bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Necrotizing Enterocolitis on Length of Stay and Hospital Charges in Very Low Birth Weight Infants
Authors: Bisquera Jennifer A. , Cooper Timothy R. , Berseth Carol Lynn 
Published: August 2004

Objective. To determine the impact of necrotizing enterocolitis (NEC) on length of stay and hospital charges.Design. Case-control study.Setting. Two neonatal intensive care units in an academic medical center.Patients. Infants born in 1992–1994 with birth weight &lt;1500 g, matched by gestational age, hospital, and month of birth.Measurements and Main Results. We performed odds ratio and t testing. As with previous studies, there was no single factor that increased the risk for developing NEC. However, the diagnosis of NEC increased the risk for death, infection, and the need for central line placement. Infants with surgical NEC had lengths of stay that exceeded those of controls by 60 days, whereas lengths of stay among infants with medical NEC exceeded those of controls by 22 days. Based on length of stay, the estimated total hospital charges for infants with surgical NEC averaged $186 200 in excess of those for controls and $73 700 more for infants with medical NEC. The yearly additional hospital charges for NEC were $6.5 million or $216 666 per survivor.Conclusions. A diagnosis of NEC in the very low birth weight infant imposes a significant additional financial burden to the individual patient as well as the neonatal community as a whole. This expense justifies additional research into preventive measures and potentially costly therapies aimed at reducing the incidence of NEC. These data also provide an estimated cost to compare the cost effectiveness of new preventive measures for NEC.
Noninvasive Continuous Monitoring of the Effects of Head Position on Brain Hemodynamics in Ventilated Infants
Authors: Pellicer Adelina , Gayá Francisco , Madero Rosario , Quero José , Cabañas Fernando 
Published: August 2004

Hypothesis. Laying supine with the head in midline position improves cerebral venous return by preventing functional occlusion of the vessels of the neck.
Objectives. To assess changes in cerebral blood volume (ΔCBV) and cerebral blood flow (CBF) with the position of the head in ventilated patients using a noninvasive method. The influence of the type of ventilation and birth weight was evaluated.
Methods. Thirteen conventionally ventilated and 8 high-frequency oscillatory ventilated infants, with mean gestational ages and birth weights of 31 ± 5 weeks (24–38) and 1575 ± 803 g (560–3000), respectively, were studied 5.8 ± 7.8 days (1–33) after birth. ΔCBV (mL/100 g) and CBF (mL/100 g/min) were measured by near-infrared spectroscopy with the head in supine midline position (ΔCBVs, CBFs) and rotated 90° to one side (ΔCBVlat, CBFlat). Heart rate, peripheral saturation, transcutaneous Pco2, and blood pressure were monitored continuously. Ventilatory settings remained constant throughout the study period.
Results. Mean ΔCBVs was lower than mean ΔCBVlat, although no changes in blood pressure, transcutaneous Pco2, oxygenation, or heart rate occurred. This change in ΔCBV was not associated with the type of ventilation or birth weight, but the differences tended to be greater (dΔCBV = ΔCBVlat−ΔCBVs) in the smallest infants (&lt;1200 g). In contrast, CBF did not vary.
Conclusion. The supine midline position of the head favors cerebral venous drainage and helps to prevent elevation of CBV.
Speculation. This finding may be important in the first days of life, particularly in tiny preterm infants recovering from lung disease with improving lung compliance, in which functional obstruction of cerebral venous drainage should be avoided.
Genetic Screening for Maternal Uniparental Disomy of Chromosome 7 in Prenatal and Postnatal Growth Retardation of Unknown Cause
Authors: Hannula Katariina , Lipsanen-Nyman Marita , Kristo Paula , Kaitila Ilkka , Simola Kalle O. J. , Lenko Hanna Liisa , Tapanainen Päivi , Holmberg Christer , Kere Juha 
Published: August 2004

