bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perinatal Screening for Group B Streptococci: Cost-Benefit Analysis of Rapid Polymerase Chain Reaction
Authors: Haberland Corinna A. , Benitz William E. , Sanders Gillian D. , Pietzsch Jan Benjamin , Yamada Sanae , Nguyen Lan , Garber Alan M. 
Published: August 2004

Objective. To evaluate the costs and benefits of a group B streptococci screening strategy using a new, rapid polymerase chain reaction test in a hypothetical cohort of expectant mothers in the United States.
Methods. Design. Cost-benefit analysis using the human capital method. We developed a decision model to analyze the costs and benefits of a hypothetical group B streptococci screening strategy using a new, rapid polymerase chain reaction test as compared with the currently recommended group B streptococci screening guidelines—prenatal culture performed at 35 to 37 weeks or risk-factor-based strategy with subsequent intrapartum treatment of the expectant mothers with antibiotics to prevent early-onset group B streptococcal infections in their infants.
Participants. A hypothetical cohort of pregnant women and their newborns.
Interventions. Screening strategies for group B streptococci using the new polymerase chain reaction technique, the 35- to 37-week culture, or maternal risk factors.
Outcome Measures. Infant infections averted, infant deaths, infant disabilities, costs, and societal benefits of healthy infants.
Results. A screening strategy using the new polymerase chain reaction test generates a net benefit of $7 per birth when compared with the maternal risk-factor strategy. For every 1 million births, 80 700 more women would receive antibiotics, 884 fewer infants would become infected with early-onset group B streptococci, and 23 infants would be saved from death or disability. The polymerase chain reaction-based strategy generates a net benefit of $6 per birth when compared with the 35- to 37-week prenatal culture strategy and results in fewer maternal courses of antibiotics (64 080 per million births), fewer perinatal infections with early-onset group B streptococci (218/million), and a reduction in 6 infant deaths and severe infant disability per million births. The benefits hold over a wide range of assumptions regarding key factors in the analysis.
Conclusions. Although additional clinical trials are needed to establish the accuracy of this new polymerase chain reaction test, initial studies suggest that strategies using this test will be superior to the other 2 strategies. Using the rapid polymerase chain reaction test becomes less attractive as the cost of the test increases. The test’s greatest strengths lie in its ability to identify women and infants at risk at the time of labor, thereby decreasing the number of false-positives and false-negatives seen with the other 2 strategies and allowing for more accurate and effective intrapartum prophylaxis.
Parental Screening for Intimate Partner Violence by Pediatricians and Family Physicians
Authors: Borowsky Iris Wagman , Ireland Marjorie 
Published: August 2004

Objective. To ascertain and compare the knowledge, practices, and training needs of pediatricians and family physicians regarding intimate partner violence screening and intervention.Methods. Surveys were mailed to national random samples of 1350 pediatricians and 650 family physicians evenly divided between senior residents, practitioners completing their residency training within the last 5 years, and practitioners completing their training &gt;5 years ago.Results. The overall response rate was 37% (41% for pediatricians, 30% for family physicians). Among practicing physicians, only 8% of family physicians and 5% of pediatricians routinely screened a parent for intimate partner violence during well-child and teen visits. Family medicine residents were significantly more likely to routinely screen for intimate partner violence (18%), whereas pediatric residents were not (7%). All groups demonstrated deficits in knowledge of appropriate management of situations of domestic abuse; for example, over 60% of family medicine and 75% of pediatric residents and practitioners agreed with the inappropriate response of always urging a woman to leave her abusive partner immediately. Many physicians indicated a need for more information about domestic violence, ranging from 40% of family medicine residents to 72% of pediatric residents. Residency training and continuing medical education in the prevention of child/adolescent violence and having an office protocol for managing cases involving domestic violence increased the likelihood of parental screening for intimate partner violence.Conclusions. Few child and adolescent primary care physicians routinely screen parents for intimate partner violence and most need more information on this topic. Residency training and continuing medical education on violence prevention, including screening and intervention skills in intimate partner violence, and office protocols for managing cases of domestic violence could increase screening rates.
Free Thyroxine Levels During the First Weeks of Life and Neurodevelopmental Outcome Until the Age of 5 Years in Very Preterm Infants
Authors: van Wassenaer Aleid G. , Briët Judy M. , van Baar Anneloes , Smit Bert J. , Tamminga Pieter , de Vijlder Jan J. M. , Kok Joke H. 
Published: August 2004

