bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized Placebo-controlled Trial of a 42-Day Tapering Course of Dexamethasone to Reduce the Duration of Ventilator Dependency in Very Low Birth Weight Infants
Authors: Kothadia Jamanadas M. , O'Shea T. Michael , Roberts Dia , Auringer Sam T. , Weaver R. Grey , Dillard III§; and Robert G. 
Published: August 2004

Objective.To assess the effect on duration of ventilator dependency of a 42-day tapering course of dexamethasone in very low birth weight neonates.Methods.Infants (N = 118) were assigned randomly, within birth weight/gender strata, to treatment with either a 42-day tapering course of dexamethasone or an equal volume of saline as placebo. Entry criteria were 1) birth weight &lt;1501 g; 2) age between 15 and 25 days; 3) &lt;10% decrease in ventilator settings for 24 hours and Fio2 ≥0.3; 4) absence of patent ductus arteriosus, sepsis, major congenital malformation, congenital heart disease; and 5) no evidence of maternal HIV or hepatitis B infection. The dosage schedule was 0.25 mg/kg bid for 3 days, then 0.15 mg/kg bid for 3 days, then a 10% reduction in the dose every 3 days until a dose of 0.1 mg/kg had been given for 3 days, from which time a dose of 0.1 mg/kg qod was continued until 42 days after entry. The primary endpoint was the number of days on assisted ventilation after study entry. Secondary outcomes of interest included days on supplemental oxygen, days of hospitalization, and potential adverse effects, such as infection, gastrointestinal bleeding, left ventricular hypertrophy, and severe retinopathy of prematurity.Results.Infants in the dexamethasone- and placebo-treated groups were similar in terms of baseline attributes, including birth weight, gestational age, gender, race, and ventilator settings at entry. Infants treated with dexamethasone were on assisted ventilation and supplemental oxygen for fewer days after study entry (median days on ventilator, 5th and 95th percentiles, 13 [1–64] vs 25 [6–104]; days on oxygen, 59 [6–247] vs 100 [11–346]). No differences were found in risk of death, infection, or severe retinopathy. In subgroup analyses, the association of dexamethasone with more rapid weaning from the ventilator was weaker among infants enrolled before the 16th day of life, infants with chest radiographs showing cystic changes and/or hyperinflation, and infants requiring an Fio2 ≥0.7 or a peak inspiratory pressure ≥19 at study entry.Conclusions.A 42-day tapering course of dexamethasone decreases the duration of ventilator and oxygen dependency in very low birth weight infants and is not associated with an increased risk of short-term adverse effects.
Physically Abused Adolescents: Behavior Problems, Functional Impairment, and Comparison of Informants' Reports
Authors: Kaplan Sandra J. , Labruna Victor , Pelcovitz David , Salzinger Suzanne , Mandel Francine , Weiner Merrill 
Published: August 2004

Objective.
This study, like earlier studies that focused on younger abused children, ascertained whether physically abused adolescents exhibited increased internalizing and externalizing behaviors. Relevance to pediatric practice is discussed.

Design.
A cross-sectional design was used to compare the behavior of physically abused adolescents and comparison adolescents using self-reports, parent reports, and teacher reports. The level of agreement among raters was also examined.

Participants.
The subjects were 99 physically abused adolescents between the ages of 12 and 18 years, who were recruited from Child Protective Services. Comparison subjects were 99 community-recruited nonabused adolescents who were matched for age, gender, and income with the abused adolescents.

Measures.
The behavior of the adolescents was assessed using the Child Behavior Checklist, and the comparable Youth Self-Report and Teacher Report Form, which are widely used measures of behavioral and emotional problems. The Child Global Assessment Scale was also used as a measure of functional impairment and of the need for mental health services.

Results.
Parents and teachers rated the problems of abused adolescents as significantly greater than the problems of nonabused adolescents on all checklist subscales. Abused adolescents reported significantly greater problems only on externalizing behavior subscales. In addition, based on interviewer ratings, physically abused adolescents exhibited significantly greater functional impairment.

Conclusions.
Similar to previous research on abused children, physically abused adolescents exhibit externalizing and internalizing behavior problems and experience greater functional impairment. Parent, teacher, and adolescent reports of externalizing behaviors were similar, but physically abused adolescents reported fewer internalizing behaviors than did the other informants.
Symptomatic Congenital Cytomegalovirus Infection in Infants Born to Mothers With Preexisting Immunity to Cytomegalovirus
Authors: Boppana Suresh B. , Fowler Karen B. , Britt William J. , Stagno Sergio , Pass Robert F. 
Published: August 2004

Objectives.
To determine the frequency of symptomatic congenital cytomegalovirus (CMV) infection in the offspring of women with a recurrent maternal CMV infection and to characterize the demographic and newborn findings.