Objective. Many short-statured children lack an etiologic explanation for their retarded growth. Recently, uniparental disomy (UPD), the inheritance of both chromosomes of a chromosome pair from only 1 parent, has been associated with short stature for many chromosomes. Silver-Russell syndrome (SRS) represents an extreme syndrome of intrauterine growth retardation (IUGR) and slight dysmorphic signs, and maternal UPD of human chromosome 7 (matUPD7) has been observed in approximately 10% of SRS cases. In addition, matUPD7 has been reported in patients with only slight dysmorphic features and prenatal or postnatal growth retardation. The objectives of this study were to study the role of matUPD7 in growth failure of unknown cause and in cases of SRS, and to evaluate the efficiency of genetic testing for matUPD7 as a diagnostic tool.
Methods. DNA samples were studied from 205 children, 92 girls and 113 boys, with short stature of unknown cause and their parents. The patient cohort included 39 cases of SRS, 91 patients with IUGR and subsequent postnatal short stature, and 75 patients with postnatal growth retardation only. MatUPD7 was screened for by genotyping DNA samples from the patient, mother, and father with 13 chromosome-7-specific polymorphic microsatellite markers.
Results. Six (3%) of 205 matUPD7 cases were observed exclusively among 39 (15%) SRS patients studied. Patients with IUGR and/or postnatal growth retardation and with dysmorphic features did not reveal cases of matUPD7.
Conclusions. Our results indicate that matUPD7 cases are predominantly observed among patients meeting the criteria of SRS, and matUPD7 is not a common cause for growth retardation. Genetic screening for cases of matUPD7 among growth-retarded patients should be focused on patients with severe IUGR and features of SRS. In addition, matUPD7 screening is advisable in individuals with cystic fibrosis and other recessive disorders mapped to chromosome 7 who have unusually short stature.
The Significance of Gastric Residuals in the Early Enteral Feeding Advancement of Extremely Low Birth Weight Infants
Authors: Mihatsch Walter A. , von Schoenaich Patrik , Fahnenstich Hubert , Dehne Norma , Ebbecke Hartmut , Plath Christian , von Stockhausen Hans-Burkhardt , Muche Rainer , Franz Axel , Pohlandt Frank 
Published: August 2004

Objective. To evaluate whether the mean gastric residual volume (GRV) and green gastric residuals (GR) themselves are significant predictors of feeding intolerance in the early enteral feeding advancement in extremely low birth weight (ELBW; &lt;1000 g) infants.
Design. Ninety-nine ELBW infants were fed following a standardized protocol (day 3–14). At 48 hours of age, milk feeding was started (12 mL/kg/d increments, 12 meals per day). GR were checked before each feeding, and a GRV up to 2 mL/3 mL in infants ≤750 g/&gt;750 g was tolerated. In cases of increased GRV, feedings were reduced or withheld. The color of GR was assessed as clear, milky, green-clear, green-cloudy, blood-stained, or hemorrhagic. Multiple regression analysis was used to study the effect of the mean GRV and the color of GR on the feeding volume on day 14 (V14).
Results. The median V14 was 103 mL/kg/d (0–166). V14 increased with an increasing percentage of milky GR, whereas the mean GRV and the color green did not have a significant effect.
Conclusions. 1) Early enteral feeding could be established in ELBW infants. The critical GRV seems to be above 2 mL/3 mL because there was no significant negative correlation between the mean GRV and V14. 2) Green GR were not negatively correlated with V14 and should not slow down the advancement of feeding volumes in absence of other clinical signs and symptoms.
The Usefulness of Children’s Drawings in the Diagnosis of Headache
Authors: Stafstrom Carl E. , Rostasy Kevin , Minster Anna 
Published: August 2004

Objective. To determine whether drawings can aid in the differential diagnosis of headaches in children.
Methods. Before taking any history, 226 children who were seen consecutively for the evaluation of headache were asked to draw a picture to show how their headache felt. The pictures were then scored as migraine or nonmigraine by pediatric neurologists who were blinded to the clinical history. A clinical diagnosis of headache type was determined independently by another pediatric neurologist using the usual history and examination. The diagnoses of headache type based on the pictures drawn and the clinical findings obtained were then compared to calculate the sensitivity, specificity, and predictive values of the drawings for the diagnosis of migraine.
Results. Children produced dramatic and insightful headache drawings. Compared with the clinical diagnosis (gold standard), headache drawings had a sensitivity of 93.1%, a specificity of 82.7%, and a positive predictive value (PPV) of 87.1% for migraine. That is, drawings that contained an artistic feature consistent with migraine (eg, pounding pain, nausea/vomiting, desire to lie down, periorbital pain, photophobia, visual scotoma) predicted the clinical diagnosis of migraine in 87.1% of cases. Predictive values were also calculated for specific migraine-associated features on drawings: artistic depiction of focal neurologic signs, periorbital pain, recumbency, visual symptoms (photophobia, scotomata), or nausea/vomiting had a PPV of &gt;90% for migraine; severe or pounding pain had a PPV of &gt;80% for migraine. Band-like pain was not predictive of migraine (PPV of 11.1%). Features on drawings such as sadness or crying did not differentiate migraine from nonmigraine headaches.
Conclusions. Children’s headache drawings are a simple, inexpensive aid in the diagnosis of headache type, with a very high sensitivity, specificity, and predictive value for migraine versus nonmigraine headaches. We encourage the use of drawings in the evaluation of any child with a headache, as an adjunct to the clinical history and physical examination.
Hypospadias and Early Gestation Growth Restriction in Infants
Authors: Hussain Naveed , Chaghtai Azhar , Herndon C. D. Anthony , Herson Victor C. , Rosenkrantz Ted S. , McKenna Patrick H. 
Published: August 2004

