bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evolution in the Recognition of Infantile Hypertrophic Pyloric Stenosis
Authors: Hulka Frieda , Campbell Timothy J. , Campbell John R. , Harrison Marvin W. 
Published: August 2004

Purpose. To analyze changes in the clinical condition at presentation and methods of establishing the diagnosis of infantile hypertrophic pyloric stenosis (IHPS).
Methods. Retrospective review of patients who underwent pyloromyotomy (PM) for suspected IHPS at two institutions from 1969 through 1994 was performed. For the purposes of comparison, the population was divided into five equal time periods.
Results. Over the 25-year period, 901 infants underwent PM. Patients presented at a younger age, weighed more, and had a shorter length of illness in the most recent time period. Hypochloremic alkalosis was found half as frequently in the most recent time period compared to the earliest group. A palpable pyloric tumor was present in 79% of patients in the earliest time period compared with 23% in the most recent time period. Sixty-one percent of patients in the earliest group and 96% in the latest group underwent an imaging study, reflecting the referring physician's evaluation before referral to the surgeon.
Conclusions. Currently, patients with IHPS less frequently present with the clinical hallmarks of the disease. The use of imaging studies to establish the diagnosis has become common practice. The result has been the diagnosis of IHPS before alkalosis has developed, a shorter clinical course, less morbidity, and a shorter postoperative hospital stay.
Food Intakes of US Children and Adolescents Compared With Recommendations
Authors: Muñoz Kathryn A. , Krebs-Smith Susan M. , Ballard-Barbash Rachel , Cleveland Linda E. 
Published: August 2004

Objectives. To determine the proportion of youth meeting national recommendations for food group intake and to identify food intake patterns.
Design. The US Department of Agriculture's 1989–1991 Continuing Surveys of Food Intakes by Individuals were used to estimate food intake. Intake was determined from 3 days of diet by disaggregating foods into their component ingredients and using weights that correspond to servings.
Participants. The sample included 3307 youth, 2 to 19 years of age, living in the 48 conterminous United States.
Main Outcome Measures. Mean number of servings and percentage of individuals meeting national recommendations for food group intake according to demographic characteristics, patterns of intake, and nutrient profiles associated with each pattern.
Results. Mean numbers of servings per day were below minimum recommendations for all food groups except the dairy group (ages 2 to 11). Percentages of youth meeting recommendations ranged from ∼30% for fruit, grain, meat, and dairy to 36% for vegetables. Sixteen percent of youth did not meet any recommendations, and 1% met all recommendations. The pattern of meeting all recommendations resulted in nutrient intakes above the recommended dietary allowances and was high in fat. Conversely, meeting none of the recommendations resulted in intakes well below the recommended dietary allowances for some nutrients. Total fat and added sugars averaged 35% and 15% of energy, respectively, and levels were similar among most demographic groups.
Conclusion. Children and teens in the United States follow eating patterns that do not meet national recommendations. Nutrition education and intervention are needed among US children.
Parents Can Dose Liquid Medication Accurately
Authors: McMahon Shawn R. , Rimsza Mary E. , Bay R. Curtis 
Published: August 2004

Objective. To determine whether parental errors in dosing liquid medication can be decreased through education.
Design. Randomized convenience sample stratified to three study groups.
Setting. General pediatric clinic, largely indigent and Latino.
Patients. A total of 45 English-speaking and 45 Spanish-speaking children diagnosed with otitis media and treated with an antibiotic suspension.
Intervention. Group 1 patients received the prescription and verbal instructions. Group 2 patients received the prescription and a syringe, then the correct dose was demonstrated. Group 3 patients received the prescription, a syringe with a line marked at the correct dose, and a demonstration. After returning from the pharmacy, parents administered the medication under observation. Parents in group 1 used a dispensing device similar to that planned for home use. The other groups used the syringe. After observation but before discharge, everyone received a syringe with a line marked at the correct dose. Patients were seen again at ∼1 month, and parents demonstrated how much medication they had administered.
Main Outcome Measure. Percent of parents who administered the correct dose.
Results. Patients in group 1 received between 32% and 147% of the correct dose, with only 11 of 30 (37%) receiving the correct dose (±0.2 mL). In group 2, 25 of 30 (83%) parents administered the correct dose, and in group 3, 30 of 30 (100%) gave the correct dose. Simultaneous logistic regression indicated that accuracy of dosage differed across instructional groups and language. At follow-up, 23 of 26 parents demonstrated the correct dose.
Conclusion. Education can decrease medication dosing errors made by both Spanish-speaking and English-speaking parents. Effectiveness was also shown at follow-up.
Outpatient Management Practices Associated With Reduced Risk of Pediatric Asthma Hospitalization and Emergency Department Visits
Authors: Lieu Tracy A. , Quesenberry Charles P. , Capra Angela M. , Sorel Michael E. , Martin Kathleen E. , Mendoza Guillermo R. 
Published: August 2004

