age. Four had no serious disabilities, 4 had one disability (cerebral palsy or mental retardation), and 5 had multiple disabilities (cerebral palsy plus mental retardation with blindness in 2 cases and deafness in 1 case).Conclusion. The majority of infants born at gestational age 20 weeks or more weighing &lt;500 g were stillborn. Among live births, neonatal intensive care was withheld in 70% and initiated in 30%. Of the latter, 11% survived to 36 months of age, and of these, 4 infants (31%), most of whom are small for gestational age, female infants, avoided major disabilities but 9 (69%) had one or more major disabilities. Survivors are prone to rehospitalizations early in life, slow growth, feeding problems, and minor visual difficulties; rates of learning-related and behavioral problems at school age are not yet known.Implications. Parents and caregivers faced with the impending delivery of an infant in this gestational age/birth weight category should understand that survival without multiple major disabilities is possible but rare. They should be made aware of local population-based results and not just isolated reports.
Growing Up With a Facial Hemangioma: Parent and Child Coping and Adaptation
Authors: Tanner J. Lane , Dechert Martha P. , Frieden Ilona J. 
Published: August 2004

Objective. To better understand the experiences, challenges, and adaptations of parents with children who have disfiguring facial hemangiomas.
Design. Qualitative, descriptive.
Methods. In-depth interviews were performed with the parent(s) of 25 children, aged 5 months to 8 years. Each child was referred to the Pediatric Dermatology Practice, Department of Dermatology, University of California, San Francisco, with a facial hemangioma of 1 cm diameter or greater. Interviews were ethnographic in style, centering on the description by parents of the particular challenges faced, supports received, and adaptive strategies developed in coping with their child's hemangioma. Analysis was by open coding of interview transcripts. Coded statements were organized within common categories and these further gathered into 4 principal themes: 1) parental emotion and adaptation; 2) experiences with public reactions; 3) issues related to parent-child interactions; and 4) expressed satisfaction/dissatisfaction with medical care.
Results. Disfiguring facial hemangiomas were found to be associated with parental reactions of disbelief, fear, and mourning, particularly during the growth phase. Reactions of strangers forced parents to confront varied aspects of social stigmatization. A broad array of effects on the parent-child interaction were observed, often connected with variables extrinsic to the hemangioma, including especially the support and acceptance by the extended family. Half of those studied expressed substantial dissatisfaction with aspects of their medical care.
Conclusions. Disfiguring facial hemangiomas in young children are frequently associated with parental reactions of loss and grief, despite the generally benign nature of the lesion and the prognosis for eventual involution. Physicians are faced with specific challenges in providing effective anticipatory guidance and support to parents.
Cardiovascular Reactivity and Adolescent Boys' Physical Health
Authors: Dobkin Patricia L. , Tremblay Richard E. , Treiber Frank A. 
Published: August 2004

Objective. Minor illnesses and major diseases are affected by individual, environmental, and social factors. The purpose of the study was to determine if cardiovascular reactivity, an individual characteristic, was related to adolescent boys' health status and behaviors.Methods. A total of 89 low socioeconomic status 16-year-old boys who had been classified using teacher ratings during childhood as anxious, disruptive, anxious–disruptive, or normal participated in a laboratory stress experiment. Systolic blood pressure (SBP) and diastolic blood pressure were measured during the Social Competence Interview. Using the upper and lower quartiles of SBP change scores, 21 boys were classified as reactors and 20 boys were classified as nonreactors. Subjects were interviewed to assess health behaviors and outcomes, as well as stressful life events.Results. No significant group differences were found for minor or major physical health problems. A logistic regression analysis indicated that risky health behaviors were associated with SBP reactivity, personality characteristics, and negative life events. Specifically, nonreactors, who were disruptive, had more negative life events and engaged in more health-compromising behaviors (eg, smoking cigarettes, unprotected sex), which may contribute to future health problems (eg, cancer, AIDS). Anxious individuals may be more vulnerable to cardiovascular diseases in part because of exaggerated cardiovascular reactivity to stress.Conclusion. Low socioeconomic status boys may be at risk for different health problems caused by differing personality characteristics associated with divergent health-related behaviors.
Early Adiposity Rebound and the Risk of Adult Obesity
Authors: Whitaker Robert C. , Pepe Margaret S. , Wright Jeffrey A. , Seidel Kristy D. , Dietz William H. 
Published: August 2004

