bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relationship Between Reason for Placement and Medical Findings Among Children in Foster Care
Authors: Takayama John I. , Wolfe Ellen , Coulter Kevin P. 
Published: August 2004

Objective. To determine the reasons for placement of children in foster care, the prevalence of medical findings during initial placement, and the relationship between reason for placement and medical findings. The association between placement reasons and parental substance abuse also was explored.
Methods. Population-based analysis of medical records of 749 children examined at the Child Protection Center in San Francisco from October 1, 1991, to December 31, 1992. Health evaluations consisted of a clearance examination of children during entry into foster care and a comprehensive examination 3 weeks later. Reasons for foster placement included abandonment, neglect, no available caretaker, physical abuse, sexual abuse, and failed placement.
Results. Nearly 50% of children in our study were &lt;6 years of age. Neglect (30%), physical abuse (25%), and no available caretaker (24%) were the most frequent placement reasons, followed by abandonment (9%), failed placement (7%), and sexual abuse (5%). Substance abuse was documented in 30% of parents, 51% when the placement reason was neglect. Medical findings were identified in 60% of children. Among 0 to 6-year-olds, 27% had upper respiratory illnesses, 23% had developmental delay, and 21% had skin conditions; for children 7 to 12 years of age, 32% failed vision screening, 12% had dental caries, and 11% had upper respiratory illnesses; and among 13- to 18-year-olds, 31% failed vision screening and 12% had positive tuberculin skin tests. For younger children, skin conditions were associated with neglect, no available care taker, and failed placement, and developmental delay with neglect and abandonment. For adolescents, history of psychiatric illness was associated with neglect and failed placement. Marks of abuse for all age groups were limited to children who had been physically abused. Three or more diagnoses were identified for ∼20% of children who had been neglected or abandoned or had failed placement, compared with 10% of children who had been either physically or sexually abused.
Conclusions. Specific medical findings associated with reasons for placement provide health professionals with additional information to assess more accurately the health care needs of children entering foster care. As important, screening tests revealed high rates of vision problems and exposures to tuberculosis, warranting earlier and more comprehensive screening. Finally, children who have endured variations of neglect or failed placement may have more health problems than anticipated previously.
Trends in Pediatric Asthma Hospitalization Rates: Regional and Socioeconomic Differences
Authors: Goodman David C. , Stukel Therese A. , Chang Chiang-hua 
Published: August 2004

Objective. Asthma hospitalization rates continue to increase nationally for children despite efforts by the National Institutes of Health and specialty organizations to improve outcomes through the dissemination of practice guidelines. To understand the generalizability of national trends to regional populations, we studied childhood hospitalizations over a 10-year period in four northeastern states.
Design. Longitudinal analysis of hospitalization rates by patient residence and patient characteristics using state hospital discharge datasets.
Population. Age &lt;18 years residing in Maine, New Hampshire, Vermont, or New York state during the period 1985 to 1994.
Results. In multivariate analyses (controlling for age, sex, race/ethnicity, median household income, metropolitan status), we found that New York asthma hospitalization rates increased 3.8% per annum (95% confidence interval: 3.3,4.2), whereas in New Hampshire, rates decreased 5.8% (95% confidence interval: 7.6,4.1). Maine and Vermont rates did not change significantly during the study period. Increased asthma hospitalization rates were noted in black and Hispanic populations, in children residing in zip codes with lower median household incomes, and in those living in metropolitan areas. Hospitalization rates for nonasthma causes fell substantially. As a result, the proportion of hospital days attributed to childhood asthma increased in all population groups.
Conclusions. Asthma discharge rates measured by the state of residence or socioeconomic characteristic do not necessarily parallel national trends. None of the current hypotheses offered to explain national trends in asthma hospitalization rates (changes in disease severity, diagnostic substitution, or differences in the supply and character of medical care) can be the sole explanation of these regional trends. Efforts intended to improve asthma outcomes may benefit a greater number of children by redirecting resources toward specific populations identified through state hospital discharge datasets.
Universal Infant Hearing Screening by Automated Auditory Brainstem Response Measurement
Authors: Mason Judith A. , Herrmann Kenneth R. 
Published: August 2004

