bluuebunny/crossref_metadata_2025_split huggingface dataset:
Respiratory Syncytial Virus (RSV) Immune Globulin Intravenous Therapy for RSV Lower Respiratory Tract Infection in Infants and Young Children at High Risk for Severe RSV Infections
Authors: Rodriguez William J. , Gruber William C. , Welliver Robert C. , Groothuis Jessie R. , Simoes Eric A. F. , Meissner H. Cody , Hemming Val G. , Hall Caroline B. , Lepow Martha L. , Rosas Angela J. , Robertsen Christine , Kramer Andrew A. ,   for the Respiratory Syncytial Virus Immune Globulin Study Group
Published: August 2004

Objectives. To evaluate the efficacy of high-titer intravenous respiratory syncytial virus immune globulin (RSVIG) in the treatment of children at high risk for severe RSV infection who were hospitalized with proven RSV.
Methods. Infants and young children younger than 2 years with bronchopulmonary dysplasia, chronic lung disease, congenital heart disease, or prematurity (&lt;32 weeks' gestational age), hospitalized with a history of lower respiratory tract infection (LRI) of less than 4 days, were enrolled in this study. Patients were randomized in a blinded fashion to receive either 1500 mg/kg RSVIG or placebo in equal volumes. They were evaluated daily for safety and respiratory scores and for RSV nasal shedding.
Results. One hundred seven high-risk children were randomized—54 in the RSVIG group and 53 in the placebo group. Of these children, 51 in each group were considered evaluable. Children with pulmonary disease, congenital heart disease, or prematurity were equally distributed between the two treatment groups. However, two important differences were found in baseline variables between the two groups: there were more patients in the placebo group who had histories of previous LRI and there was a trend toward more severe disease at study entry in the RSVIG group. This was manifested by a higher entry respiratory score in the RSVIG group than in the placebo group (3.4 ± 0.2 vs 3.1 ± .01). A higher proportion of children in the RSVIG group (47%) than in the placebo group (28%) required intensive care at entry and mechanical ventilation at study entry (31% RSVIG-treated vs 18% placebo-treated patients). No significant difference was found between groups in the mean unadjusted duration of hospitalization (RSVIG group, 9.10 ± 1.18 days; control group, 8.17 ± 1.08 days). When the mean was adjusted for entry respiratory score, likewise, no difference was observed between each group (8.41 ± 0.97 vs 8.89 ± .99 days). The lack of efficacy observed in the study primary endpoint was observed in all diagnostic groups. No differences between the RSVIG and placebo groups were observed in the following secondary endpoints: duration of intensive care unit stay, duration of intensive care unit stay for RSV, mechanical ventilation, or supplemental oxygen. No significant differences in adverse events were reported in the RSVIG group (16 children) when compared with the control group (10 children).
Conclusion. RSVIG treatment was safe but not efficacious in the treatment of children with bronchopulmonary dysplasia, congenital heart disease, or premature gestation who were hospitalized with RSV LRI.
Risk of Diarrhea Related to Iron Content of Infant Formula: Lack of Evidence to Support the Use of Low-iron Formula as a Supplement for Breastfed Infants
Authors: Scariati Paula D. , Grummer-Strawn Laurence M. , Fein Sara Beck , Yip Ray 
Published: August 2004

