bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hypocarbia in Preterm Infants With Periventricular Leukomalacia: The Relation Between Hypocarbia and Mechanical Ventilation
Authors: Okumura Akihisa , Hayakawa Fumio , Kato Toru , Itomi Kazuya , Maruyama Koichi , Ishihara Naoko , Kubota Tetsuo , Suzuki Motomasa , Sato Yoshiaki , Kuno Kuniyoshi , Watanabe Kazuyoshi 
Published: August 2004

Objective.The aim of this study was to elucidate the relationship between mechanical ventilation and hypocarbia in infants with periventricular leukomalacia (PVL).Study Design.Matched pair analysis was conducted for 26 infants with PVL and 26 with normal development, who were born between 27 and 32 weeks' gestational age and required mechanical ventilation. The time-averaged carbon dioxide (CO2) index, Paco2, and pH were calculated every 24 hours for samples obtained from indwelling arterial catheters within the first 72 hours of life. The time-averaged respiratory rate of the ventilator (RR), peak inspiratory pressure (PIP), mean airway pressure (MAP), and ventilator index (VI) were also determined. The time-averaged total respiratory rate (TRR) was determined by observing the movement of the chest wall. The patients' characteristics, antenatal and neonatal variables, and electroencephalographic findings were also compared.Results.The time-averaged CO2 index was larger, the time-averaged CO2 lower and the time-averaged pH higher in infants with PVL than in those with normal development on the third day of life. There was no significant difference in the time-averaged RR, PIP, MAP, or VI on any day. TRR was larger in the PVL group than in the control group on each day, but there was no significant difference. No significant difference was observed in the clinical characteristics or neonatal variables. Electroencephalographic abnormalities within 48 hours of life were more frequent in infants with PVL than in those with normal development.Conclusion.Hypocarbia was associated with PVL because the time-averaged CO2 index was larger and the time-averaged Paco2 lower in infants with PVL than in those with normal development. However, the ventilator settings were similar among the infants with and without PVL.
Neurologic Outcomes of 90 Neonates and Infants With Persistent Hyperinsulinemic Hypoglycemia
Authors: Menni Francesca , de Lonlay Pascale , Sevin Caroline , Touati Guy , Peigné Catherine , Barbier Valérie , Nihoul-Fékété Claire , Saudubray Jean-Marie , Robert Jean-Jacques 
Published: August 2004

Objective.
To evaluate the neurologic outcomes of neonates and infants suffering from persistent hyperinsulinemic hypoglycemia of infancy (PHHI).

Methods.
The neurologic development of 90 PHHI patients was studied retrospectively. Sixty-three patients were treated surgically and 27 were treated medically. Fifty-four patients were neonates, of whom 8 were treated medically and 46 were operated on (19 for a focal adenomatous hyperplasia and 27 for diffuse hyperinsulinism). Thirty-six patients had infancy-onset hyperinsulinism, of whom 19 were treated medically and 17 underwent pancreatectomy (10 patients for a focal adenomatous hyperplasia and 7 for diffuse hyperinsulinism).

Results.
Severe psychomotor retardation was found in 7 patients, 6 with neonatal-onset PHHI. Intermediate psychomotor disability existed in 12 patients; epilepsy existed in 16. Neonatal-onset was the main risk factor for severe retardation or epilepsy. Medically treated patients were less severely affected than those treated by surgery, and there was no difference between the diffuse and focal forms of hyperinsulinism.

Conclusion.
Neonatal hyperinsulinemic hypoglycemia is still a severe disease with an important risk to rapidly develop severe mental retardation and epilepsy.
Association of Plasma Cortisol and Chronic Lung Disease in Preterm Infants
Authors: Banks Beverly A. , Stouffer Nicole , Cnaan Avital , Ning Yue , Merrill Jeffrey D. , Ballard Roberta A. , Ballard Philip L. ,   the North American Thyrotropin-Releasing Hormone Trial Collaborators
Published: August 2004