Objectives. Effective outpatient care is believed to prevent hospitalization and emergency department (ED) visits resulting from childhood asthma. The aim of this study was to suggest priority areas for intervention by identifying outpatient management practices associated with the risk of these adverse outcomes in a large population.Methods. This case-control study included children aged 0 to 14 years with asthma who were members of a regional health maintenance organization. Cases were children undergoing either a hospitalization or an ED visit for asthma during the study period. Control subjects were children with asthma without a hospitalization or an ED visit during the study period who were matched to patients on age, gender, and number of asthma-related hospitalizations in the past 24 months. Data on provider and parent asthma management practices were collected using chart review, closed-ended telephone interviews with parents, and computerized use databases. Multivariate analyses were conducted using conditional logistic regression models.Results. Data were collected on 508 cases and 990 control subjects. A total of 43% of cases were reported by their parents to have moderately severe or severe asthma, compared with 20% of control subjects. Parents of cases with hospitalization were less likely than control subjects to have a written asthma management plan (44% vs 51%) and to report washing bedsheets in hot water at least twice a month (77% vs 86%). Cases with hospitalization were more likely to have a nebulizer (74% vs 56%).In the final multivariate model, race/ethnicity was not associated with having had either a hospitalization or an ED visit, as was lower socioeconomic status. Having a written asthma management plan [odds ratio (OR): 0.54; 95% confidence interval (CI): 0.30, 0.99] and washing bedsheets in hot water at least twice a month (OR: 0.45; 95% CI: 0.21, 0.94) were associated with reduced odds of hospitalization. Having a written asthma management plan (OR: 0.45; 95% CI: 0.27, 0.76) and starting or increasing medications at the onset of a cold or flu were associated with reduced odds of making an ED visit.Conclusions. Practices that support early intervention for asthma flare-ups by parents at home, particularly written management plans, are strongly associated with reduced risk of adverse outcomes among children with asthma.
Apnea Frequently Persists Beyond Term Gestation in Infants Delivered at 24 to 28 Weeks
Authors: Eichenwald Eric C. , Aina Abimbola , Stark Ann R. 
Published: August 2004

Background. Apnea of prematurity remains among the most commonly diagnosed conditions in the Newborn Intensive Care Unit and may prolong hospital stays in some infants. Because survival of extremely premature infants has improved markedly, the natural history of apnea in this population needs to be reassessed.
Objective. To document the natural history of recurrent apnea and/or bradycardia events in infants delivered at 24 to 28 weeks' gestation.
Methods. Medical records of all infants delivered at 24 to 28 weeks' gestation admitted to the Brigham and Women's Hospital Newborn Intensive Care Unit between January 1989 and March 1994 were reviewed to document the clinical course of apnea of prematurity. Subjects were included in the study sample if they were discharged home from the Brigham and Women's Hospital or after transfer to an affiliated hospital. Recordings of apnea and/or bradycardia events were based on nursing observations of monitor alarms and assessment of the infant's condition.
Results. Of 457 eligible infants, 226 were included in the study sample and stratified by gestational age at birth assigned by the attending neonatologist. The time to resolution of recurrent apnea/bradycardia events was longer with lower gestational age at birth. Apnea/bradycardia events were frequently observed beyond 36 weeks' postconceptional age in all gestational age groups. The incidence of apnea persisting beyond 38 weeks postconceptional age was significantly higher in the 24- to 27-week infants combined compared with the 28-week infants.
Conclusions. Apnea of prematurity frequently persists beyond term gestation in infants delivered at 24 to 28 weeks' gestational age. These persistent apnea and/or bradycardia events may contribute to prolonged hospitalization. Programs to promote earlier discharge of premature infants should take into account the variability in resolution of apnea and specifically address management of persistent apnea.
Purpuric Phototherapy-induced Eruption in Transfused Neonates: Relation to Transient Porphyrinemia
Authors: Paller Amy S. , Eramo Lynne R. , Farrell Elaine E. , Millard Dietra D. , Honig Paul J. , Cunningham Bari B. 
Published: August 2004