Background. Concern has been raised by infant feeding experts that supplementing breastfed infants with iron-fortified formula rather than low-iron formula may have an undesirable impact on their gastrointestinal flora. Thus far, there have been no clinical studies to address this issue directly. We compared the reported frequency of diarrhea for breastfed infants given iron-fortified formula with those fed low-iron formula.Methods. Mothers participating in a mail panel provided feeding and diarrhea information on their infants at 2, 3, 4, 5, 6, 7, 9, and 12 months (n = 1743). Infants were grouped into five feeding categories: (1) breast milk only, (2) breast milk and low-iron formula, (3) breast milk and iron-fortified formula, (4) low-iron formula only, and (5) iron-fortified formula only. We calculated the number of diarrheal episodes per week for each feeding category and used rate ratios to estimate the relative impact of low-iron and iron-fortified formulas.Results. Among infants who received both breast milk and formula, the rate ratio for iron-fortified formula versus low-iron formula was 1.06 (confidence interval, 0.84 to 1.34), indicating that the type of formula a breastfed infant receives does not significantly affect the frequency of diarrhea.Conclusions. We found no evidence to support the hypothesis that breastfed infants given iron-fortified formula are at greater risk of having diarrhea. This, in addition to the fact that iron-fortified formula has played a major role in preventing childhood iron deficiency anemia, supports the current recommendation that any formula given to infants be fortified with iron. infant food, diarrhea, breastfeeding, iron.
Admixture of a Multivitamin Preparation to Parenteral Nutrition: The Major Contributor to In Vitro Generation of Peroxides
Authors: Lavoie Jean-Claude , Bélanger Sylvie , Spalinger Monica , Chessex Philippe 
Published: August 2004

Background. Peroxides have been reported to contaminate lipid emulsions and amino acid solutions used in total parenteral nutrition (TPN). This is particularly disturbing in newborn infants who are prone to several diseases related to immature defense mechanisms against oxidative challenges. It is not clear whether the antioxidants in multivitamins help protect parenteral nutrients against the hazards of oxidation.Objective. To evaluate the role of a multivitamin preparation (MVI) on the actual peroxide load received by patients on TPN.Methodology. The generation of peroxides in parenteral nutrition was tested first using test solutions. We compared the relative contribution of commercially available amino acid solutions, a lipid emulsion, and MVI on the level of peroxides in clinically relevant TPN solutions. Second, we measured the level of peroxides actually infused at the bedside. In both circumstances, the effects of time and light exposure were isolated. The level of peroxides was determined by a colorimetric technique and expressed as μm equivalents tert-butyl hydroperoxide (μm = TBH).Results. Even when protected from light, the addition of MVI produced a 10-fold increase in peroxides (mean ± SEM, n = 3, 19 ± 4 to 189 ± 8 μm = TBH at 4 h) in the fat-free TPN solution and a fourfold increase (64 ± 6 to 244 ± 8 μm = TBH at 4 h) in the lipid-containing TPN solution. A dose–response relationship was found between the concentration of MVI and peroxide levels. The effect of light was the strongest in the presence of multivitamins. The amino acid solutions had a relative inhibitory effect on the generation of peroxides by MVI, which varied (from 54 ± 1% to 72 ± 1%) all according to the amino acid blend. In parenterally fed premature infants, protecting the intravenous set from light decreased the load of infused peroxides (146 ± 15 vs 215 ± 24 μm= TBH).Conclusions. The lipid emulsion had a significant but minor additive effect compared with the multivitamin preparation, which was the major contributor to the generation of peroxides. Protection from photooxidation is not sufficient to prevent peroxidation of TPN solutions. Contrary to what one would expect, increasing the concentration of MVI will lead to a greater generation of peroxides, suggesting that the essential antioxidants in MVI do not have antiperoxide properties. amino acids, antioxidants, detergents, lipids, newborn infants, oxidation, parenteral nutrition.
Have Medicaid Reimbursements Been a Credible Measure of the Cost of Pediatric Care?
Authors: Broyles R. Sue , Tyson Jon E. , Swint J. Michael 
Published: August 2004