Background.It has been suggested that preterm infants may have developmental immaturity of the hypothalamic-pituitary-adrenal axis, and that decreased cortisol response to stress increases risk of chronic lung disease (CLD) secondary to inflammatory lung injury.Methods.To investigate the relationship between endogenous corticosteroid and CLD, we measured plasma cortisol during the first 28 days of life in a subset of neonates in the North American Thyrotropin-Releasing Hormone (TRH) Collaborative Trial. Analyses were performed on 314 infants, 24 to 32 weeks' gestation, whose mothers received 1 or 2 courses of antenatal corticosteroids plus TRH or placebo.Results.Mean cortisol was 3.1 μg/dL (range: 0.1–17.9) at birth, reached maximal levels at 24 hours (19.4 μg/dL, range: 0.8–124.6), and decreased to 5.9 μg/dL (range: 0.2–24.7) at 14 to 28 days of age; levels during the first week were not associated with gestational age. The Clinical Risk Index for Babies (CRIB), a neonatal assessment tool that is correlated with risk of mortality, was positively associated with cortisol level on days 1 and 3 through 7. TRH versus placebo treatment did not influence cortisol levels at any time point. To examine the relationship between cortisol and adverse outcome of death or CLD at 36 weeks' postmenstrual age (CLD36), logistic regression models adjusting for known contributing clinical factors (gestational age and CRIB score) were fit. There was a statistically borderline negative association between median cortisol level at 3 to 7 days and CLD36. After adjusting for gestational age and CRIB score, the predicted probability of CLD36 was only minimally influenced by the cortisol concentration.Conclusion.In preterm infants, basal plasma cortisol concentration during the first week is a weak predictor for CLD36. Possible benefits as well as risks of supplemental, low-dose cortisol treatment of high-risk preterm infants remain to be determined.
Excess Risk of Severe Acute Illness in Children With Chronic Health Conditions
Authors: Dosa Nienke P. , Boeing Nancy M. , MS NP, , Kanter Robert K. 
Published: August 2004

We estimated the relative risk (RR) of an unscheduled pediatric intensive care unit (ICU) admission as a marker for severe acute illness in children with chronic health conditions, compared with previously healthy children. Potentially preventable events that lead to acute illness were identified to develop preventive strategies.
Methods. Children with chronic conditions were defined as those who have a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally. RR was estimated from admissions and regional population data. Potentially preventable events that lead to ICU admission of chronically ill children were identified retrospectively from hospital records.
Results. Children with chronic health conditions had an RR of 3.3 for an unscheduled ICU admission related to their chronic condition, compared with previously healthy individuals (95% confidence interval [CI] = 2.5–4.2). The risk of severe acute illness in the small subgroup that received technology-assisted care was much greater (RR = 373; 95% CI = 330–422) than for the large group of chronically ill patients who did not require technology-assisted care (RR = 2.3; 95% CI = 1.7–3.0), each expressed relative to previously healthy children. Acute illness related to chronic health conditions accounted for 45% of 251 unscheduled ICU admissions during the 1-year study. Thirty-two percent of admissions that were related to chronic conditions were judged to have been potentially preventable. Preventable events were more common for those who did not require technology-assisted care, occurring in 38% of admissions, compared with those who received technology-assisted care, for whom 19% of admissions involved a preventable event. Fifty-six percent of potentially preventable events involved the physical or social environment and decisions made by the family, whereas 64% could be attributed to health care system factors.
Conclusions. Children with chronic health conditions account for a substantial share of severe acute illness in a region. Because their underlying conditions have already been identified, problems may be anticipated. The small number of children who receive technology-assisted care each have such a high risk of severe and unavoidable acute illness that individualized emergency care plans are justified. For the remainder of children with chronic conditions, investigation of health system strategies to improve families' ability to anticipate, minimize, or prevent related acute illness is warranted.
Relation of Two Different Subtypes of Croup Before Age Three to Wheezing, Atopy, and Pulmonary Function During Childhood: A Prospective Study
Authors: Castro-Rodrı́guez José A. , Holberg Catharine J. , Morgan Wayne J. , Wright Anne L. , Halonen Marilyn , Taussig Lynn M. , Martinez Fernando D. 
Published: August 2004

Objective.
Some retrospective evidence suggests that children with a history of croup may be at increased risk of subsequently developing asthma, atopy, and diminished pulmonary function. The objective of this study was to determine the long-term outcome of croup (as diagnosed by a physician) in early life.