Objective. Blue light phototherapy is commonly administered to neonates as treatment of indirect hyperbilirubinemia, often in conjunction with blood transfusions to treat hemolytic anemia. We observed a distinctive cutaneous complication of phototherapy in six neonates with hyperbilirubinemia.
Methodology. We studied the clinical and histologic characteristics of the eruption, as well as the porphyrin levels in affected neonates. Five of the patients had erythroblastosis fetalis; the other had profound anemia from twin–twin transfusion. All of the neonates developed purpuric patches at sites of maximal exposure to the phototherapy lights, with dramatic sparing at shielded sites within 24 hours after initiation of the phototherapy. On discontinuation of phototherapy, all eruptions cleared within 1 week. Examination of skin biopsy sections showed purpura without significant inflammation or keratinocyte necrosis. Plasma porphyrins (copro- and proto-) were elevated in the two patients in which they were assessed.
Conclusions. The distribution of the eruption in areas exposed to light and presence of circulating porphyrins suggest that porphyrinemia may underlie the light-induced purpuric eruption. Additional studies will be required to determine definitively the mechanisms of both the purpuric phototherapy-induced eruption and the development of increased blood porphyrin levels in these transfused neonates.
In Vivo Bone Lead Measurement in Suburban Teenagers
Authors: Hoppin Jane A. , Aro Antonio , Hu Howard , Ryan P. Barry 
Published: August 2004

Objective. Bone represents a biologically active long-term storage site for lead, and bone lead data on teenagers are limited. Therefore, this study was designed to identify the distribution of bone lead in a teenage population and to explore the environmental and demographic factors associated with bone lead concentrations in young, nonoccupationally exposed subjects.
Design. A cross-sectional study of bone lead levels in high school students.
Participants. A total of 168 students at a suburban Boston high school. Subjects (90 boys, 78 girls) ranged in age from 13.5 to 19 years and included 40% nonwhite minorities. Of the 168 subjects, 45 lived in homes constructed before 1960. None of the participants reported a history of lead poisoning.
Outcome Measures. Tibial bone lead concentrations were measured in vivo for 60 minutes using K x-ray fluorescence. Lead exposure information was obtained by self-administered questionnaire.
Results. Point estimates of bone lead levels ranged from −7.15 to 14.23 μg lead/g bone mineral (μg/g), (mean, 4.0 μg/g; standard deviation, 4.4 μg/g). The reported measurement uncertainties accompanying each of the point estimates ranged from 2.56 to 9.01 μg/g (mean, 3.9 μg/g; standard deviation, 1.0 μg/g). Bone lead levels were not associated with the demographic factors of age, sex, or race. Additionally, current home conditions (housing age, traffic level) were not predictive of bone lead levels, even though these factors were predictive of in-home lead concentrations.
Conclusions. These results demonstrate that although bone lead levels are measurable in this age group, the common predictors of blood and bone lead concentrations are not explanatory for bone lead levels.
Cardiac Effects of a Competitive Road Race in Trained Child Runners
Authors: Rowland Thomas , Goff Donna , DeLuca Patricia , Popowski Barbara 
Published: August 2004