Objective. Despite uncertain validity as a measure of cost, Medicaid reimbursements may be used to compare the costs of different pediatric interventions. We explored the credibility of Medicaid reimbursements as a measure of the costs of inpatient care associated with two different approaches to follow-up care for high-risk indigent infants.Design. Analysis of Medicaid reimbursements within a randomized trial of primary follow-up care.Patients. Infants ≤1500 g at birth in a large county hospital (Parkland Memorial Hospital).Intervention. Conventional care after nursery discharge (with well-baby care and care for chronic illnesses provided in our follow-up clinic) or primary care (with care for acute illnesses also provided in the follow-up clinic). Measures to prevent a lapse in Medicaid coverage were included in all clinic visits.Outcome Measures. The completeness, comparability, and plausibility of Medicaid reimbursements for inpatient care of the two groups between nursery discharge and 1 year adjusted age.Results. A high percentage (90% to 91%) of both groups were enrolled in Medicaid. However, with fewer clinic visits in the conventional care group, Medicaid coverage often lapsed in this group, particularly among the highest risk infants. As a result, the proportion of hospital days reimbursed by Medicaid was substantially lower for conventional care than primary care infants (53% [92/174] vs 96% [298/310]). An even larger disparity was observed for pediatric intensive care days (10% [6/61] vs 100% [33/33]). Implausible Medicaid reimbursements included a lower reimbursement rate per day in the pediatric intensive care unit than on the pediatric floor (1 infant), a lower reimbursement rate per day for hospital care than home care (1 infant), and a mean reimbursement rate per day for our private pediatric teaching hospital ($1244/day) that did not exceed that for the private nonteaching pediatric hospital ($1268/day). The reimbursement rate for our public teaching hospital was particularly low ($507/day) despite a high acuity of illness (21% of hospital days in the pediatric intensive care unit).Conclusions. Without proper validation, reimbursements from Medicaid (or any program that replaces it) should not be assumed to provide an unbiased or acceptably accurate measure of the relative or absolute cost of pediatric health care interventions. primary care, follow-up care, cost, Medicaid, economic analysis, health care delivery.
Secondary Sexual Characteristics and Menses in Young Girls Seen in Office Practice: A Study from the Pediatric Research in Office Settings Network
Authors: Herman-Giddens Marcia E. , Slora Eric J. , Wasserman Richard C. , Bourdony Carlos J. , Bhapkar Manju V. , Koch Gary G. , Hasemeier Cynthia M. 
Published: August 2004

Objective. To determine the current prevalence and mean ages of onset of pubertal characteristics in young girls seen in pediatric practices in the United States.
Methods. A cross-sectional study was conducted by 225 clinicians in pediatric practices belonging to Pediatric Research in Office Settings, a practice-based research network. After standardized training in the assessment of pubertal maturation, practitioners rated the level of sexual maturation on girls 3 through 12 years who were undergoing complete physical examinations.
Results. Data were analyzed for 17 077 girls, of whom 9.6% were African-American and 90.4% white. At age 3, 3% of African-American girls and 1% of white girls showed breast and/or pubic hair development, with proportions increasing to 27.2% and 6.7%, respectively, at 7 years of age. At age 8, 48.3% of African-American girls and 14.7% of white girls had begun development. At every age for each characteristic, African-American girls were more advanced than white girls. The mean ages of onset of breast development for African-American and white girls were 8.87 years (SD, 1.93) and 9.96 years (SD, 1.82), respectively; and for pubic hair development, 8.78 years (SD, 2.00) and 10.51 years (SD, 1.67), respectively. Menses occurred at 12.16 years (SD, 1.21) in African-American girls and 12.88 years (SD, 1.20) of age in white girls.
Conclusions. These data suggest that girls seen in a sample of pediatric practices from across the United States are developing pubertal characteristics at younger ages than currently used norms. Practitioners may need to revise their criteria for referral of girls with precocious puberty, with attention to racial differences.
Outcome of Very Low Birth Weight Infants at 12 to 18 Months of Age in Soweto, South Africa
Authors: Cooper Peter A. , Sandler Daniel L. 
Published: August 2004