Methods.
Lower respiratory illnesses (LRIs) in the first 3 years of life were assessed in 884 children who were enrolled in a large longitudinal study of airway diseases at birth. Pulmonary function tests, markers of atopy, and wheezing episodes were studied at different ages between birth and 13 years.

Results.
Ten percent of children had croup with wheeze (Croup/Wheeze), 5% had croup without wheeze (Croup/No Wheeze), 36% had another LRI (Other LRI), and 48% had no LRI. Respiratory syncytial virus was more frequently isolated in children with Croup/Wheeze and Other LRI than in those with Croup/No Wheeze. There was no association between croup in early life and markers of atopy measured during the school years. Only children with Croup/Wheeze and with Other LRI had a significant risk of subsequent persistent wheeze later in life. Significantly lower levels of indices of intrapulmonary airway function were observed at ages &lt;1 (before any LRI), 6, and 11 years in children with Croup/Wheeze and Other LRI compared with children with No LRI. Conversely, inspiratory resistance before any LRI episode was significantly higher in infants who later developed Croup/No Wheeze than in the other 3 groups.

Conclusions.
We distinguish 2 manifestations of croup with and without wheezing. Children who present with croup may or may not be at increased risk of subsequent recurrent lower airway obstruction, depending on the initial lower airway involvement, and preillness and postillness abnormalities in lung function associated with this condition.
Association of Lower Continuity of Care With Greater Risk of Emergency Department Use and Hospitalization in Children
Authors: Christakis Dimitri A. , Mell Loren , Koepsell Thomas D. , Zimmerman Frederick J. , Connell Frederick A. 
Published: August 2004

Context.The benefits of continuity of pediatric care remain controversial.Objective.To determine whether there is an association between having a continuous relationship with a primary care pediatric provider and decreased risk of emergency department (ED) visitation and hospitalization.Design.Retrospective cohort study.Setting and Population.We used claims data from 46 097 pediatric patients enrolled at Group Health Cooperative, a large staff-model health maintenance organization, between January 1, 1993, and December 31, 1998, for our analysis. To be eligible, patients had to have been continuously enrolled for at least a 2-year period or since birth and to have made at least 4 visits to one of the Group Health Cooperative clinics.Main Exposure Variable.A continuity of care (COC) index that quantifies the degree to which a patient has experienced continuous care with a provider.Main Outcome Measures.ED utilization and hospitalization.Results.Compared with children with the highest COC, children with medium continuity were more likely to have visited the ED (hazard ratio [HR]: 1.28 [1.20–1.36]) and more likely to be hospitalized (HR: 1.22 [1.09–1.38]). Children with the lowest COC were even more likely to have visited the ED (HR: 1.58 [1.49–1.66]) and to be hospitalized (HR: 1.54 [1.33–1.75]). These risks were even greater for children on Medicaid and those with asthma.Conclusions.Lower continuity of primary care is associated with higher risk of ED utilization and hospitalization. Efforts to improve and maintain continuity may be warranted.
Back to Sleep: Good Advice for Parents but Not for Hospitals?
Authors: Hein Herman A. , Pettit Stephanie F. 
Published: August 2004

Background.In October 1998, when we surveyed nurses working in Iowa obstetric units about infant sleeping position in the hospital and recommendations for infant sleeping position at home, we learned that the side position was used frequently in the hospital and also was considered to be an acceptable alternative for sleeping position at home.Objective.The purpose of our present study was to determine why nurses continued to use and endorse the side sleeping position rather than the supine position.Design.We surveyed all Iowa hospitals that had an obstetric service as of July 1999 to learn why the side position was used.Results.All 94 hospitals with obstetric services responded to the survey and revealed that 2 major factors were considered when an infant was put to sleep on his/her side. The most frequent response was fear of aspiration (57 responses or 51.4%) and the second was adherence to a federal brochure that lists side sleeping as a reasonable alternative (38 responses or 34.2%).Conclusion.We conclude that the reasons reported for use of the side position in Iowa maternity hospitals do not justify its continuing use. We believe that information about the importance of placing an infant on his/her back to sleep and its superiority over placing an infant on his/her side to sleep is sufficient to warrant its availability in every maternity hospital. We speculate that if the infant sleeping position used in the hospital is not different from that taught to parents, there will be less parental confusion and greater adherence to infant positioning shown to reduce sudden infant death syndrome.
The Timing and Predictors of the Early Termination of Breastfeeding
Authors: Ertem Ilgi Ozturk , Votto Nancy , Leventhal John M. 
Published: August 2004