Background. We have conducted a randomized trial with thyroxine (T4) in 200 infants &lt;30 weeks’ gestation. T4 treatment was associated with better 5-year outcome in infants &lt;29 weeks’ gestation, but with worse outcome in infants of 29 weeks. These effects could be related to low, respectively high free thyroxine (FT4) levels
Methods. For each infant, the average FT4 of 5 scheduled measurements was calculated between day 3 and day 28. Infants of the placebo and the T4 group separately were divided in 2 groups. The placebo group consisted of a group of infants with average FT4 in the lowest quartile and a group in the upper 75%. The T4 group consisted of a group of infants with average FT4 in the upper quartile and a group in the lower 75%. Developmental outcome (mental/cognitive, motor, and neurologic) at 2 and 5.7 years was compared between high and low FT4 groups, and then compared separately for the T4 and placebo group.
Results. In the placebo group, low FT4 was associated with worse outcome on all domains at both time points. After correction for confounding variables, mental and neurologic outcome remained significantly different at 2 years, and motor outcome at 5 years.
In the T4 group, high FT4 was not associated with worse outcome, neither at 2 nor at 5 years.
Conclusions. In untreated infants, low FT4 values during the first 4 weeks after birth in infants born at &lt;30 weeks’ gestation are associated with worse neurodevelopmental outcome at 2 and 5 years. In T4-treated infants, high FT4 is not associated with worse outcome. Other factors than high FT4 concentrations must play a role in the worse outcome of the T4-treated group of 29 weeks’ gestational age.
Comparison of Oral Versus Normal and High-Dose Rectal Acetaminophen in the Treatment of Febrile Children
Authors: Scolnik Dennis , Kozer Eran , Jacobson Sheila , Diamond Shelley , Young Nancy L. 
Published: August 2004

Objectives. To compare the defervescent effect of high-dose rectal suppository acetaminophen with the recommended oral and rectal dosages and to evaluate acceptability of rectal acetaminophen.Methods. A randomized, controlled trial was performed in 70 patients aged 6 months to 6 years with fever ≥39°C. Group A received rectal acetaminophen 15 mg/kg, group B received rectal acetaminophen 30 mg/kg, and group C received oral acetaminophen 15 mg/kg. Primary outcome was maximal change in temperature during the 3-hour study period after initial treatment.Results. There were 24 patients in group A, 23 in group B, and 23 in group C. There was no significant difference in temperature change between the groups during the 3 hours or in the maximum drop in temperature or final temperature. Visual analog scores for satisfaction of parents did not reveal any significant differences between the oral and rectal routes.Conclusions. There was no difference between the temperature decrement in patients treated with 15 mg/kg oral acetaminophen and the same or double dose rectally. Thus, there seems to be no evidence to support the use of higher doses of rectal acetaminophen for the treatment of fever in children. The rectal route proved to be as acceptable as the oral among parents.
Birth Weight and Hearing Impairment in Norwegians Born From 1967 to 1993
Authors: Nafstad Per , Samuelsen Sven O. , Irgens Lorentz M. , Bjerkedal Tor 
Published: August 2004

Objectives. To estimate the association between birth weight and hearing impairment among Norwegians born between 1967 and 1993, taking other pregnancy-related conditions into consideration.
Methods. A cohort study was conducted of all Norwegian live births from 1967 to 1993 (n = 1 548 429) linking information of the Medical Birth Registry of Norway and the register for the National Insurance Administration, which covers all Norwegians. The Medical Birth Registry of Norway has recorded information on birth weight and other pregnancy-related conditions as well as diseases of the mother before and during pregnancy. The register of the National Insurance Administration contains information on all Norwegians who have received cash benefits for a disease/disability, including hearing impairment. Data up to 1997 are included; thus, the follow-up period varies between 29 and 3 years.
Results. The occurrence of hearing impairment was 11 per 10 000, decreasing from 60 per 10 000 for birth weights &lt;1500 g to 6 per 10 000 for birth weights &gt;4499g. Compared with birth weights between 3000 g and 3499 g, the adjusted rate ratio of hearing impairment was 7.55 (95% confidence interval: 4.81–11.87) for birth weights &lt;1500 g and 0.50 (95% confidence interval: 0.34–0.73) for birth weights &gt;4499 g. The association did not change substantially with adjustment for other pregnancy-related conditions. Restricting the analyses to term born, the association between hearing impairment and low birth weight became stronger.
Conclusions. Birth weight was a strong predictor of hearing impairment in the Norwegian population. Children who were born at term with a low birth weight seemed to be a particularly vulnerable group.
Validation of 2 Pain Scales for Use in the Pediatric Emergency Department
Authors: Bulloch Blake , Tenenbein Milton 
Published: August 2004