Objective. To describe the long-term outcome of very low birth weight infants growing up in poor socioeconomic conditions in Soweto, South Africa.Methods. A stratified sample of infants weighing &lt;1500 g surviving to hospital discharge was enrolled. Group 1 consisted of 49 infants 1000 to 1499 g who required mechanical ventilation; group 2 consisted of 39 infants 1000 to 1499 g who did not require mechanical ventilation; and group 3 consisted of 25 infants &lt;1000 g (such infants are not routinely ventilated). Growth and neurological status were recorded at follow-up visits at 3, 6, and 12 months' corrected age and the infants were evaluated further using the Bayley scales of infant development between 12 and 18 months.Results. Fifteen infants died during the period between hospital discharge and 1 year corrected age, and 12 others were lost to follow-up. Although some catch-up growth was noted in the early months, all group means for weight and length were below the 25th percentile at 1 year. Cerebral palsy was diagnosed in nine infants (8 from group 1). Periventricular leukomalacia and/or porencephaly was diagnosed in eight of the nine infants during their initial hospital stay and was also the strongest negative predictor of the Bayley scores. Higher maternal education and better intrauterine growth were associated with higher Bayley scores.Conclusions. Mortality after hospital discharge in this study cohort was extremely high. However, despite marked differences in socioeconomic conditions and tertiary care facilities, the handicap rates were comparable with recent studies from developed countries, and some of the predictors of handicap, eg, periventricular leukomalacia and porencephaly, were also similar.
Elevated Plasma Norepinephrine After In Utero Exposure to Cocaine and Marijuana
Authors: Mirochnick Mark , Meyer Jerrold , Frank Deborah A. , Cabral Howard , Tronick Edward Z. , Zuckerman Barry 
Published: August 2004

Objective. To compare plasma catecholamine concentrations between cocaine-exposed and unexposed term newborns and to determine the relationship between plasma catecholamines and newborn behavior.Methods. Forty-six newborn infants participating in a prospective study of the neonatal and long-term effects of prenatal cocaine exposure were studied. Based on maternal self-report, maternal urine screening, and infant meconium analysis, 24 infants were classified as cocaine-exposed and 22 as unexposed. Between 24 and 72 hours postpartum, plasma samples for norepinephrine (NE), epinephrine, dopamine, and dihydroxyphenylalanine analysis were obtained. The Neonatal Behavioral Assessment Scale was administered at 1 to 3 days of age and at 2 weeks of age by examiners masked to the drug exposure status of the newborns.Results. The cocaine-exposed newborns had increased plasma NE concentrations when compared to the unexposed infants (geometric mean, 923 pg/mL vs 667 pg/mL). There were no significant differences in plasma epinephrine, dopamine, or dihydroxyphenylalanine concentrations. Analysis for the effect of potential confounding variables revealed that maternal marijuana use was also associated with increased plasma NE, although birth weight, gender, and maternal use of alcohol or cigarettes were not. Geometric mean plasma NE was 1164 pg/mL in those infants with in utero exposure to both cocaine and marijuana compared to 812 pg/mL in those exposed to only cocaine and 667 pg/mL in those exposed to neither. Among the cocaine-exposed infants, plasma NE concentration correlated with an increased score for the depressed cluster (r = .53) and a decreased score for the orientation cluster (r = −.43) of the Neonatal Behavioral Assessment Scale administered at 1 to 3 days of age. Adjusting for marijuana exposure had no effect on these relationships between plasma NE and the depressed and orientation clusters.Conclusion. Plasma NE is increased in newborns exposed to cocaine and marijuana. Increased plasma NE is associated with selected neurobehavioral disturbances among cocaine exposed infants at 1 to 3 days of life but not at 2 weeks.
Regression in Pervasive Developmental Disorders: Seizures and Epileptiform Electroencephalogram Correlates
Authors: Tuchman Roberto F. , Rapin Isabelle 
Published: August 2004