Background. Animal studies and investigations of adult endurance athletes indicate a transient depression of myocardial function after prolonged high-intensity exercise.
Purpose. To determine whether a similar decrease is observed in child distance runners after a 4-km competitive road race.
Methods. Anthropometric measures, resting M-mode echocardiograms, maximal cycle exercise tests with estimation of cardiac output, and electrocardiograms were performed before a 4-km road race in nine run-trained boys (mean age, 12.2 years). Weight and resting echocardiogram and electrocardiogram were assessed immediately after the race. The entire test battery was repeated 24 hours later.
Results. Small but significant decreases in mean body weight and left ventricular end–diastolic dimension were observed immediately after the race, but there were no changes in shortening fraction. These findings are consistent with the effects of dehydration. Measurements returned to prerace values by 24 hours of recovery. Peak work capacity, maximal stroke volume, and maximal cardiac output were similar on prerace and 24-hour-postrace testing. No electrocardiographic abnormalities were observed.
Conclusions. No adverse cardiac effects were observed from a competitive 4-km road race in male child distance runners.
The Effect of Insurance Status on Likelihood of Neonatal Interhospital Transfer
Authors: Durbin Dennis R. , Giardino Angelo P. , Shaw Kathy N. , Harris Mary C. , Silber Jeffrey H. 
Published: August 2004

Objective. To determine the effect of insurance status on the likelihood of interhospital transfer for neonates.
Design. Population-based retrospective cohort study.
Setting. All general acute care nonpediatric hospitals in the five counties of southeastern Pennsylvania.
Patients. Fifty-six thousand, seven hundred eighty-nine infants from 0 to 28 days of age admitted to or born in study hospitals between January 1 and December 31, 1991.
Intervention. None.
Main Outcome Measure. Transfer to another general or specialty acute care hospital.
Results. The incidence (95% confidence interval) of interhospital transfer was 1.69% (1.60, 1.78). Uninsured infants were nearly twice as likely [relative risk (RR) = 1.96 (1.67, 2.31)] to be transferred as commercially insured infants, even when adjusted for the effects of prematurity, severity of illness, and the level of neonatal intensive care unit in the referring hospital. Similarly, infants with Medicaid were more likely to be transferred [RR = 1.20 (1.01, 1.43)] than similar commercially insured neonates. Uninsured and publicly insured infants were also more likely to be born premature [RR 1.49 (1.39, 1.60)] than privately insured neonates, and were more likely to have both moderate [RR 1.11 (1.04, 1.23)] and high [RR 1.21 (1.11, 1.32)] illness severity on admission to the hospital than privately insured infants.
Conclusions. Neonates with no insurance and those with Medicaid coverage were more likely to be transferred than infants with private insurance. These results are consistent with those of other investigators who have studied financially motivated patient transfers— so-called patient dumping—in nonpediatric populations of patients. Our study may represent the first documentation of this phenomenon in a pediatric population. Our results are also consistent with those of other investigators who have examined the effect of insurance status on maternal interhospital transfer, thus providing further evidence for the existence of financially motivated transfers within regional systems of perinatal care. Future investigation into the effect of economic factors on variation in the utilization of transport services, and on how transfer influences ultimate patient outcome, is needed as managed care health systems become more widespread.
Tuberculosis Transmission Among Five School Bus Drivers and Students in Two New York Counties
Authors: Yusuf Hussain R. , Braden Christopher R. , Greenberg Abby J. , Weltman Andre C. , Onorato Ida M. , Valway Sarah E. 
Published: August 2004