Background. Our purpose was to identify infants with a bilateral, permanent, handicapping hearing loss and to provide them with amplification before age 6 months.
Methodology. The study population consisted of 10 372 infants born during a 5-year period. Universal hearing screening by automated auditory brainstem response was done in the nursery. Infants who failed the screening test were followed up diagnostically. Infants who were not tested in the nursery were followed up as outpatients. Hearing aids were recommended for those infants who had bilateral hearing loss.
Results. Successful screening in the nursery was achieved for 96% of infants. The failure rate was 4%. The incidence of bilateral loss requiring amplification was 1.4/1000. The false-positive rate was 3.5% after the initial screening and .2% when a two-stage screening procedure was used. The incidence of congenital bilateral hearing loss in the well population was 1/1000, and in the neonatal intensive care unit population, 5/1000. The cost of screening was $17 per infant, and the cost to identify each true bilateral hearing loss was $17 750. Amplification was recommended for 15 infants; well infants who used hearing aids before age 6 months achieved age-appropriate speech and language development.
Conclusions. Mild, moderate, and severe bilateral, persistent hearing loss can be identified in the nursery by automated auditory brainstem response measurement to provide amplification before age 6 months and thus optimize speech and language development.
Birth Outcome From a Prospective, Matched Study of Prenatal Crack/Cocaine Use: II. Interactive and Dose Effects on Neurobehavioral Assessment
Authors: Eyler Fonda Davis , Behnke Marylou , Conlon Michael , Woods Nanci Stewart , Wobie Kathleen 
Published: August 2004

Objective. This prospective, longitudinal project was designed to determine the effects of prenatal cocaine use on the neurodevelopmental outcomes of infants from a historically understudied rural public health population.Methodology. We interviewed &gt;2500 women prenatally, identified 154 cocaine users, and matched 154 controls on race, parity, socioeconomic status, and location of prenatal care (that related to level of pregnancy risk). Drug testing was required at enrollment and at delivery; detailed demographic, psychosocial, and drug histories were taken at each available trimester and follow-up visit. After birth, certified evaluators, blinded to maternal history of drug use, administered the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) under controlled conditions. Evaluation time for preterm infants was adjusted for gestational age.Results. After controlling for the effects of marijuana (users of other illicit drugs were excluded), alcohol, and tobacco use, the following results remained. There were significant drug group interactions on the BNBAS Qualifier Score of Alert Responsiveness that demonstrated lower scores among infants who were exposed to both cocaine and tobacco and among those exposed to both marijuana and tobacco. There were also significant correlations between the amount of cigarette, alcohol, marijuana, and cocaine exposure and several BNBAS scores. The reported amount of cocaine use in the third trimester was negatively related to scores of Orientation, Cost of Attention, and Alert Responsiveness (that was also related to amount of cocaine used over the entire pregnancy). When the effects of marijuana, alcohol, and tobacco were partialled out, the amount of cocaine use in the third trimester was negatively related to Regulation of State, a precursor of alertness, and the infant's ability to orient to the environment.Conclusions. The observed decrement in state regulation, attention, and responsiveness among cocaine-exposed neonates raises concerns about later developmental abilities as well as the effect these infants may have on caregivers (who themselves may be compromised in their parenting abilities by their drug use). Follow-up of these infants will reveal if these disadvantages continue. These early results also emphasize the importance of considering amount and time of drug exposure as well as the interactive effects of drug exposure and other risk variables.
Prevalence of IgA-Antigliadin Antibodies and IgA-Antiendomysium Antibodies Related to Celiac Disease in Children With Down Syndrome
Authors: Carlsson Annelie , Axelsson Irené , Borulf Stefan , Bredberg Anders , Forslund Marianne , Lindberg Bengt , Sjöberg Klas , Ivarsson Sten-Anders 
Published: August 2004

