bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relative Efficacy of Amethocaine Gel and Lidocaine–Prilocaine Cream for Port-a-Cath Puncture in Children
Authors: Bishai Raafat , Taddio Anna , Bar-Oz Benjamin , Freedman Melvin H. , Koren Gideon 
Published: August 2004

Background. Lidocaine–prilocaine cream (EMLA) is currently standard therapy to alleviate procedural pain in children. One of the disadvantages of lidocaine–prilocaine is the need to wait for 60 minutes for adequate skin anesthesia. Amethocaine gel (Ametop) is a new topical anesthetic that requires a shorter application time for skin anesthesia.Objectives. To compare the relative efficacy and safety of amethocaine gel and lidocaine–prilocaine cream in children with cancer undergoing Port-a-Cath puncture and to determine which patient factors influence judgments about pain.Methods. Randomized, blinded, crossover study. Each child received either 1 g of amethocaine gel for 30 minutes, preceded by a placebo gel for 30 minutes, or 1 g of lidocaine–prilocaine cream for 60 minutes. Children rated the pain using the faces scale, for which scores ranged from 0 to 5. Parents and attending nurse operators rated pain on a 10-cm visual analog scale.Results. Thirty-nine children participated. The mean age was 10.2 years (range: 5–16 years), and 69% were male. There were no differences in mean pain assessments between amethocaine and lidocaine–prilocaine as rated by the children (2.0 vs 0.5), parents (2.6 vs 6.4), or nurse operators (2.0 vs 0.9). No serious adverse effects were detected with either preparation. Pain scores assigned by parents and children were not influenced by age, gender, duration of diagnosis, or anesthetic regimen (amethocaine versus lidocaine–prilocaine) in the child. Nurses, however, rated pain higher for younger children, and in males during pretreatment with lidocaine–prilocaine.Conclusion. Amethocaine achieves similar anesthesia to lidocaine–prilocaine during Port-a-Cath administration in children, with an application time that is half of lidocaine–prilocaine. Pain assessments were not influenced by age, gender, or duration of diagnosis of the child. Nurses may perceive that pain is greater for younger children and in males. lidocaine–prilocaine, amethocaine, pain, children, Port-a-Cath puncture.
Clinical Indicators of Intracranial Injury in Head-injured Infants
Authors: Greenes David S. , Schutzman Sara A. 
Published: August 2004

Objectives.1) To determine whether clinical signs of brain injury are sensitive indicators of intracranial injury (ICI) in head-injured infants. 2) To determine whether radiographic imaging of otherwise asymptomatic infants with scalp hematoma is a useful means of detecting cases of ICI. 3) To determine whether head-injured infants without signs of brain injury or scalp hematoma may be safely managed without radiographic imaging.Methods.We performed a 1-year prospective study of all infants younger than 2 years of age presenting to a pediatric emergency department with head trauma. Data were collected on historical features, physical findings, radiographic findings, and hospital course. Follow-up telephone calls were made 2 weeks after discharge to assess for any late deterioration.Results.Of 608 study subjects, 30 (5%) had ICI; 12/92 (13%) infants 0 to 2 months of age had ICI, compared with 13/224 (6%) infants 3 to 11 months of age, and 5/292 (2%) infants 12 months of age or older.Only 16/30 (52%) subjects with ICI had at least one of the following clinical symptoms or signs of brain injury: loss of consciousness, history of behavior change, seizures, emesis, depressed mental status, irritability, bulging fontanel, focal neurologic findings, or vital signs indicating increased intracranial pressure.Of the 14 asymptomatic subjects with ICI, 13 (93%) had significant scalp hematoma. Among subjects who had head computed tomography, significant scalp hematoma had an odds ratio of 2.78 (95% confidence interval: 1.15,6.70) for association with ICI.A total of 265 subjects (43%) were asymptomatic and had no significant scalp hematoma. None (95% confidence interval: 0,1.2%) required specific therapy or had any subsequent clinical deterioration.Conclusions.Clinical signs of brain injury are insensitive indicators of ICI in infants. A substantial fraction of infants with ICI will be detected through radiographic imaging of otherwise asymptomatic infants with significant scalp hematomas. Asymptomatic infants older than 3 months of age who have no significant scalp hematoma may be safely managed without radiographic imaging.
Rehospitalization for Respiratory Syncytial Virus Among Premature Infants
Authors: Joffe Steven , Escobar Gabriel J. , Black Steven B. , Armstrong Mary Anne , Lieu Tracy A. 
Published: August 2004

Objectives.
New interventions to prevent respiratory syncytial virus (RSV) have recently become available. Clinical decisions about the use of these interventions require a better understanding of the incidence of and risk factors for RSV. We sought to characterize the epidemiology of severe RSV disease among premature infants and to identify high-risk subgroups.