Objective. There has been a major increase in the incidence of hypospadias in infants in the 1990s, but the risk factors are not known. Although there are scattered reports in the literature regarding the association of low birth weight and hypospadias, this has not been systematically studied. The objective of this study was to determine the association between early gestation intrauterine growth and hypospadias.
Methods. A retrospective review of 13 years of admissions to 2 tertiary care neonatal intensive care units (NICUs) in Connecticut (1987–2000) showed that 112 (1.66%) of 6746 male infants had any degree of hypospadias. Of these, 8 were part of a genetic syndrome and were excluded. A retrospective cohort analysis of these 6738 infants was performed. Infant growth parameters at birth (weight, head circumference, and length) were analyzed along with maternal risk factors known to be associated with changes in fetal growth, including maternal age, race, diagnosis of preeclampsia, gestational diabetes, and maternal use of alcohol or tobacco or substance abuse during pregnancy.
Results. The incidence of hypospadias in the NICU population increased 10-fold from 0.4% in 1987 to 4% in the first quarter of 2000. Hypospadias was significantly more common in infants who had uniformly poor intrauterine growth (&lt;10th percentiles) in the various parameters measured: birth weight, length, or head circumference. There were no significant differences in maternal age or race, nor were there differences in the use of alcohol, tobacco, or street drugs by the mother. There were no differences between singletons and multiple-gestation births. However, the frequency of occurrence was significantly higher among first-born infants (1.9%) compared with all other infants (0.9%).
Conclusions. The incidence of hypospadias in our NICU population has increased 10-fold during the 13-year period of study. There was a significant association of hypospadias with poor intrauterine growth. The growth restriction was probably of early gestational cause as there was proportionate involvement of somatic (weight and length) and brain growth (head circumference). The increasing frequency of hypospadias and its association with poor intrauterine growth originating in early gestation suggests that common environmental factor(s) that have an impact on both conditions may be involved.
Appendicostomy for Antegrade Enema: Effects on Somatic and Psychosocial Functioning in Children With Myelomeningocele
Authors: Aksnes Gunnar , Diseth Trond H. , Helseth Are , Edwin Bjørn , Stange Marianne , Aafos Gabrielle , Emblem Ragnhild 
Published: August 2004

Objective. To assess changes in somatic variables, psychosocial functioning, mental health and self-esteem after appendicostomy for antegrade enema (MACE) in children with myelomeningocele (MMC).
Methods. We performed the MACE procedure in 20 children, aged 6.3 to 17.0 years. Twelve patients had an open and 8 had a laparoscopic operation. Somatic function was assessed preoperatively and 6 and 16 months postoperatively. Psychosocial functioning and mental health were assessed preoperatively and 6 months postoperatively by a structured clinical interview and standardized questionnaires, Youth Self-Report, Child Behavior Checklist, and Harter’s Self-Perception Profile for Adolescents.
Results. Preoperatively, 9 patients had fecal leaks several times a week, 7 had leaks 1 to 4 times per month, and 4 were continent. The corresponding numbers 6 and 16 months postoperatively were 0, 6, and 14 and 0, 3, and 16. Six patients have had postoperative stoma complications that required surgery; 5 had a well-functioning stoma thereafter, and 1 had a colostomy 7 months later. Preoperatively, 14 patients reported considerable, 4 moderate, 2 minor, and 0 no psychosocial problems related to bowel control and emptying regimen. Six months postoperatively, the corresponding numbers were 1, 2, 6, and 11. The standardized questionnaires revealed substantial psychopathology in the MMC patients. The Child Behavior Checklist and Youth Self-Report scores were not significantly changed postoperatively, but global self-esteem score and close friends score from the Self-Perception Profile for Adolescents were significantly improved.
Conclusions. Fecal incontinence and constipation were greatly reduced by MACE. Children with MMC often have psychological and psychosocial problems, but important improvements in self-esteem and psychosocial function were observed 6 months after the MACE procedure.
A Pediatric, Practice-Based, Randomized Trial of Drinking and Smoking Prevention and Bicycle Helmet, Gun, and Seatbelt Safety Promotion
Authors: Stevens Marguerite M. , Olson Ardis L. , Gaffney Cecelia A. , Tosteson Tor D. , Mott Leila A. , Starr Pamela 
Published: August 2004

