bluuebunny/crossref_metadata_2025_split huggingface dataset:
Birth Outcome From a Prospective, Matched Study of Prenatal Crack/Cocaine Use: I. Interactive and Dose Effects on Health and Growth
Authors: Eyler Fonda Davis , Behnke Marylou , Conlon Michael , Woods Nanci Stewart , Wobie Kathleen 
Published: August 2004

Objective. This prospective, longitudinal project was designed to determine the effects of prenatal cocaine use on the pregnancy outcomes of women from a historically understudied rural public health population.Methodology. We interviewed over 2500 women prenatally, identified 154 cocaine users, and matched 154 controls on race, parity, socioeconomic status, and location of prenatal care (that related to level of pregnancy risk). Drug testing was required at enrollment and at delivery; detailed demographic, psychosocial, and drug histories were taken at each available trimester and follow-up visit. After birth, neonatal nurse practitioners, blinded to maternal history of drug use, examined infants to assess gestational age and take growth measurements. Medical charts were reviewed and the Hobel Risk Scale was completed.Results. Compared with controls, the cocaine users had significantly higher Hobel Prenatal and Total Risk Scores and more preterm infants (28 vs 14), but not a significantly greater number of fetal deaths (3 vs 1).After controlling for the effects of marijuana, alcohol, and tobacco use, the following results remained. There was no difference in gestational age, Ponderal Index, birth weight, or length between infants born to cocaine users and controls. There was a significant interaction effect such that infant head and chest circumference were smaller in cocaine users who also smoked tobacco.Significant correlation coefficients demonstrated the effects of the amount of drug usage on fetal growth during each trimester of pregnancy. The average cocaine use per day for trimesters one and three and for the entire pregnancy was negatively related to birth length. The mean amounts used in trimesters two and three were negatively related to head circumference. Amounts of tobacco and alcohol use in pregnancy were also inversely related to fetal growth measures. When the effects of marijuana, alcohol, and tobacco were partialed out, there continued to be a negative relationship between the amount of cocaine used in the third trimester and infant length and head circumference.Conclusions. The observed decrement in fetal growth, especially head circumference, among cocaine-exposed neonates raises concerns about later growth and development. Follow-up of these infants will reveal if these disadvantages continue. These early results also emphasize the importance of considering amount and time of drug exposure as well as the interactive effects of drug exposure and other risk variables.
Reproducibility of 24-Hour Intraesophageal pH Monitoring in Pediatric Patients
Authors: Mahajan Lori , Wyllie Robert , Oliva Luis , Balsells Francisco , Steffen Rita , Kay Marsha 
Published: August 2004

Objective. Despite the widespread use of 24-hour intraesophageal pH monitoring for evaluation of gastroesophageal reflux in infants and children, there is little published information regarding the reproducibility of ambulatory pH studies in this patient population. The purpose of our study was to evaluate the reproducibility of 24-hour intraesophageal pH monitoring in pediatric patients.
Methods. We prospectively investigated 26 patients with symptoms suggestive of gastroesophageal reflux (14 females and 12 males) ranging in age from 1 month to 18 years (mean, 9.2 years). The patients underwent extended intraesophageal pH monitoring over two consecutive 24-hour periods.
Results. Data analysis revealed that the overall reproducibility of ambulatory 24-hour pH monitoring is only 69% (r = 0.32). Eight of 26 patients had conflicting results on day 1 compared with results on day 2. Of the 8 patients with conflicting results on day 1 versus day 2, 5 had normal studies on day 1, but demonstrated pathologic reflux on day 2. Thus, the false-negative rate for day 1 was 19.2%. The κ statistic calculated for the total time the pH was abnormal was 0.32, with values &lt;0.4 representing poor correlation. Spearman correlation coefficients indicated that the percentage of time with pH &lt;4 (r = 0.64) and the number of reflux episodes (r = 0.71) per 24-hour period are the most reproducible pH parameters.
Conclusion. The reproducibility of 24-hour intraesophageal pH monitoring in the pediatric population is suboptimal. The investigation should be extended or repeated if the result does not correlate with the patient's clinical history.
Community Characteristics Associated With Elevated Blood Lead Levels in Children
Authors: Lanphear Bruce P. , Byrd Robert S. , Auinger Peggy , Schaffer Stanley J. 
Published: August 2004