Design.
Retrospective cohort.

Setting.
Kaiser Permanente Northern California, July 1992 to April 1996.

Participants.
One thousand seven hundred twenty-one premature infants born at 23 to 36 weeks who were discharged from a neonatal intensive care nursery (NICU) within 12 months before the December to March RSV season. A secondary analysis included 769 infants discharged during the RSV season.

Outcome Measures.
Hospitalization for RSV.

Results.
Of 1721 infants already home from the NICU at the start of the season, 3.2% were rehospitalized for RSV. In a multivariate model, risk factors for RSV hospitalization included gestation ≤32 weeks (odds ratio [OR], 2.6), ≥28 days of perinatal oxygen (OR, 3.7), and NICU discharge during September to November (OR, 2.7). Predicted risk of hospitalization varied by subgroup, ranging from 1.2% to 24.6%. Among 769 infants discharged from the NICU during the RSV season, 3.5% were rehospitalized for RSV during the same season; gestation and perinatal oxygen were not associated with admission.

Conclusions.
Most premature infants in this population were at less risk of severe RSV disease than previous studies in other populations have suggested. Preterm infants with a lower gestational age, a prolonged perinatal oxygen requirement, and NICU discharge within 3 months of the RSV season were most likely to require hospitalization for RSV disease. Cost-effectiveness analyses are needed to help define the role of available prophylactic interventions.
Relative and Attributable Risks for Moderate to Profound Bilateral Sensorineural Hearing Impairment Associated With Lower Birth Weight in Children 3 to 10 Years Old
Authors: Van Naarden Kim , Decouflé Pierre 
Published: August 2004

Objective.
To determine the prevalence, relative risks, and attributable fractions for congenital bilateral sensorineural hearing impairment in relation to lower birth weight among children born in the 1980s and living in the metropolitan Atlanta area from 1991 through 1993.

Methods.
We used the population-based, active case ascertainment Metropolitan Atlanta Developmental Disabilities Surveillance Program that conducts surveillance in the five-county metropolitan Atlanta area. Hearing impairment was defined as a bilateral, pure-tone hearing loss at frequencies of 500, 1000, and 2000 Hz averaging 40 dBs or more, unaided, in the better ear. Case children, 3 to 10 years of age, with sensorineural loss of presumed congenital origin were included in these analyses (n = 172). Prevalence rates and relative risks were computed for various birth weight categories by hearing level, sex, race, the presence or absence of coexisting developmental disabilities, and gestational age. Attributable fractions were calculated for low birth weight and very low birth weight children by race.

Results.
The overall prevalence rate of presumed congenital bilateral sensorineural hearing impairment was 5.3 cases per 10 000 3-year survivors. The prevalence was 4.1 per 10 000 among children weighing ≥4000 g, 3.7 per 10 000 among those weighing 3000 to 3999 g, 6.6 per 10 000 among those 2500 to 2999 g, 12.7 per 10 000 among those 1500 to 2499 g, and 51.0 per 10 000 among those &lt;1500 g. There was virtually no difference in birth weight-specific rates of hearing impairment across three hearing levels. The presence of coexisting developmental disabilities was associated with a much stronger inverse trend with birth weight. Black children weighing &lt;2500 g had much higher rates of hearing impairment than comparable white children. The overall percentage of moderate to profound congenital bilateral sensorineural hearing loss in the entire study population that was attributable to children weighing &lt;2500 g or &lt;1500 g was estimated to be 18.9% and 9.4%, respectively. Prematurity did not alter the magnitude of risk among children weighing &lt;2500 g.