Objective. To prevent early adolescent health risk behaviors and to maintain or improve safety behaviors, we compared the effects of 2 interventions, delivered through pediatric primary care practices. The interventions, based on an office systems’ approach, sought to prevent early drinking and smoking or to influence bicycle helmet use, gun storage, and seatbelt safety for children who were followed from fifth/sixth grades through eighth/ninth grades.Design. Settings and Participants. Twelve pediatric practices in New England were paired according to practice size and assigned randomly within pairs to deliver the multicomponent interventions, which built on pediatric primary care clinicians performing as counselors and role models during health supervision visits and other office encounters.Intervention. One intervention arm focused on alcohol and tobacco use. The other intervention arm focused on gun safety, bicycle helmet, and seatbelt use. Office systems provided infrastructure that supported the clinician’s role. Clinician messages encouraged family communication and rule setting about the issues of the middle school years. The intervention was initiated during a health supervision visit and continued for 36 months. Both child and parent received quarterly newsletters to reinforce the clinician messages.Outcome Measures. The primary outcomes were ever drinking alcohol, ever smoking, ever using smokeless tobacco, using a bicycle helmet in the previous year, using a seatbelt in the previous 30 days, and guns in the child’s home in locked storage.Results. The pediatric practices recruited 85% (N = 3525) of the practices’ fifth/sixth grade children and their responding parents. We obtained 36 months’ follow-up data on 2183 child-parent pairs. Chart audit verified that the intervention was implemented. Additional data from interviews and surveys showed that parents, children, and pediatric clinicians found the intervention useful. Despite this, comparisons between the 2 study arms show no significant intervention effects in the prevention of alcohol and tobacco use or gun storage or seatbelt safety. There was a negative effect in the alcohol arm. Only bicycle helmet use showed a positive outcome.Conclusion. With rigorous evaluation, 2 office interventions failed to produce desired outcomes. Coordinated multiple settings for prevention interventions are probably necessary.
Seven-Year Follow-up of Vaccine Response in Extremely Premature Infants
Authors: Kirmani Khaver I. , Lofthus Geraldine , Pichichero Michael E. , Voloshen Timothy , D’Angio Carl T. 
Published: August 2004

Objective. To assess the immune response of 7-year-old former extremely preterm (PT) infants to routine childhood immunizations.Methods. Sixteen PT (&lt;29 weeks and &lt;1000 g) infants, followed since their primary immunizations at the recommended chronological ages, and 16 age-matched full-term (FT) control subjects were evaluated at 7 years of age. Antibodies to Haemophilus influenzae type b polyribosylribitol phosphate (Hib-PRP), tetanus, pertussis, diphtheria, polio, and hepatitis B (HBsAb) were measured.Results. The FT group had higher antidiphtheria geometric mean titers (GMT) than the PT group (1.07 vs 0.36 IU/mL). All FT and 13 of 16 PT had protective diphtheria antibody titers (&gt;0.1 IU/mL). The tetanus GMT were 4.22 IU/mL (FT) and 1.99 IU/mL (PT). All children had protective tetanus titers (&gt;0.01 IU/mL). Pertussis titers did not differ between FT and PT. Hib-PRP GMT were higher in FT than in PT (3.21 vs 1.41 μg/mL). All children had anti-PRP ≥0.15 μg/mL; 12 of 16 FT and 10 of 16 PT had levels ≥1.0 μg/mL. Polio serotype 1 and 2 GMT were similar between groups, and all children had protective titers (≥8). Polio serotype 3 GMT were 59 (FT) and 24 (PT) Karber units; all FT and 12 of 16 PT had protective titers. Among children who had received hepatitis B vaccine, GMT were similar in FT and PT children (120 vs 186 mIU/mL, and similar proportions of children (11 of 16 FT and 12 of 14 PT) had protective HBsAb titers (&gt;10 mIU/mL).Conclusions. At 7 years of age, PT children had lower antibody titers to many vaccine antigens than FT children. However, most PT children maintained antibody titers in the protective range.
Health Supervision for Children with Sickle Cell Disease
Authors:   Section on Hematology/Oncology and Committee on Genetics
Published: August 2004