Objective. At 5 to 6 years of age, body fatness normally declines to a minimum, a point called adiposity rebound (AR), before increasing again into adulthood. We determined whether a younger age at AR was associated with an increased risk of adult obesity and whether this risk was independent of fatness at AR and parent obesity.Design. A retrospective cohort study using lifelong height and weight measurements recorded in outpatient medical records.Setting. Group Health Cooperative of Puget Sound (GHC), a health maintenance organization based in Seattle, Washington.Participants. All 390 GHC members (and their parents) born at GHC between January 1, 1965, and January 1, 1971, who had at least one recorded adult height and weight measurement plus two visits with recorded height and weight measurements in each of three age intervals: 1.5 to 4, 4 to 8, and 8 to 16 years.Main Outcome Measures. We calculated the mean body mass index (BMI) of each subject during young adulthood (age 21 to 29 years) and the BMI of the parents when each subject was 1.5 years of age. Adult obesity was defined as a BMI ≥27.8 for males and ≥27.3 for females. Curves were fit to each subject's BMI values between ages 1.5 and 16 years, and the age and BMI at AR were calculated from these curves. Subjects were divided into tertiles of age at AR (early, middle, and late), BMI at AR, and parent BMI (heavy, medium, and lean).Results. The mean age at AR was 5.5 years, and 15% of the cohort was obese in young adulthood. Adult obesity rates were higher in those with early versus late AR (25% vs 5%), those who were heavy versus lean at AR (24% vs 4%), those with heavy versus lean mothers (25% vs 5%), and those with heavy versus lean fathers (21% vs 5%). After adjusting for parent BMI and BMI at AR, the odds ratio for adult obesity associated with early versus late AR was 6.0 (95% CI, 1.3–26.6).Conclusion. An early AR is associated with an increased risk of adult obesity independent of parent obesity and the BMI at AR. Future research should examine the biological and behavioral determinants of AR.
Three-year Follow-up of Vaccine Response in Extremely Preterm Infants
Authors: Khalak Rubia , Pichichero Michael E. , D'Angio Carl T. 
Published: August 2004

Objective. To assess whether the adequate antibody response observed in former extremely premature infants after the primary series of immunizations is sustained after the first booster vaccines.Subjects and Methods. Sixteen former extremely premature (&lt;29 weeks, &lt;1000 g at birth) and 17 former full-term (&gt;37 weeks) infants had sera obtained for antibody titer measurement at 3 to 4 years of age. All had received the primary series and first booster vaccines for diphtheria, pertussis, tetanus, polio, andHaemophilus influenzae type b. Twelve preterm and 14 full-term children had completed the hepatitis B vaccine series.Results. At 3 to 4 years of age, former preterm and full-term children had similar geometric mean titer (GMT) values of antibodies to tetanus, diphtheria, and pertussis. Preterm children had a lower GMT value of Haemophilus polyribosylribitol phosphate (PRP) antibody than did full-term children (0.99 vs 3.06 μg/mL). Fifty percent of preterm and 88% of full-term children had PRP antibody &gt;1.0 μg/mL; 100% of preterm and 94% of full-term children had anti-PRP titers &gt;0.15 μg/mL. GMT values of neutralizing antibodies to polio serotypes 1 and 2 were similar, with 94% to 100% of both groups above protective levels (≥1:8). The difference in GMT values of polio serotype 3 approached significance (29 vs 73); fewer preterm children had protective titer values (75% vs 100%). Among children vaccinated against hepatitis B, 75% of preterm and 71% of full-term children were protected (10 mIU/mL).Conclusions. Preterm children immunized at the recommended chronological ages displayed antibody responses similar to those for full-term children for most immunizing antigens. Responses to PRP and polio serotype 3 were less robust than those of full-term children.
Persistent Low Immunization Coverage Among Inner-city Preschool Children Despite Access to Free Vaccine
Authors: Kenyon Thomas A. , Matuck Michael A. , Stroh George 
Published: August 2004

Objective. To compare vaccination coverage among children 19 to 35 months of age from public housing developments where a free vaccine outreach program was in place with children residing elsewhere in the city.Design. A household survey using a multistage cluster sampling method to compare community areas which accounted for 80% of measles cases during 1989 (high-risk stratum), areas which accounted for the remaining 20% of cases (low-risk stratum), and public housing developments (public housing stratum) having free, on-site vaccination services.Setting. Inner-city Chicago households, April to May 1994.Outcome Variables. Antigen-specific and series-specific coverage based on written records.Results. Based on evaluation of 1244 children, citywide coverage for four doses of diphtheria-tetanus-pertussis vaccine, three doses of polio vaccine, and one dose of measles-containing vaccine (4:3:1) was 47% [95% confidence interval (CI), 40% to 55%]. Coverage was significantly lower among children residing in public housing (23%; 95% CI, 18% to 28%) compared with those residing in high-risk strata (45%; 95% CI, 38% to 52%) and low-risk strata (51%; 95% CI, 43% to 60%). Compared with white children (53%), coverage for the 4:3:1 series was lower among African-American children in public housing (29%) or outside public housing (36%). Moreover, 11% (95% CI, 8% to 14%) of children residing in public housing had never received any immunizations.Conclusions. African-American children throughout Chicago, particularly in public housing, remain at increased risk for vaccine-preventable diseases and should be targeted further for vaccination services. Vaccination coverage remains low several years after a major outbreak of measles and implementation of a free vaccine outreach program. Cluster surveys may be useful for monitoring vaccination coverage in high-risk urban settings.
Does Child Abuse Predict Adolescent Pregnancy?
Authors: Fiscella Kevin , Kitzman Harriet J. , Cole Robert E. , Sidora Kimberly J. , Olds David 
Published: August 2004