Objective. To determine the construct, content, and convergent validity of 2 self-report pain scales for use in the untrained child in the emergency department (ED).
Methods. A prospective study was conducted of all children who presented to an urban ED between 5 and 16 years of age inclusive after written informed consent was obtained. Children were excluded if they were intoxicated, had altered sensorium, were clinically unstable, did not speak English, or had developmental delays. Children marked their current pain severity on a standardized Color Analog Scale (CAS) and a 7-point Faces Pain Scale (FPS). They were then asked whether their pain was mild, moderate, or severe. Children were then administered an analgesic at the discretion of the attending physician and asked to repeat these measurements. For assessing content validity, the scales were also administered to age- and gender-matched children in the ED for nonpainful conditions. Convergent validity was assessed by determining the Spearman correlation coefficient between the 2 pain scales.
Results. A total of 60 children were enrolled, 30 with pain and 30 without, with a mean age of 9.3 ± 3.3 years. Boys accounted for 38 of the enrollees (63.3%). The median score before analgesic administration was 6.0 cm (interquartile range [IQR]: 4.0–8.0) on the CAS and 3.0 faces (IQR: 2.0–5.0) on the FPS; after analgesic administration, the median scores decreased to 3.1 cm (IQR: 1.1–4.3) and 2.0 faces (IQR: 1.0–3.0), respectively. As the reported pain intensity increased, so did the scores on the 2 pain scales. The 30 children with no pain had a median score on the CAS of 0.0 (IQR: 0.0–1.0) and on the FPS of 0.0 (IQR: 0.0–1.0), whereas the 13 children with severe pain had a median CAS of 7.0 (IQR: 6.0–8.0) and a median FPS of 5.0 (IQR: 4.0–6.0). The Spearman correlation coefficient between the CAS and the FPS was positive and strong (r = 0.894).
Conclusion. The CAS and the FPS exhibit construct, content, and convergent validity in the measurement of acute pain in children in the ED.
Clinical Chorioamnionitis, Elevated Cytokines, and Brain Injury in Term Infants
Authors: Shalak Lina F. , Laptook Abbot R. , Jafri Hasan S. , Ramilo Octavio , Perlman Jeffrey M. 
Published: August 2004

Objectives. To determine the initial inflammatory cytokine response in term infants born to mothers with clinical chorioamnionitis and to assess whether the cytokine response is associated with birth depression, abnormal neurologic examination, and hypoxic-ischemic encephalopathy (HIE).Methods. Infants who were exposed to chorioamnionitis and admitted to the neonatal intensive care unit (n = 61) were studied prospectively. Cytokine concentrations were measured from umbilical cord blood and at 6 and 30 hours after birth. Control values (n = 50) were determined from cord blood of healthy term infants. Enzyme-linked immunosorbent assays were performed for interleukin (IL)-1β; IL-6; IL-8; regulated on activation, normal T-cell expressed and secreted (RANTES); macrophage inflammatory protein-1α; and tumor necrosis factor-α. Serial blinded neurologic examinations using a modified Dubowitz score were performed simultaneously at 6 and 30 hours.Results. Cord IL-6 (1071 ± 1517 vs 65 ± 46 pg/mL), IL-8 (2580 ± 9834 vs 66 ± 57 pg/mL), and RANTES (95 917 ± 16 518 vs 54 000 ± 14 306 pg/mL) concentrations only were higher in infants with chorioamnionitis versus control infants. IL-6 increased at 6 hours to 1451 ± 214 pg/mL, followed by a 5-fold decline at 30 hours in contrast to progressive decreases over time in IL-8 and RANTES. There was no relationship between cytokines and birth depression. Modified Dubowitz score correlated with IL-6 at 6 hours (r = 0.5). Infants with HIE/seizures (n = 5) had significantly higher cytokine concentrations at 6 hours versus infants without either (n = 56): IL-6 (3130 vs 1219 pg/mL), IL-8 (5433 vs 780 pg/mL), and RANTES (97 396 vs 46 914 pg/mL).Conclusions. There was a significant association between abnormalities in the neurologic examination and cytokine concentrations, with the highest cytokines concentrations observed in infants who developed HIE/seizures.
Effect of Intense Exercise on Inflammatory Cytokines and Growth Mediators in Adolescent Boys
Authors: Nemet Dan , Oh Youngman , Kim Ho-Seong , Hill MaryAnn , Cooper Dan M. 
Published: August 2004