Objectives. To identify community characteristics associated with children having elevated blood lead levels (≥10 μg/dL) and examine whether these characteristics can be used to identify children with elevated blood lead levels.Participants and Setting. A total of 20 296 children in Monroe County, New York (&lt;6 years old) who had blood lead testing in the first 12 months after statewide mandated reporting of blood lead tests began.Design. A logistic regression analysis was conducted to examine the association of children's blood lead levels and community characteristics by using community characteristics of 653 census block groups.Results. The following community level variables were associated with increased risk of elevated blood lead levels in children: residence within the city [odds ratio (OR), 2.0; 95% confidence interval (CI), 1.6, 2.7]; block groups with a higher proportion of individuals of Black race (OR, 1.6; CI, 1.4, 2.0); higher screening rate (OR, 1.9; CI, 1.6, 2.4); lower housing value (OR, 1.6; CI, 1.2, 2.0); housing built before 1950 (OR, 1.5; CI, 1.3, 1.8); higher population density (OR, 1.5; CI, 1.3, 1.8); higher rates of poverty (OR, 1.4; CI, 1.2, 1.8); lower percent of high school graduates (OR, 1.3; CI, 1.1, 1.6), and lower rates of owner-occupied housing (OR, 1.2; CI, 1.0, 1.4). Community characteristics were comparable with clinic-based individual risk assessment to identify children with elevated blood lead levels.Conclusions. These data demonstrate that community characteristics can be used to develop screening strategies to identify children who have elevated blood lead levels and shift our efforts toward identifying houses containing lead hazards before occupancy and before children are unduly exposed.
Catecholamine Neurons Alteration in the Brainstem of Sudden Infant Death Syndrome Victims
Authors: Obonai Toshimasa , Yasuhara Masahiro , Nakamura Toshihiko , Takashima Sachio 
Published: August 2004

Background. Sudden infant death syndrome (SIDS) is a leading cause of postneonatal infant death. The pathogenesis of sudden death is still unknown, but an abnormality in the central nervous regulation of breathing during sleep has been suggested.
Objective. The aim of study is to confirm the brainstem disorder of SIDS victims. In order to do this, it is necessary to investigate the alterations of brain neurotransmitter systems thought to be involved in respiratory control.
Design. Neuropathologic study performed on the brainstem of SIDS victims.
Subject/Methods. The disorders of catecholaminergic systems in 22 SIDS victims were examined on the substantia nigra in the midbrain, locus coeruleus in the pons, vagal nuclei, and area reticularis superficialis ventrolateralis with the immunohistochemical method. Immunoperoxidase staining was performed with the antityrosine hydroxylase (TH) and the glial fibrillary acidic protein antibodies. Immunoreactivity was compared with 13 age-matched control infants. For statistical analysis, the χ2 test and the Student'st test were performed.
Results. The main finding was diminished TH immunoreactivity in the vagal nuclei and area reticularis superficialis ventrolateralis of SIDS victims, suggesting that adrenaline and noradrenaline neurons are altered in SIDS. In addition, this decrease in TH was closely correlated with brainstem gliosis.
Conclusion. These catecholaminergic changes may be caused by chronic hypoxia or ischemia, and also may underlie alterations in respiratory and cardiovascular control in sleep.
The Role of the Capnography Head-up Tilt Test in the Diagnosis of Syncope in Children and Adolescents
Authors: Naschitz Jochanan E. , Hardoff Daniel , Bystritzki Irena , Yeshurun Daniel , Gaitini Luis , Tamir Ada , Jaffe Michael 
Published: August 2004