Objective. To determine whether sexual and nonsexual childhood abuse are risk factors for early adolescent sexual activity and pregnancy.
Design. Cross-sectional study.
Setting. Prenatal clinic within an inner-city teaching hospital from June 1990 to August 1991.
Population. One thousand twenty-six primiparous, African-American women enrolled in a randomized clinical trial of nurse home visitation.
Main Outcome Measures. Four measures of child abuse were used: sexual abuse, incidents of physical abuse, any major physical abuse, and emotional abuse. The outcome measures were age of first consensual coitus and age of first pregnancy.
Results. After adjustments for household income, parental separation, urban residence, age of menarche, and teen smoking, sexual abuse during childhood was associated with younger age at first coitus (7.2 months; 95% confidence interval [CI], 2.6 to 11.7 months) and younger age at first pregnancy (9.7 months; 95% CI, 3.0 to 16.3 months). Incidents of physical abuse showed minimal effect on age at first coitus (1.2 days per incident; 95% CI, 0.5 to 1.9 days) and no effect on age of first pregnancy. A history of major physical abuse or emotional abuse showed no effect on age of first coitus or first pregnancy.
Conclusion. Child sexual abuse, but not child physical or emotional abuse, seems to be a risk factor for earlier pregnancy among African-American adolescents.
Neurodevelopmental Outcomes in Children With Fontan Repair of Functional Single Ventricle
Authors: Uzark Karen , Lincoln Alan , Lamberti John J. , Mainwaring Richard D. , Spicer Robert L. , Moore John W. 
Published: August 2004

Objectives. The purpose of this study was to assess the neurodevelopmental status of children after Fontan repair of functional single ventricle and to examine the relationship between cognitive function and selected patient characteristics.Study Design. Neurodevelopmental tests including the Stanford-Binet Intelligence (IQ) scale and the Developmental Test of Visual Motor Integration (VMI) were administered to 32 children (26 months to 16 years of age) with complex single ventricle. The mean and distribution of IQ and VMI scores were compared with population norms. The relationship between test scores and patient characteristics was examined utilizing analysis of variance and correlational methods.Results. The majority of children had intellectual function within the normal range (mean, 97.5 ± 12.1). Below average VMI scores were found in 21.4% of children. There were no significant correlations between intellectual function or visual motor integration ability and preoperative oxygen saturation or age at Fontan. Children who had deep hypothermic circulatory arrest during a prior Norwood procedure tended to have a lower IQ score.Conclusions. Intellectual development in children with Fontan repair of complex heart defects is essentially within the normal range. Visual motor integration deficits may be more prevalent in these children. In our population, the duration and degree of preoperative hypoxemia had no apparent effect on cognitive function.
Trends in Mortality and Cerebral Palsy in a Geographically Based Cohort of Very Low Birth Weight Neonates Born Between 1982 to 1994
Authors: O'Shea T. Michael , Preisser John S. , Klinepeter Kurt L. , Dillard Robert G. 
Published: August 2004

Objective. To analyze whether the increasing survival of very low birth weight infants during the 1980s and 1990s has increased the risk of cerebral palsy among survivors.Methods. The study cohort consisted of 2076 consecutively born infants, with birth weights of 500 to 1500 g and no major anomaly, born July 1, 1982, through June 30, 1994, to residents of a 17-county region in North Carolina. These infants had a mean birth weight of 1096 g (standard deviation, 251 g) and a mean gestational age of 29 weeks (standard deviation, 3 weeks). One thousand five hundred sixty-eight infants (76%) survived to 1 year adjusted age, at which point 1282 infants (82%) were examined at our medical center. The diagnosis of cerebral palsy was made only if the examining pediatrician and a pediatric physical therapist agreed on the diagnosis. To analyze trends across time, the Cochran-Armitage χ2 test and logistic regression were applied to data for infants categorized into six 2-year epochs according to year of birth.Results. Mortality did not change significantly through 1990, and then began to decrease in 1990 to 1994. During the study period, mortality decreased from 36.8% between 1982 and 1984, to 13.8% between 1992 and 1994. The prevalence of cerebral palsy among survivors was constant from 1982 to 1988 (11.3%), decreased slightly from 1988 to 1990 (9.2%), and was lowest in 1990 to 1994 (5.2%). These secular trends in mortality and cerebral palsy risk remained significant when adjusted for gestational age, gender, and race. When adjusted for surfactant use, the trend in mortality was no longer significant, whereas the trend in cerebral palsy risk persisted.Conclusions. The increasing survival of very low birth weight infants in the 1980s and 1990s has not resulted in an increased prevalence of cerebral palsy among survivors.