Conclusions.
The results presented here provide recent estimates of the rates, relative risks, and attributable fractions for congenital bilateral sensorineural hearing impairment by birth weight among children in the United States. The elevated relative risks among children weighing 2500 to 2999 g and 1500 to 2499 g may have implications for future newborn hearing screening criteria.
Weight Concerns, Weight Control Behaviors, and Smoking Initiation
Authors: Tomeo Catherine A. , Field Alison E. , Berkey Catherine S. , Colditz Graham A. , Frazier A. Lindsay 
Published: August 2004

Objective.
To examine the cross-sectional relationships between weight concerns, weight control behaviors, and initiation of tobacco use among youths.

Study Design.
Smoking status, weight concerns, and weight control behaviors were assessed in a cross-sectional sample of 16 862 children, 9 to 14 years of age, in 1996. Logistic regression was used to examine the relationship between weight concerns, weight control behaviors, and early stages of smoking initiation (precontemplation, contemplation, and experimentation). All analyses were adjusted for age, body mass index, and known predictors of initiation.

Results.
Approximately 9% of participants had experimented with cigarettes, and 6% were contemplating cigarette smoking. Contemplation of tobacco use was associated with misperception of being overweight (boys: odds ratio [OR], 1.65; 95% confidence interval [CI], 1.10–2.48), unhappiness with appearance (girls: OR, 2.05; 95% CI, 1.48–2.84; boys: OR, 1.60; 95% CI, 1.05–2.42), and a tendency to change eating patterns around peers (girls: OR, 2.87; 95% CI, 2.28–3.62; boys: OR, 1.83; 95% CI, 1.25–2.66). Experimentation with cigarettes was associated with daily exercise to control weight among boys (OR, 1.92; 95% CI, 1.07–3.43) and with monthly purging (OR, 2.54; 95% CI, 1.27–5.07) and daily dieting among girls (OR, 1.79; 95% CI, 1.09–2.96).

Conclusions.
Our findings suggest that, among both girls and boys, contemplation of smoking is positively related to weight concerns. Experimentation seems to be positively related to weight control behaviors. It is important for both pediatricians and comprehensive school health programs to address healthy methods of weight maintenance and to dispel the notion of tobacco use as a method of weight control.
The Use of Physician Financial Incentives and Feedback to Improve Pediatric Preventive Care in Medicaid Managed Care
Authors: Hillman Alan L. , Ripley Kimberly , Goldfarb Neil , Weiner Janet , Nuamah Isaac , Lusk Edward 
Published: August 2004

Objective.
Immunizations and other cost-effective preventive services remain underused by many children, especially those living in poverty. Given the effectiveness of provider-based tracking systems and the widespread use by managed care organizations of financial incentives to influence physician practice patterns, we designed and tested an intervention combining these strategies. We studied whether a system of semiannual assessment and feedback, coupled with financial incentives, could improve pediatric preventive care in a Medicaid health maintenance organization (HMO).

Methodology.
We randomly assigned primary care sites serving children in a Medicaid HMO to one of three groups: a feedback group (where physicians received written feedback about compliance scores), a feedback and incentive group (where physicians received feedback and a financial bonus when compliance criteria were met), and a control group. We evaluated compliance with pediatric preventive care guidelines through semiannual chart audits during the years 1993 to 1995.

Results.
Compliance with pediatric preventive care improved dramatically in the study period. Repeated measures ANOVA demonstrated a significant increase in all three study groups throughout the time in total compliance scores (from 56%–73%), as well as scores for immunizations (from 62%–79%) and other preventive care (from 54%–71%). However, no significant differences were observed between either intervention group and the control group, nor were there any interaction (group-by-time) effects.

Conclusions.
Feedback to physicians, with or without financial incentives, did not improve pediatric preventive care in this Medicaid HMO during a time of rapid, secular improvements in care. Possible explanations include the context and timing of the intervention, the magnitude of the financial incentives, and lack of physician awareness of the intervention.
Pediatric Physician Profiling
Authors:   Committee on Practice and Ambulatory Medicine and Committee on Medical Liability
Published: August 2004

This Policy Statement was retired May 2007.
Employers, insurers, and other purchasers of health care services collect data to profile the practice habits of pediatricians and other physicians. This policy statement delineates a series of recommendations that should be adopted by health care purchasers to guide the development and implementation of physician profiling systems.
Neurofibromatosis Bright Objects in Children With Neurofibromatosis Type 1: A Proliferative Potential?
Authors: Griffiths Paul D. , PhD FRCR, , Blaser Susan , Mukonoweshuro William , Armstrong Derek , Milo-Manson Golda , Cheung Sylvester 
Published: August 2004

Objectives.
The purpose of this study was to investigate the natural history of the high signal intensities shown on long TR sequences—neurofibromatosis type 1 bright objects (NBO)—in children with neurofibromatosis type 1 (NF1). We have paid particular attention to the development of tumors in these areas of abnormality.