Objective. Exercise can enhance growth and development in children, but recent investigations have revealed an intriguing paradox. Namely, the early (4–5 weeks) response to training programs in children lead to a catabolic, growth hormone (GH)-resistant state rather than the expected anabolic activation of the GH→insulin-like growth factor-I (IGF-I) axis. This paradox led us to hypothesize that single bouts of exercise in children could stimulate proinflammatory cytokines known to inhibit directly anabolic activity of the GH→IGF-1 axis (interleukin [IL]-6, IL-1β, and tumor necrosis factor-α [TNF-α]).
Methods. Eleven healthy high school-age boys, age 14 to 18.5 years, performed a single, typical, 1.5-hour wrestling practice session. Blood was sampled before and after the session.
Results. We found significant decreases in anabolic mediators: total IGF-I (−11.2 ± 2.3%), bound IGF-I (−11.2 ± 2.4%), and insulin (−42 ± 10%. However, there was no change in unbound IGF-I. Remarkable increases were found in proinflammatory cytokines IL-6 (795 ± 156%), TNF-α (30 ± 12%), and IL-1β (286 ± 129%) and in IGF-binding protein-1 (835 ± 234%), which itself is stimulated by inflammatory cytokines and is known to inhibit IGF-I. Evidence for compensatory mechanisms to counter the antianabolic inflammatory response to acute exercise were also noted: IL-1ra increased (80 ± 20%) and IGF-binding protein-3 proteolysis (which can maintain unbound, biologically active IGF-I despite losses in total IGF-I) increased significantly (101 ± 39%) as well.
Conclusions. These data demonstrate that an intense exercise bout in male adolescents leads to reductions in anabolic mediators and profound increases in inflammatory cytokines. This might explain the development of what seems to be a paradoxical catabolic state in the initial phases of exercise training programs.
Trends in Incidence and Antimicrobial Resistance of Early-Onset Sepsis: Population-Based Surveillance in San Francisco and Atlanta
Authors: Hyde Terri B. , Hilger Tami M. , Reingold Arthur , Farley Monica M. , O’Brien Katherine L. , Schuchat Anne ,   for the Active Bacterial Core surveillance (ABCs) of the Emerging Infections Program Network
Published: August 2004

Objective. Although increased use of intrapartum antibiotics caused significant declines in early-onset group B Streptococcus (GBS) infection, the effect on infections caused by other pathogens is not clear. The objective of this study was to determine trends in the incidence of early-onset sepsis caused by organisms other than group B streptococcus in the era of antimicrobial prophylaxis.
Methods. We conducted surveillance for early-onset sepsis as part of the Active Bacterial Core surveillance. A case was defined as isolation of bacteria from blood or cerebrospinal fluid from an infant who was 0 to 6 days of age and born in the surveillance area during 1998 through 2000 (248 184 births).
Results. We identified 408 cases of early-onset infection. GBS caused 166 (40.7%) cases (52 in 1998, 51 in 1999, and 63 in 2000 for incidences 0.62, 0.62, and 0.76 cases per 1000 live births, respectively). Other bacterial pathogens were identified in 242 cases (82 in 1998, 79 in 1999, and 81 in 2000 for incidences 0.99, 0.95, and 0.98 per 1000 live births, respectively) of early-onset sepsis. Escherichia coli caused 70 cases (0.25, 0.28, and 0.31 cases per 1000 live births, respectively, in 1998–2000). The proportion of E coli infections that were resistant to ampicillin increased significantly among preterm infants from 29% (2 of 7) in 1998 to 84% (16 of 18) in 2000 but not in full-term infants: 50% (4 of 8) in 1998 and 25% (1 of 4) in 2000.
Conclusions. Whereas rates of early-onset sepsis caused by GBS and other pathogens were low and did not change significantly during the study period, antibiotic-resistant E coli infections among preterm infants increased. Overall, these trends are reassuring, but careful evaluation of the increase in resistant infections in very young infants is critical in the future.
Barriers to Booster Seat Use and Strategies to Increase Their Use
Authors: Simpson Edith M. , Moll Elisa K. , Kassam-Adams Nancy , Miller Gwenyth J. , Winston Flaura K. 
Published: August 2004