Objective. Between November 1994 and April 1995, more than 3300 students in 49 schools in two counties in New York were potentially exposed to five school bus drivers with tuberculosis. This investigation was carried out to determine the extent of transmission of Mycobacterium tuberculosis among students.
Methods. Components of the epidemiologic investigation included tuberculin skin-test screening and collection of demographic information for students exposed to a driver with tuberculosis, chest radiography and medical evaluation of individuals with positive skin tests, and DNA fingerprinting of M tuberculosis isolates. A positive skin test was defined as ≥10 mm induration, and a converter was an individual with an increase in reaction size of ≥10 mm in the past 2 years.
Results. The rates of positive skin tests were 0.8%, 0.3%, 9.9%, 1.1%, and 0.7% among US-born students exposed to drivers 1 through 5, respectively. The relative risk for a positive tuberculin skin test was significant only for students exposed to driver 3, and the only secondary case identified among students was exposed to driver 3. The DNA fingerprint patterns of isolates from drivers 3 and 4 matched.
Conclusion. There was no clear evidence of transmission ofM tuberculosis to students from drivers 1, 2, 4, or 5. However, evidence suggests that driver 3 transmitted M tuberculosis to students and another driver. Routine annual tuberculin skin-test screening of drivers would not have prevented these tuberculosis exposures.
Effect of Nursing in the Head Elevated Tilt Position (15°) on the Incidence of Bradycardic and Hypoxemic Episodes in Preterm Infants
Authors: Jenni Oskar G. , von Siebenthal Kurt , Wolf Martin , Keel Matthias , Duc Gabriel , Bucher Hans U. 
Published: August 2004

Objective. We investigated whether nursing in the head elevated tilt position (HETP), compared with the horizontal position, has any effect on the incidence of bradycardic and hypoxemic episodes in preterm infants.Methods. Twelve spontaneously breathing preterm infants with idiopathic recurrent apnea were studied in a randomized controlled crossover trial. Nine infants were treated with aminophylline. Each spent a total of 24 hours in the horizontal prone position and a total of 24 hours in HETP (prone, 15°). The position was changed in random order every 6 hours. Thoracic impedance, heart rate, and arterial oxygen saturation were recorded continuously. The frequency of isolated hypoxemia (arterial saturation &lt;80%), of isolated bradycardia (heart rate &lt;90 beats per minute), and of mixed events was analyzed and compared without knowledge of the allocated position.Results. In total, there were significantly fewer bradycardic and/or hypoxemic episodes (28.2%) in HETP compared with the horizontal position (mean difference, 13.35 episodes/24 hours; 95% confidence interval [CI]: 5.9- 20.8). The decrease was largest for isolated hypoxemic episodes (48.5%; mean difference, 11.74 episodes/24 hours; 95% CI: 6.1–17.4). Isolated bradycardic episodes (mean difference, 2.27 episodes/24 hours; 95% CI: −0.78–5.31) and mixed events were not decreased significantly in HETP.Conclusions. Nursing in a moderately tilted position (15°) reduces hypoxemic events in preterm infants. This intervention is easy to apply, quickly reversible, and can be combined with drugs such as aminophylline.
Pain and Pain Management in Newborn Infants: A Survey of Physicians and Nurses
Authors: Porter Fran Lang , Wolf Cynthia M. , Gold Jennifer , Lotsoff David , Miller J. Philip 
Published: August 2004

Background. Despite an increased awareness among clinicians regarding pain and pain management for infants undergoing surgery, pain associated with procedures performed outside the operating room may not be adequately managed.Purpose. To examine the beliefs and self-described behavior of physicians and nurses regarding the management of procedural pain in newborn infants.Methods. A survey was distributed to 467 clinicians (nurses and physicians) working in 11 level II and 4 level III nurseries in a large metropolitan area. Respondents were asked to rate the painfulness of 12 common bedside nursery procedures and how often pharmacologic and nonpharmacologic (comfort) measures are currently used and should be used for those procedures. Demographic data were also collected.Results. Surveys were completed by 374 clinicians (80% response rate). Physicians and nurses believe infants feel as much pain as adults and that 9 of the 12 listed procedures are moderately to very painful. Neither pharmacologic nor comfort measures are believed to be used frequently, even for the most painful procedures. Physicians and nurses believe both pharmacologic and comfort measures should be used more frequently, but nurses believe comfort measures should be used more frequently than do physicians. Beliefs about infant pain and procedural pain were related to pain management preferences. Physicians' but not nurses' ratings were associated with significant personal pain.Conclusions. Despite their beliefs that infants experience significant procedure-related pain, clinicians believe pain management for infants remains below optimal levels. Barriers to more consistent and effective pain management need to be identified and surmounted.