Methods.
During a 12-month period in 1992 to 1993, 46 children with clinically proven NF1 had a magnetic resonance (MR) examination at our institution. These were reviewed along with any previous or subsequent MR examinations that had been performed. We recorded the number, volume, and distribution of the abnormal high signal intensities and their change with time when serial examinations were performed.

Results.
NBO were found in 93% of 46 children with NF1 on the original cross-sectional study. The most common anatomic sites were the globus pallidus (30.4%), cerebellum (23.5%), and midbrain (16.2%). The number and volume of NBO varied significantly with age. NBO were uncommon in children younger than 4 years but were very common and extensive between 4 to 10 years. A significant reduction in the number and volume of NBO was demonstrated in children older than 10 years as shown on both the cross-sectional and longitudinal portions of the study. Eight brain tumors (nonoptic pathway) were demonstrated in the 46 children (17%) with 1 child having two tumors. Only 1 child had symptoms referable to the tumor at the time of diagnosis. Five tumors developed in NBO that were documented on serial MR examinations. All those cases developed in children aged 7 to 12 years, and all these children had higher than average numbers and volumes of NBO.

Conclusions.
NBO occur commonly in children with NF1 and are most prevalent between the ages of 4 and 10. We have shown a high frequency of brain tumors in our children with NF1, but the majority of these were asymptomatic. We have demonstrated proliferative change NBO in 11% of 46 children. Most NBO regress with age and seem to be benign, however, young children with a large number and volume of NBO should be followed closely with regular MR examinations because of an increased risk of proliferative change. neurofibromatosis type 1, magnetic resonance, tumor, astrocytoma, childhood.
Breastfeeding Patterns in Relation to Thumb Sucking and Pacifier Use
Authors: Aarts Clara , Hörnell Agneta , Kylberg Elisabeth , Hofvander Yngve , Gebre-Medhin Mehari 
Published: August 2004

Objectives.To analyze the influence of thumb sucking and pacifier use on breastfeeding patterns in exclusively breastfed infants, on the duration of exclusive breastfeeding, and on the total breastfeeding duration.Study Design.Descriptive, longitudinal, prospective study.Setting.The subjects were recruited from a population of 15 189 infants born in the maternity ward at the University Hospital, Uppsala, Sweden between May 1989 and December 1992.Study Population.506 mother–infant pairs.Methods.Daily recordings by the mothers on infant feeding from the first week after delivery through the duration of the study. Fortnightly home visits with structured interviews by a research assistant.Results.Pacifier use was associated with fewer feeds and shorter suckling duration per 24 hours, shorter duration of exclusive breastfeeding, and shorter total breastfeeding duration compared with no pacifier use. These associations were not found for thumb sucking. The possible negative effects of pacifiers on breastfeeding seemed to be related to the frequency of their use. Maternal age and education only slightly modified the association between pacifier use and breastfeeding duration.Conclusions.More frequent use of a pacifier was associated with shorter breastfeeding duration, even among a group of mothers who were highly motivated to breastfeed. breastfeeding duration, breastfeeding pattern, exclusive breastfeeding, pacifier use, thumb sucking.
Behavioral Effects of Corticosteroids in Steroid-sensitive Nephrotic Syndrome
Authors: Soliday Elizabeth , Grey Shannon , Lande Marc B. 
Published: August 2004

Objectives.
The objective of this study was to define the frequency and severity of steroid-related behavioral side effects in children with steroid-sensitive idiopathic nephrotic syndrome (SSNS) during treatment for relapse.

Study Design.
We conducted a prospective, repeated- measures study in which 10 children with SSNS underwent behavioral assessment using the Child Behavior Checklist at baseline and during high dose prednisone therapy for relapse.