Objective.To determine the prevalence and correlates of the early discontinuation of breastfeeding by mothers eligible for the Women, Infants, and Children Program (WIC).Methodology.A longitudinal observational study in which we enrolled English-speaking mothers who initiated breastfeeding after delivering healthy-term infants at Yale-New Haven Hospital and planned to bring their infants to the hospital's primary care center. Data on mother's baseline knowledge, attitudes, beliefs, and problems regarding breastfeeding were collected by semistructured interviews within 48 hours after delivery, at 1 and 2 weeks' postpartum, and by chart reviews at 2 and 4 months. A nonparticipating control group was used to test the Hawthorne effect.Results.Of the 64 participating mothers, the majority were minority (56% black, 34% of Puerto Rican origin), single (75%), and already enrolled in WIC (91%). The rates of discontinuation of breastfeeding were 27%, 37%, 70%, and 89% by 1 week, 2 weeks, 2 months, and 4 months, respectively. The mother's knowledge and problems of lactation were not associated with the early discontinuation of breastfeeding. After using logistic regression to control for potential confounders, mothers who lacked confidence at baseline that they would still be breastfeeding at 2 months (risk ratio: 2.38, 95% confidence interval: 1.82–6.18), and those who believed that the baby prefers formula (risk ratio: 1.68, 95% confidence interval: 1.04–2.71) were more likely to stop breastfeeding within the first 2 weeks postpartum.Conclusions.The results of this study demonstrate that interventions aimed at prolonging the duration of breastfeeding in this population will need to shift focus from increasing knowledge and managing problems of lactation to enhancing the mother's confidence regarding breastfeeding, while also addressing beliefs regarding an infant's preferences.
A Randomized Trial of Alternative Two- and Three-Dose Hepatitis B Vaccination Regimens in Adolescents: Antibody Responses, Safety, and Immunologic Memory
Authors: Cassidy William M. , Watson Barbara , Ioli Virginia A. , Williams Karen , Bird Steven , West David J. 
Published: August 2004

Objectives.Hoping to increase hepatitis B (HB) vaccination of adolescents, we did the following: 1) studied if modified regimens of the recombinant HB vaccine, Recombivax HB (2 or 3 doses of 5 or 10 μg given over 4 or 6 months), induce protective anti-hepatitis B surface antibody [anti-HBsAb] levels (≥10 mIU/mL) comparable to the recommended regimen (5 μg at 0 and 1, and 6 months); 2) measured early antibody response after a single dose; and 3) assessed immunologic memory after 2- and 3-dose regimens.Design.One thousand twenty-six adolescents were randomized to 1 of 5 treatment groups (10 μg at 0 and 4 or 0 and 6 months; 5 μg at 0 and 6 or 0, 2, and 4 or 0, 1, and 6 months) in an open trial. Anti-HBsAb was measured in all participants just before and 1 month after the last dose, and at several other times in a subset of vaccinees. Anti-HBsAb response to a booster dose 2 years later was examined to assess immunologic memory in participants vaccinated with 5 μg at 0 and 6 or 0, 1, and 6 months.Results.All regimens induced ≥10 mIU/mL of anti-HBs in ≥95% of vaccinees. Geometric mean titers ranged from 674.8 to 3049.4 mIU/mL. Geometric mean titers were higher with regimens using the following: 1) 10 versus 5 μg; 2) 3 versus 2 doses; and 3) vaccination intervals of 6 versus 4 months. After 6 months, 63.8% of vaccinees given one 10-μg dose had ≥10 mIU/mL of anti-HBsAb versus 41.6% after one 5-μg dose. Participants vaccinated with either two or three 5-μg doses retained robust immunologic memory.Conclusions.The results of this study show that a 2-dose regimen of Recombivax HB is as immunogenic and induces immunologic memory as effectively as the recommended 3-dose regimen. A regimen of two 10-μg doses may be of significant benefit for vaccinees who are poorly compliant or deviate from the intended vaccination schedule.
Randomized Trial of Nasal Synchronized Intermittent Mandatory Ventilation Compared With Continuous Positive Airway Pressure After Extubation of Very Low Birth Weight Infants
Authors: Barrington Keith J. , Bull Dale , Finer Neil N. 
Published: August 2004

Objective.
To determine whether noninvasive, nasal synchronized intermittent mandatory ventilation (nSIMV) improves the likelihood that very low birth weight infants will be successfully extubated.