Objectives. To evaluate the role of the capnography head-up tilt test (CHUTT) in the diagnosis of syncope in pediatric patients.Methods. The CHUTT is a head-up tilt test with concomitant capnometry. Hyperventilation on CHUTT was diagnosed when the patient's end-tidal carbon dioxide pressure (ETPCO2) was ≤25 mm Hg. Hyperventilation syncope was diagnosed when three criteria were met: loss of consciousness, ETPCO2 ≤25 mm Hg, and no significant drop in blood pressure. The cohort included 65 consecutive children and adolescents (mean age, 14.2 years) who were assessed for syncope by routine investigations and CHUTT.Results. The cause of the syncope was established in 67% of cases: cardioinhibitory reaction in 17%, vasodepressor in 20%, psychogenic in 22%, and mixed neurally mediated-psychogenic in 8% of the patients. The history indicated a cause of syncope in 40%, the CHUTT in 49%, and a combination of the history and positive CHUTT in 66% of patients. Neither the patients' clinical data nor values of the blood pressure, heart rate, respiratory rate, and ETPCO2 measured during recumbency predicted which patients would manifest hyperventilation or hyperventilation syncope on tilt.Conclusions. The CHUTT contributes substantially to the diagnosis of syncope in pediatric patients. The CHUTT advances the understanding of the pathophysiological mechanisms of syncope and enables the physician to reassure the patient regarding the essentially benign nature of the condition. Because it is not possible to predict which patients would develop a hyperventilation syncope on the standard tilt test, the modification of this procedure by measuring the ETPCO2 for the assessment of children with syncope should be considered.
Restricting Access to Neonatal Intensive Care: Effect on Mortality and Economic Savings
Authors: Stolz Jeffrey W. , McCormick Marie C. 
Published: August 2004

Objective. Neonatal intensive care for very low birth weight (VLBW) infants is expensive, and cost-containment policies have been proposed that would restrict care according to birth weight. We examined the potential reduction in neonatal intensive care unit (NICU) VLBW charges and the impact on survivors if care were not offered to infants of extremely low birth weights or gestational ages.Design. We reviewed hospital charges for a retrospective cohort of VLBW infants born during the 5-year period from 1988 to 1992. Local charges and survival statistics were applied to national VLBW birth statistics to estimate the national effects of a birth weight-based rationing program.Setting. A high-risk perinatal referral center.Patients. A consecutive sample of 1361 VLBW infants was tracked from birth to discharge home, transfer to a level II nursery, or death.Main Outcome Measures. Hospital charges and survival.Results. Mean charges per survivor ranged from $250 654 for infants weighing &lt;500 g to $74 101 for those weighing 1000 to 1500 g. Policies denying care to infants born at &lt;500, 600, or 700 g would lead to total NICU care savings of 0.8%, 3.2%, and 10.3%, respectively. Applying the local birth weight-specific survival rates, such policies applied nationally would not have offered care to 136, 575, and 2689 potential survivors annually. Birth weight-based rationing schemes also are shown to increase further the racial disparity of NICU deaths.Conclusions. To attain significant reduction in NICU charges, policies offering care to the larger or more mature VLBW infants only will result in denying care to many infants who would otherwise survive.
Neuropsychological and Behavioral Changes in Asthmatic Children Treated With Beclomethasone Dipropionate Versus Theophylline
Authors: Bender Bruce G. , Iklé David N. , DuHamel Thomas , Tinkelman David 
Published: August 2004

Objective. Results from previous investigations that examined the psychological side effects of theophylline have been inconsistent, and none have reported about inhaled corticosteroids. The objective of this study was to assess the relative psychological side effects of theophylline and beclomethasone in asthmatic children.
Methods. This was a multicenter, randomized, double-blind, parallel-groups study in which 102 asthmatic patients were assigned to one of two treatments: beclomethasone three times daily or theophylline twice daily. At baseline, 1 month, and 1 year, parents completed standardized behavioral questionnaires while the children received psychometric testing of attention and concentration, memory and learning, and problem-solving.
Results. Although power was sufficient to detect meaningful mean score changes, no consistent differential treatment effects were observed. Two significant treatment-by-period interactions were discordant, with one suggesting slightly better attention in the theophylline group, whereas the other indicated a small advantage in attention scores in the beclomethasone group. Numerous significant period effects revealed that behavior and cognitive test performance improved over the 1-year period, regardless of treatment, and confirmed a well established practice effect resulting from repeated administrations of such tests.
Conclusions. Neither theophylline nor beclomethasone should be avoided out of concern for significant psychological side effects. The possibility remains that a subset of asthmatic children may be susceptible to such medication-induced changes; investigators have suggested that preschool children may be at particular risk, although no controlled studies with this age group have been conducted. Parental perceptions of medication side effects can be influenced by temporary effects present at initiation of treatment or by erroneous attribution of the psychological effects of the chronic illness. Reports of psychological changes in response to asthma medications must be addressed respectfully but objectively, with due consideration of available evidence and an awareness of other potential explanations.
Surgical Treatment of Gastroesophageal Reflux in Children: A Combined Hospital Study of 7467 Patients
Authors: Fonkalsrud Eric W. , Ashcraft Keith W. , Coran Arnold G. , Ellis Dick G. , Grosfeld Jay L. , Tunell William P. , Weber Thomas R. 
Published: August 2004