This Clinical Report was revised. See https://doi.org/10.1542/peds.2024-066842.
Sickle cell disease (SCD) is a group of complex genetic disorders with multisystem manifestations. This statement provides pediatricians in primary care and subspecialty practice with an overview of the genetics, diagnosis, clinical manifestations, and treatment of SCD. Specialized comprehensive medical care decreases morbidity and mortality during childhood. The provision of comprehensive care is a time-intensive endeavor that includes ongoing patient and family education, periodic comprehensive evaluations and other disease-specific health maintenance services, psychosocial care, and genetic counseling. Timely and appropriate treatment of acute illness is critical, because life-threatening complications develop rapidly. It is essential that every child with SCD receive comprehensive care that is coordinated through a medical home with appropriate expertise.
A Double-Blind, Placebo-Controlled Study of Modified-Release Methylphenidate in Children With Attention-Deficit/Hyperactivity Disorder
Authors: Greenhill Laurence L. , Findling Robert L. , Swanson James M. ,   MPH MR ADHD Study Group
Published: August 2004

Objective. To compare the efficacy, safety, and tolerability of once-daily administration of modified-release methylphenidate (MPH MR) with placebo in children with attention-deficit/hyperactivity disorder (ADHD).
Methods. The study was a 3-week, double-blind, 32-site, randomized clinical trial comparing MPH MR with placebo. Children were 6 to 16 years of age, had a diagnosis of ADHD, and had not failed a previous trial of stimulant treatment for ADHD. After a 1-week, single-blind, placebo-washout period, participants received a once-daily dose of MPH MR or placebo, which was started with 1 capsule (20 mg) and individually titrated up to a maximum of 3 capsules (60 mg). The primary outcome measure was specified as a reduction in ADHD symptom severity from the teacher version of the 10-item Conners’ Global Index. Investigators, teachers, and parents evaluated safety.
Results. The study randomized 321 children: 158 to MPH MR and 163 to placebo. Children in the MPH MR group were started on a dose of 20 mg/d and reached a mean dose of 40.7 mg/d (1.28 mg/kg/d) at endpoint. Compared with placebo, MPH MR significantly reduced ADHD symptoms ratings on the teacher version of the 10-item Conners’ Global Index, on the parent version of the Conners’ Global Index, on the parent assessment of global efficacy, and on investigator assessment of global improvement. The most common adverse events in the MPH MR group were headache, anorexia, abdominal pain, and insomnia. Only anorexia occurred at a rate that was significantly greater than placebo.
Conclusion. MPH MR administered once daily in the morning is effective and safe in controlling ADHD symptoms throughout the school day.
Outpatient and Hospital Visits Associated With Otitis Media Among American Indian and Alaska Native Children Younger Than 5 Years
Authors: Curns Aaron T. , Holman Robert C. , Shay David K. , Cheek James E. , Kaufman Stephen F. , Singleton Rosalyn J. , Anderson Larry J. 
Published: August 2004

Objective. To describe the burden of otitis media (OM) among American Indian and Alaska Native (AI/AN) children.Methods. OM morbidity among AI/AN younger than 5 years was evaluated using OM-associated outpatient visit and hospitalization rates. These rates were compared with outpatient and hospitalization rates for the general US population of children younger than 5 years. AI/AN children who were younger than 5 years and receiving care through the Indian Health Service or tribally operated facilities and US children younger than 5 years of age were studied.Results. From 1994–1996, the average annual rate of AI/AN OM-associated outpatient visits was 138 per 100 children younger than 5 years. Among AI/AN children younger than 1 year (infants), these rates were almost 3 times greater than those for US infants (318 vs 110 visits per 100 infants, respectively). AI/AN children 1 to 4 years of age had rates 1.5 times greater than US children of the same age (107 vs 65 visits per 100 children, respectively). AI/AN children also experienced higher rates of OM-associated hospitalization than did US children (5643 vs 2440 per 100 000 infants, 823 vs 665 per 100 000 1- to 4-year-olds).Conclusion. We found that AI/AN children, especially AI/AN infants, have higher OM-associated outpatient and hospitalization rates than those for the general US population of children. The disparity in rates suggests that additional prevention programs and continued resources are needed to reduce OM morbidity among AI/AN children.