Objective. Children who have outgrown child safety seats and been placed in adult seat belts are at increased risk for injury. Pediatricians and other advocates have been called on to encourage booster seat use in these children. The objective of this study was to identify barriers to booster seat use and strategies to increase their use.
Methods. A qualitative study consisting of focus groups and follow-up in-depth discussions were conducted among parents and/or children to elicit barriers and strategies to appropriate/best practice child restraint system use. Phase I focus groups (parents and children) identified barriers to booster seat use along with children’s self-reported likes and dislikes about booster seats. Phase II focus groups (parents only) identified additional barriers to booster seat use and suggestions for strategies to increase the use of booster seats. In-depth telephone discussions (parents only) were conducted after each phase of focus groups to identify new themes and to explore further previously emerged topics that were not conducive to probing in focus group settings.
Results. This study demonstrated that although knowledge of the benefits and purpose of booster seats is an important issue in promoting booster seat use, it is not the only issue. In particular, differences in risk perception, awareness/knowledge, and parenting style were noted when comparing parents of children in booster seats with those whose children were in seat belts. Media campaigns, improved laws, parenting education, and extending the use of child restraints to older ages were among the strategies suggested by parents to increase booster seat use.
Conclusions. Anticipatory guidance regarding booster seats may be new for many pediatricians. This article arms pediatricians with insights from parents about their perceptions regarding booster seats and how parents think that the booster seat message can be most effectively delivered. Furthermore, it gives insight into how parents make safety decisions for their children and the important role of children in this decision-making process.
Variables Associated With Medication Errors in Pediatric Emergency Medicine
Authors: Kozer Eran , Scolnik Dennis , Macpherson Alison , Keays Tara , Shi Kevin , Luk Tracy , Koren Gideon 
Published: August 2004

Objective. Medication errors are a common cause of iatrogenic morbidity and mortality. The incidence of medication errors in pediatric emergency departments (EDs) has not been described. The objective of this study was to describe the incidence and type of drug errors in a pediatric ED and determine factors associated with risk of errors.
Methods. A retrospective cohort study was conducted of the charts of 1532 children who were treated in the ED of a pediatric tertiary care hospital during 12 randomly selected days from the summer of 2000. Two pediatricians, blinded to other study variables, independently decided whether a medication error occurred and ranked it according to a severity score. Disagreement was resolved by consensus.
Results. Prescribing errors were identified in 10.1% of the charts. The following variables were associated in univariate analysis with an increased proportion of errors: patients seen between 4 am and 8 am (odds ratio [OR]: 2.45; 95% confidence interval [CI]: 1.10–5.50), patients with severe disease (OR: 2.53; 95% CI: 1.18–5.41), medication ordered by a trainee (OR: 1.48; 95% CI: 1.03–2.11), and patients seen during weekends (OR: 1.48; 95% CI: 1.04–2.11). Among trainees, there was a higher rate of errors at the beginning of the academic year (OR: 1.67; 95% CI: 1.06–2.64). Logistic regression revealed increased risk for errors when a medication was ordered by a trainee (OR: 1.64; 95% CI: 1.06–2.52) and in seriously ill patients (OR: 1.55; 95% CI: 1.06–2.26).
Conclusions. In the pediatric ED, trainees are more likely to commit prescribing errors, and the most seriously ill patients are more likely to be subjected to prescribing errors.