Objective. To review retrospectively the combined clinical experience with the surgical treatment of persistently symptomatic gastroesophageal reflux (SGER) in childhood from seven large children's surgery centers in the United States.
Design. During the past 20 years, 7467 children &lt;18 years of age underwent antireflux operations for SGER at the seven participating hospitals. Fifty-six percent were neurologically normal (NN) and 44% were neurologically impaired (NI). The most frequent diagnostic studies were upper gastrointestinal series (68%), esophageal pH monitoring (54%), gastric emptying study (32%), and esophagoscopy (25%). The age at operation was under 12 months in 40% and 1 to 10 years in 48%. The type of fundoplication was Nissen (64%), Thal (34%), and Toupet (1.5%). A gastric emptying procedure was performed on 11.5% of NN patients and 40% of NI patients. Laparoscopic fundoplication was performed on 2.6% of patients.
Results. Good to excellent results were achieved in 95% of NN and 84.6% of NI patients. Major complications occurred in 4.2% of NN and 12.8% of NI patients. The most frequent complications were recurrent reflux attributable to wrap disruption (7.1%), respiratory (4.4%), gas bloat (3.6%), and intestinal obstruction (2.6%). Postoperative death occurred in 0.07% of NN and 0.8% of NI patients. Reoperation was performed in 3.6% of NN and 11.8% of NI patients. The results and complications were similar among the participating hospitals and did not seem related to the type of fundoplication used.
Conclusion. The excellent results (94% cure) and low morbidity with gastroesophageal fundoplication with or without a gastric emptying procedure from a large combined hospital study indicate that operation should be used early for SGER in NN children and to facilitate enteral feedings and care in NI children.
Development and Evaluation of a CD-ROM Computer Program to Teach Residents Telephone Management
Authors: Ottolini Mary C. , Greenberg Larrie 
Published: August 2004

Objective. Under managed care, telephone management is crucial to pediatric practice, but an effective method is needed to teach residents telephone skills. Our objective was to design an interactive CD-ROM program to teach residents an organized, consistent approach to telephone complaints and to determine whether use of the program was associated with better subsequent telephone management than reading the same information.
Setting. The general pediatric ambulatory center of a tertiary care children's hospital.
Participants.  A total of 24 PL-2 and PL-3 pediatric residents.
Design. A randomized, prospective, controlled comparison was conducted of resident management of two telephone calls: a 5-year-old with cough and trouble breathing, and a 7-year-old with fever. Thirteen residents were randomized to the computer group and 11 to the reading control group.
Intervention. Scripts, scoring, and feedback for 10 CD-ROM-simulated calls were developed from texts and pediatrician survey using a modified Delphi technique. Volunteers acted out the caller's role in scenario scripts and were recorded onto a CD-ROM. The computer simulated calls by recognizing questions typed in a free-form format and answering with a voice response. Feedback was provided for omissions in history-taking and errors in assessment, triage, and home management. The computer group worked through the CD-ROM calls while the control group had equal time to read the same information.
Evaluation Measures. A trained, standardized patient acted as the mother in pretest calls placed at the beginning of the month and posttest calls at the end. Calls were recorded and scored in a blinded manner using scoring templates and on interpersonal skills using the Patient Perception Questionnaire.
Results. Pretest scores for the two calls were similar in the computer versus the control group (cough, 70.33% ± 8.36 vs 68.46% ± 6.73; fever, 75.64% ± 9.82 vs 73.59% ± 9.06). Posttest scores were significantly higher in the computer group than in the control group on both calls (cough, 79.08% ± 8.17 vs 69 ± 13.3; fever: 83.33% ± 9.96 vs 70.35% ± 9.66). Interpersonal skills also were similar pretest (19 ± 3.4 vs 20 ± 2.7). There was modest improvement in both groups without a statistically significant difference in posttest scores (24.2 ± 2.9 vs 22.5 ± 3.1).
Conclusions. Use of this CD-ROM telephone management program was associated with better postintervention telephone management. The program augments faculty instruction by teaching a consistent, general approach to telephone management.
Blood Cultures in the Evaluation of Children With Cellulitis
Authors: Sadow Karin Berger , Chamberlain James M. 
Published: August 2004