Objective. This study was undertaken to investigate the prevalence of celiac disease in children and adolescents with Down syndrome.
Material and Methods. Forty-three children and adolescents with Down syndrome were screened for IgA-antigliadin antibodies (AGA) and IgA-antiendomysium antibodies (EMA). Patients found to be either AGA- or EMA-positive were investigated further with intestinal biopsy.
Results. None of the 43 patients had known celiac disease at entry into the study; 37% (16/43) were found to have AGA levels above normal, and 16% (7/43) to be EMA-positive. Of the 15 patients who underwent biopsy, 8 manifested villous atrophy. Villous atrophy was present in all 7 of the EMA-positive patients, whereas the villi were normal in 7 of the 13 AGA-positive patients who underwent biopsy.
Conclusions. EMA is a good immunologic marker for use in screening for celiac disease, and screening is justified in patients with Down syndrome.
Late Vascular Occlusion of Central Lines in Pediatric Malignancies
Authors: Wilimas Judith A. , Hudson Melissa , Rao Baskar , Luo Xiaolong , Lott Lennie , Kaste Sue C. 
Published: August 2004

Objective.  To determine whether thrombi or vascular occlusion represent a late complication persisting several years after removal of central venous lines (CVLs) in children and adolescents treated for childhood cancer.
Methods. Children whose treatment for malignancy included placement of a CVL that had been removed at least 2 months previously were studied during scheduled follow-up that included contrast-enhanced computed tomography. Spiral volume acquisition was used to obtain 3-mm images from the chest apices through the right hilum, and three-dimensional reconstruction of angiograms was performed. Thrombosis/occlusion was defined as narrowing, obstruction, or filling defect of the deep venous system, with or without the formation of collateral veins. Charts were reviewed to document patient characteristics, previous CVL complications, administration of hyperalimentation, use of urokinase, and family history of venous thrombosis.
Results. Twenty-three patients treated for solid tumors and 2 treated for B-cell acute lymphocytic leukemia or lymphoma were studied. Lines had been in place from 0.2 to 36 months (median, 7.4) and were removed at 2.3 to 121.8 months (median, 32.5) before study. Nine patients received hyperalimentation for periods ranging from 2 to 38 weeks (median, 12). Four patients had required urokinase instillations, and one developed superior vena cava syndrome; 4 had a CVL-related infection (two superficial and two Candida line infections). Occlusion was seen on computed tomography angiograms in 3 of the 25 patients (12%; 95% confidence interval: 4.5–31%). One of the patients with occlusion had superior vena cava syndrome; none had a family history of thrombosis, use of a double lumen CVL, or multiple instillations of urokinase.
Conclusions. Persistent asymptomatic vascular occlusion does occur as a late complication of CVL placement for treatment of childhood malignancies, although the frequency appears low among patients treated primarily for solid tumors. Prospective studies of large numbers of patients with a broader spectrum of diagnoses are necessary to define the incidence of and risk factors for this complication and to assess the need for prevention with anticoagulation or other therapy. Pediatricians caring for patients with a history of cancer and CVLs should be aware that these patients may have persistent vascular occlusion that could predispose them to recurrent thrombosis or postphlebitic syndrome.
Inhaled Nitric Oxide for the Early Treatment of Persistent Pulmonary Hypertension of the Term Newborn: A Randomized, Double-Masked, Placebo-Controlled, Dose-Response, Multicenter Study
Authors: Davidson Dennis , Barefield Elaine S. , Kattwinkel John , Dudell Golde , Damask Michael , Straube Richard , Rhines Jared , Chang Cheng-Tao ,   the I-NO/PPHN Study Group
Published: August 2004