Results.
Of the 10 children, 8 had normal behavior at baseline. Of these 8 children, 5 had Child Behavior Checklist scores above the 95th percentile for anxious/depressive behavior and/or aggressive behavior during relapse. Such scores are in the range normally considered appropriate for referral to a mental health provider. The 2 children who had abnormal behavior at baseline also experienced a worsening of their behavior during relapse. The behavioral changes occurred almost exclusively at prednisone doses of 1 mg/kg every 48 hours or more. Regression analysis showed that prednisone dose was a strong predictor of abnormal behavior, especially increased aggression.

Conclusion.
Children with SSNS often experience serious problems with anxiety, depression, and increased aggression during high-dose prednisone therapy for relapse.
Early Perinatal Hospital Discharge and Parenting During Infancy
Authors: Britton John R. , Britton Helen L. , Gronwaldt Virginia 
Published: August 2004

Objective.To evaluate the relationship between early perinatal hospital discharge and several parenting outcomes during infancy, including breastfeeding, mother–infant interaction, and mother–infant attachment.Study Design.A prospective, longitudinal, nonrandomized study of mother–infant dyads discharged ≤36 hours after birth (early discharge), compared with those discharged &gt;36 hours after birth (late discharge).Methods.Demographic, perinatal, and psychosocial factors were determined from medical record review and maternal questionnaires. Questionnaires also assessed maternal perceptions of the hospital stay and breastfeeding rates. Mother–infant interaction was assessed at 3 months after birth using the NCAST Feeding Scale and at 9 months after birth using the NCAST Teaching Scale. Security of attachment was measured in the Ainsworth Strange Situation at 12 months after birth.Results.Early and late discharge groups were similar with respect to major demographic, perinatal, and psychosocial characteristics and perceptions of the hospital stay. Even after adjusting for these factors in regression analyses, no significant association was found between early discharge and breastfeeding at 3 months, NCAST scores at 3 and 9 months, and security of attachment at 12 months.Conclusion.Parenting outcomes, such as breastfeeding, mother–infant interaction, and attachment, are not influenced by early perinatal hospital discharge.
Candidal Mycetoma in the Neonatal Kidney
Authors: Benjamin Daniel K. , Fisher Randall G. , McKinney Ross E. , Benjamin Daniel K. 
Published: August 2004

Objective.To determine the natural history of renal mycetoma (fungal balls) in the neonate.Design.Retrospective chart review of all neonatal intensive care unit patients with systemic candidiasis and sonographic evidence of renal mycetoma admitted to the Duke University Medical Center between January 1, 1993, and July 1, 1998.Results.Fourteen patients were reviewed. Three died from fungemia, and 3 died from other causes months after completing treatment. Ten patients had urine cultures obtained within 1 week of diagnosis; each had a positive routine or fungal urine culture for candida. The rate of improvement of renal mycetoma by ultrasound was variable, ranging from 10 days to 4 months and was not predictive of survival or long-term renal function. All patients who were discharged from the hospital had creatinine ≤0.5 mg/dL on discharge. Only 1 patient had surgical intervention (nephrostomy tube placement). Of the 11 patients who survived fungemia, 7 were treated for 3 weeks from the time negative cultures were obtained, while 4 were treated for 5 weeks or more after negative cultures. A declining platelet count was suggestive of fungemia in the patients we reviewed.Conclusions.For our patients with renal mycetoma without complete obstruction (patients continued to have urine output) surgical intervention was rarely necessary, the rate of sonographic improvement neither correlated with clinical course nor necessitated longer therapy, and long-term creatinine levels were normal. Sustained declines in platelet count of 10% per day or more in a neonate on broad-spectrum antibiotics for suspected sepsis may be indicative of fungemia.
The Child in Court: A Subject Review
Authors:   Committee on Psychosocial Aspects of Child and Family Health
Published: August 2004

This Policy Statement was retired May 2014.
When children come to court as witnesses, or when their needs are decided in a courtroom, they face unique stressors from the legal proceeding and from the social predicament that resulted in court action. Effective pediatric support and intervention requires an understanding of the situations that bring children to court and the issues that will confront children and child advocates in different court settings.