Objective. To evaluate the yield of blood cultures obtained from immunocompetent children admitted for cellulitis in the post-Haemophilus influenzae type b (Hib) vaccine era and to determine whether these cultures are cost-effective.Design. Retrospective case series.Setting. Urban pediatric emergency department.Study Population. Patients 2 days to 22 years of age admitted with cellulitis from 1994 through 1995.Measurements and Results. Of 381 patients identified, 266 (70%) had blood cultures and 243 of these children were enrolled. Data recorded include demographics, immunization status, initial clinical appearance, antibiotic pretreatment, preexisting illness, location and precipitating cause of cellulitis, white blood cell count, and band-to-neutrophil ratio (BNR). Blood cultures were categorized as positive, negative, or contaminant. Five cultures (2%) were positive, and 13 (5.4%) were contaminants. The positive blood cultures grew streptococcus and staphylococcus organisms, and none of the children were bacteremic with H influenzae. All patients with group A β-hemolytic streptococcus had active varicella. The mean age was lower (26 vs 75 months) in those with a positive blood culture, and mean BNR was higher (0.32 vs 0.07). Patient management did not change for bacteremic patients with uncomplicated cellulitis. All repeat cultures were negative. The cumulative charge for all blood cultures was $50 986.Conclusions. Blood cultures are not cost-effective and are more frequently contaminated than positive in the evaluation of a patient with uncomplicated cellulitis. Since introduction of theH influenzae type b vaccine, the most common organisms are streptococci. Using a BNR = 0.20 as a threshold for sending blood cultures, we would have missed one positive culture, but would have avoided blood cultures in 213 patients (88%) with an estimated savings of $42 850.
Anemia and Elevated Lead Levels in Underimmunized Inner-city Children
Authors: Adams William G. , Geva Judith , Coffman Jerry , Palfrey Sean , Bauchner Howard 
Published: August 2004

Objective. Underimmunized children are less frequently screened for anemia and elevated lead levels than those who are up-to-date (UTD). However, the association between underimmunization and actual disease (hemoglobin [Hgb] &lt;11 g/dL or blood lead level [PbB] ≥10 μg/dL) has not been reported. The objective of this study was to evaluate the association between underimmunization, anemia, and elevated lead levels among children attending an inner-city clinic.Study Design. Data from a computer-based immunization tracking system were integrated with primary care-based laboratory data. Cross-sectional data for immunization coverage, anemia, and elevated lead levels were evaluated for children who were 1, 2, 3, and 4 years of age. The first Hgb or PbB values obtained within 6 months of the child's birthday were used.Setting. An inner-city hospital-affiliated pediatric primary care center.Patients. A child was considered to be a pediatric primary care center patient if he/she had at least 3 immunizations in the immunization tracking system and at least 1 Hgb or PbB screening test during February 1993 through February 1996.Results. A total of 4045 Hgb tests from 2672 children were available for analysis (1198, 1102, 945, and 800 at 1, 2, 3, and 4 years of age, respectively). Anemia was common during the first 4 years of life (21.2%, 15.8%, 11.0%, and 10.3% at 1, 2, 3, and 4 years of age, respectively). At 2 and 3 years of age, underimmunized children were significantly more likely to be anemic compared with UTD children (relative risk [RR] = 1.49, 95% confidence interval [CI] = 1.24–1.79 at 2 years of age; RR = 1.43, 95% CI = 1.12–1.83 at 3 years of age). Underimmunized children with anemia at 1 year of age were less likely than UTD children to resolve their anemia by 2 years of age (52.5% vs 20.8%, RR = 2.39; 95% CI = 1.47–3.87). Underimmunized children were also significantly more likely to have elevated lead levels at 2 years of age (RR = 1.24; 95% CI = 1.03–1.5).Conclusion. Underimmunized children in the inner city are at especially high risk for anemia and elevated lead levels. These children need routine preventive health services, as well as immunization. Integrating laboratory screening data with immunization tracking systems would be an important step toward improving the health of inner-city children.