Objectives. To assess the dose-related effects of inhaled nitric oxide (I-NO) as a specific adjunct to early conventional therapy for term infants with persistent pulmonary hypertension (PPHN), with regard to neonatal outcome, oxygenation, and safety.Methods. Randomized, placebo-controlled, double-masked, dose-response, clinical trial at 25 tertiary centers from April 1994 to June 1996. The primary endpoint was the PPHN Major Sequelae Index ([MSI], including the incidence of death, extracorporeal membrane oxygenation (ECMO), neurologic injury, or bronchopulmonary dysplasia [BPD]). Patients required a fraction of inspired oxygen [Fio2] of 1.0, a mean airway pressure ≥10 cm H2O on a conventional ventilator, and echocardiographic evidence of PPHN. Exogenous surfactant, concomitant high-frequency ventilation, and lung hypoplasia were exclusion factors. Control (0 ppm) or nitric oxide (NO) (5, 20, or 80 ppm) treatments were administered until success or failure criteria were met. Due to slowing recruitment, the trial was stopped at N = 155 (320 planned).Results. The baseline oxygenation index (OI) was 24 ± 9 at 25 ± 17 hours old (mean ± SD). Efficacy results were similar among NO doses. By 30 minutes (no ventilator changes) the Pao2 for only the NO groups increased significantly from 64 ± 39 to 109 ± 78 Torr (pooled) and systemic arterial pressure remained unchanged. The baseline adjusted time-weighted OI was also significantly reduced in the NO groups (-5 ± 8) for the first 24 hours of treatment. The MSI rate was 59% for the control and 50% for the NO doses (P = .36). The ECMO rate was 34% for control and 22% for the NO doses (P = .12). Elevated methemoglobin (&gt;7%) and nitrogen dioxide (NO2) (&gt;3 ppm) were observed only in the 80 ppm NO group, otherwise no adverse events could be attributed to I-NO, including BPD.Conclusion. For term infants with PPHN, early I-NO as the sole adjunct to conventional management produced an acute and sustained improvement in oxygenation for 24 hours without short-term side effects (5 and 20 ppm doses), and the suggestion that ECMO use may be reduced.
A Phase I/II Study of the Protease Inhibitor Ritonavir in Children With Human Immunodeficiency Virus Infection
Authors: Mueller Brigitta U. , Nelson Robert P. , Sleasman John , Zuckerman Judy , Heath-Chiozzi Margo , Steinberg Seth M. , Balis Frank M. , Brouwers Pim , Hsu Ann , Saulis Rima , Sei Shizuko , Wood Lauren V. , Zeichner Steve , Katz T. Teresa K. , Higham Colleen , Aker Diane , Edgerly Maureen , Jarosinski Paul , Serchuck Leslie , Whitcup Scott M. , Pizzuti David , Pizzo Philip A. 
Published: August 2004

Background. Ritonavir, a potent antiretroviral protease inhibitor, has been approved for the treatment of adults and children with human immunodeficiency virus (HIV) infection. In a phase I/II study, we assessed the safety, tolerability, and pharmacokinetic profile of the oral solution of ritonavir in HIV-infected children and studied the preliminary antiviral and clinical effects.Methods. HIV-infected children between 6 months and 18 years of age were eligible. Four dose levels of ritonavir oral solution (250, 300, 350, and 400 mg/m2 given every 12 hours) were evaluated in two age groups (≤2 years, &gt;2 years). Ritonavir was administered alone for the first 12 weeks and then in combination with zidovudine and/or didanosine. Clinical and laboratory parameters were monitored every 2 to 4 weeks.Results. A total of 48 children (median age, 7.7 years; range, 0.5 to 14.4 years) were included in this analysis. Dose-related nausea, diarrhea, and abdominal pain were the most common toxicities and resulted in discontinuation of ritonavir in 7 children. Ritonavir was well absorbed at all dose levels, and plasma concentrations reached a peak 2 to 4 hours after a dose. CD4 cells counts increased by a median of 79 cells/mm3 after 4 weeks of monotherapy and were maintained throughout the study. Plasma HIV RNA decreased by 1 to 2 log10 copies/mL within 4 to 8 weeks of ritonavir monotherapy, and this level was sustained in patients enrolled at the highest dose level of 400 mg/m2 for the 24-week period.Conclusions. The oral solution of ritonavir has potent antiretroviral activity as a single agent and is relatively well tolerated by children when administered alone or in combination with zidovudine or didanosine.
The Use of Albuterol in Hospitalized Infants With Bronchiolitis
Authors: Dobson Joseph V. , Stephens-Groff Susan M. , McMahon Shawn R. , Stemmler Margaret M. , Brallier Susan L. , Bay Curtis 
Published: August 2004