Methods.
Infants of &lt;1251-g birth weight who were due to be extubated before 6 weeks of age were eligible once they were receiving &lt;35% oxygen and were on a ventilator rate of &lt;18 breaths per minute (bpm). Extubation was performed following intravenous loading with aminophylline, after a successful trial of 12 hours of endotracheal synchronized intermittent mandatory ventilation at a rate of 8. Infants were randomized to either nasal continuous positive airway pressure (nCPAP) at 6 cm H2O or nSIMV after extubation. nSIMV was commenced at a rate of 12 bpm with pressure on the ventilator set to achieve a delivered pressure of at least 12 cm H2O and a peak end expiratory pressure of 6 cm H2O. Continuous recording for diagnosis of apnea was performed for 72 hours after extubation. Objective criteria for failure of extubation were as follows: a Paco2 &gt;70; Fio2 &gt;0.7; or severe recurrent apnea (&gt;2 apneas requiring intermittent positive-pressure ventilation in 24 hours or &gt;6 apneas &gt;20 seconds per day). The study ended after 72 hours postextubation or when infants satisfied failure criteria. A sample size of 54 was determined by power analysis.

Results.
Mean birth weight (831 standard deviation [SD]: 193 g) and gestation (26.3 SD: 1.8 weeks) did not differ between groups. Mean age at extubation was 7.6 (SD: 9.7) days, range 1 to 40 days. The nSIMV group had a lower incidence of failed extubation 4/27 compared with the continuous positive airway pressure group, 12/27. This was attributable to both a decreased incidence of apnea and a decreased incidence of hypercarbia. There was no increase in the incidence of abdominal distension or feeding intolerance.

Discussion.
nSIMV is effective in preventing extubation failure in very low birth weight infants in the first 72 hours after extubation. Noninvasive ventilation may have other roles in the care of the very low birth weight infant.
Screening Guidelines for Retinopathy of Prematurity: The Need for Revision in Extremely Low Birth Weight Infants
Authors: Subhani Muhammad , Combs Adriann , Weber Pamela , Gerontis Corina , DeCristofaro Joseph D. 
Published: August 2004

Objective.
To determine whether significant retinopathy of prematurity (ROP) can be detected before 31 to 33 weeks' postmenstrual age (PMA) in extremely low birth weight (ELBW) infants.

Methods.
Medical records of all ELBW infants (&lt;1000 g at birth) admitted to our regional perinatal center between April 1995 and January 1999 were reviewed retrospectively. Screening examinations for ROP were routinely performed at 4 to 6 weeks' chronological age (CA) from birth and followed at least every other week. Data were collected for infants who developed ROP. We determined the PMA at which the first screening eye examination demonstrated prethreshold disease and the subsequent examination that showed threshold disease (if it occurred). The percentages of infants who developed prethreshold ROP diagnosed at ≤31 weeks' PMA and of those who progressed to threshold ROP before 34 weeks' PMA were determined.

Results.
All 258 ELBW infants were screened for ROP. Seventy-eight infants (30%) were diagnosed with prethreshold ROP. Twenty-seven of these infants (35%) progressed to threshold ROP. Ten infants who progressed to threshold ROP were &lt;34 weeks' PMA at the time of this diagnosis. Of these 10 infants, 3 were diagnosed at 31 weeks' PMA, 4 at 32 weeks', and 3 at 33 weeks'.

Conclusion.
More than 80% of ELBW infants who developed prethreshold disease in this cohort were ≤33 weeks' PMA. The joint statement screening option of independently using 31 to 33 weeks' PMA for the first eye examination would have led to a diagnosis of threshold ROP on first examination in as many as 13% (10/78) of our patients. Early identification of prethreshold ROP is important for providing timely intervention in this rapidly progressive disease. Therefore, ELBW infants should receive initial ROP screening using the CA guideline of 4 to 6 weeks rather than the 31- to 33-week postconceptional age guideline.