Background. Approximately one third of the parents of children with pervasive developmental disorders or autistic spectrum disorders reports an early regression of unknown cause in their children's language, sociability, and play. Seizures or an epileptiform electroencephalogram (EEG) are associated with language regression in acquired epileptic aphasia (Landau–Kleffner syndrome) and some other pediatric epileptic syndromes. The importance of epilepsy or epileptic EEGs as contributors to autistic regression is not known.
Method. Subjects were 482 boys and 103 girls on the autistic spectrum seen consecutively in consultation by one child neurologist. Data on autistic regression, seizures, sleep EEGs, and cognitive function were entered prospectively into a data base.
Results. Of the 585 children, 176 (30%) had a history of regression, and 66 children (11%) had a history of epilepsy, defined as two or more unprovoked seizures. Among 392 children with available sleep EEGs, the EEG was epileptiform in 59% of the 66 epileptic children and 8% of the 335 nonepileptic children. Regression had occurred equally among children without seizures and in those with epilepsy. Regression was associated with an epileptiform EEG in 14% of 155 nonepileptic children who had undergone a regression, as opposed to 6% of 364 children with neither regression nor epilepsy. Mean age at regression was 21 months. There was no difference in the proportion of children with epilepsy or epileptiform EEGs who had regressed before or after 2 years of age. Approximately half of the epileptiform discharges were centrotemporal, whether or not the child was epileptic or had regressed. Children with lower cognitive function were more likely to have undergone regression than those with better cognitive skills (34% vs 20%).
Conclusion. Epilepsy or epileptiform EEGs occur in a significant minority of autistic children with a history of regression and in a smaller minority without regression. Prompt recognition of regression and recording of prolonged sleep EEGs is recommended, even though information on the potential efficacy of antiepileptic treatment to improve language and behavior in autistic children with epilepsy or an epileptiform EEG is still lacking.
General Principles in the Care of Children and Adolescents With Genetic Disorders and Other Chronic Health Conditions
Authors:   Committee on Children With Disabilities
Published: August 2004

This Policy Statement was retired January 2004.
The intent of this statement is to describe the breadth of issues that have special pertinence to pediatricians who care for children and families affected by genetic disorders and other chronic health conditions. The Committee on Children With Disabilities believes that because these children are leading healthier and longer lives, pediatricians are the more highly qualified to serve them, by virtue of their training and experience, and to provide them a “medical home.” This statement is designed to assist pediatricians in the treatment of these patients by describing their potential roles in relationship to their patients' changing needs, as they work with various members of the health care team and as they respond to the requirements of government agencies and various third-party payers.
The Resurgence of Breastfeeding in the United States
Authors: Ryan Alan S. 
Published: August 2004

Objective. To update reported rates of breastfeeding through 1995 and to compare rates in 1995 with those from 1989.Methods. The Ross Laboratories Mothers’ Survey, first conducted in 1955, is a large, national, mail survey designed to determine patterns of milk feeding to 6 months of age. Questionnaires are mailed to a representative sample of mothers when their infants are 6 months of age. In 1989, 196 000 questionnaires were mailed, and in 1995, 720 000 questionnaires were mailed. Mothers were asked to recall the type of milk fed to their infants immediately after birth, in the hospital, and during each of the first 6 months of age. The rates of breastfeeding in the hospital and at 6 months of age were evaluated.Results. The Ross Laboratories Mothers’ Survey demonstrates recent increases in both the initiation of breastfeeding and continued breastfeeding at 6 months of age. Comparing rates in 1989 and 1995, the initiation of breastfeeding increased more than 14% (from 52.2% to 59.7%). There was a 19.3% increase in the rate of breastfeeding at 6 months of age (from 18.1% to 21.6%). The increases in breastfeeding were observed across all sociodemographic groups but were greater among groups that have historically been less likely to practice breastfeeding: women who were black, younger (&lt;25 years of age), in the lowest income group (&lt;$10 000), no more than grade school educated, primiparous, and living in the South Atlantic region of the United States; women who had infants of low birth weight; women who were employed full time outside the home; and women who participated in the Women, Infants, and Children supplemental food program. Nevertheless, breastfeeding was most common in the western states and among women who were older, college educated, and multiparous, did not enroll in the Women, Infants, and Children program, were not employed outside the home, had infants of normal birth weight, and had higher disposable incomes.Conclusion. The sharp increase in rates of breastfeeding among groups that are less likely to breastfeed is encouraging. However, these groups are still the least likely to initiate breastfeeding. Educational efforts that extol positive attitudes about breastfeeding must be continued to support mothers who are young, poor, and less educated. breastfeeding, infant feeding, demography.