Objectives. To determine whether the use of albuterol by nebulization enhances physiologic or clinical recovery in hospitalized infants with moderate bronchiolitis.Methods. This prospective, double-blind, placebo-controlled, randomized clinical trial was performed from December 1995 to March 1996. A total of 52 patients &lt;24 months of age with a diagnosis of moderately severe, acute viral bronchiolitis were enrolled and assigned to receive nebulized albuterol or normal saline placebo for 72 hours under a standardized protocol. Primary outcome measures included improvement in oxygen saturation (Sao2) during hospitalization and survival analysis to assess the time required to reach preestablished discharge criteria on three measures: Sao2, accessory muscle use, and wheezing. An additional secondary outcome measure was actual length of hospital stay. Adverse outcomes also were compared between treatment groups.Results. There was no significant difference in mean Sao2 between albuterol and placebo at baseline, 24 hours, or maximum Sao2 achieved during hospitalization. Both groups showed significant improvement in oxygen saturation over time, but there was no significant difference in improvement between the two groups. The study had a power of 90% to detect a difference in mean percentage point improvement of 2% Sao2. There was no difference in time to reach discharge criteria as defined by Sao2, accessory muscle use, or wheezing. There was no difference in length of hospital stay or in the frequency of adverse outcomes.Conclusions. Nebulized albuterol therapy does not appear to enhance recovery or attenuate severity of illness in infants hospitalized with acute, moderate bronchiolitis, as evidenced by improvement in oxygen saturation, time to meet standardized discharge criteria, or length of hospital stay.
The Role of Parents in End-of-Life Decisions in Neonatology: Physicians' Views and Practices
Authors: van der Heide Agnes , van der Maas Paul J. , van der Wal Gerrit , Kollée Louis A. A. , de Leeuw Richard , Holl Robert A. 
Published: August 2004

Objective. End-of-life decisions for newborn infants are usually made with the consent of parents as well as physicians, but may occasionally involve disagreement about which decision is in the best interest of the child. Our study was aimed at providing an empirical background for the ethical discussion on the parent's versus the physician's role in decision-making.Methods. We conducted face-to-face interviews with a stratified sample of pediatricians. The response rate was 99%. The most recent decisions in newborn infants to hasten death or not prolong life and the most recent cases in which such decisions were not made because either the parents or the physician objected were comprehensively discussed.Results. Decisions to hasten death or not prolong life were usually made after discussing it with parents and did not occur while parents were known to disagree. Situations in which an end-of-life decision was not made because parents did not consent predominantly involved infants with complications of prematurity (24%) or perinatal asphyxia (40%), whereas situations in which parents requested an end-of-life decision that was not acceded to by the pediatrician involved Down syndrome as the main diagnosis in 43% and as a concurrent diagnosis in 21%. Pediatricians afterwards often expressed feelings of discontent about situations in which there had been disagreement with parents.Conclusions. The opinion of parents about which medical decision is in the best interest of their child is for pediatricians only decisive in case it invokes the continuation of treatment. The principle of preserving life is abandoned only when the physician feels sufficiently sure that the parents agree that such a course of action is in the best interest of the child.