Methods.
Study subjects consisted of infants with symptomatic congenital CMV infection identified by a newborn virologic screening program at the University of Alabama Hospital between 1991 and 1997 and were enrolled in a long-term follow-up study. Maternal infections were categorized by an analysis of archival serum specimens collected before pregnancy and at the time of delivery. Demographic data and clinical findings at birth were collected from maternal and newborn hospital records and from parents at the time of initial evaluation.

Results.
Of the 47 infants with symptomatic congenital CMV infection identified during the study period, 8 were born to mothers with a confirmed nonprimary or recurrent CMV infection. The type of maternal infection could be ascertained in only ∼43% (20/47) of the children with symptomatic congenital CMV infection born at the University of Alabama Hospital during the study period. There were no significant differences in demographic characteristics of the recurrent infection group and the infants who were born to mothers with either primary CMV infection during pregnancy or unclassified maternal infection. Similarly, the range of severity of clinical abnormalities during the newborn period did not differ in the two groups of children. Furthermore, there were no significant differences in the incidence of sequelae at long-term follow-up in the two groups of children.

Conclusions.
Symptomatic congenital CMV infection can occur after a nonprimary or recurrent maternal infection. However, the exact incidence of symptomatic congenital CMV infection among children born to women with preexisting immunity remains to be defined.
Cost of Chickenpox in Canada: Part II. Cost of Complicated Cases and Total Economic Impact
Authors: Law Barbara , Fitzsimon Catherine , Ford-Jones Lee , McCormick John , Rivière Marc ,   Members of the Immunization Monitoring Program—Active (IMPACT)
Published: August 2004

Objective.Primarily, to determine the direct medical costs and productivity losses associated with complicated chickenpox (hospitalized cases) and, secondarily, to quantify the overall economic burden of chickenpox in Canada.Methods.Direct medical resource consumption patterns were determined by chart review of 160 otherwise healthy children and 40 children with leukemia hospitalized for chickenpox. Children were selected from the database of the Immunization Monitoring Program Active (IMPACT), a network of 11 tertiary-care hospitals in Canada that collected information at the time of hospitalization from January 1991 to March 1996. An additional 26 healthy children hospitalized were recruited prospectively by IMPACT. Productivity losses (time lost from work and daily activities) were assessed by caregiver interviews. Treatment costs were determined from the patient, Ministry of Health, and societal perspectives.Results.The average societal per case cost for complicated chickenpox in healthy children was $7060 and $8398, respectively, from the retrospective and prospective assessments. For children with leukemia, the direct medical cost was estimated at $7228. These costs were combined with a cost established previously for uncomplicated chickenpox. The estimated yearly overall economic impact of chickenpox in Canada was $122.4 million, with $24.0 million attributable to Ministry of Health costs, assuming an estimated yearly incidence of 346 527 cases and a 0.54% rate of hospitalization for healthy children.Conclusions.Direct medical costs are the major cost driver in the care of complicated chickenpox. However, in the context of the overall economic burden of the disease, uncomplicated chickenpox is the major cost driver, contributing 89% to the total cost.
A Three-day Course of Dexamethasone Therapy to Prevent Chronic Lung Disease in Ventilated Neonates: A Randomized Trial
Authors: Garland Jeffery S. , Alex Colleen P. , Pauly Thomas H. , Whitehead Vicki L. , Brand Joseph , Winston James F. , Samuels David P. , McAuliffe Timothy L. 
Published: August 2004

Background.Although several trials of early dexamethasone therapy have been completed to determine if such therapy would reduce mortality and chronic lung disease (CLD) in infants with respiratory distress, optimal duration and side effects of such therapy remain unknown.Purpose.The purpose of this study was: 1) to determine if a 3-day course of early dexamethasone therapy would reduce CLD and increase survival without CLD in neonates who received surfactant therapy for respiratory distress syndrome and 2) to determine adverse effects associated with such therapy.Design.This was a prospective multicenter randomized trial comparing a 3-day course of dexamethasone therapy beginning at 24 to 48 hours of life to placebo therapy. Two hundred forty-one neonates (dexamethasone n = 118, placebon = 123), who weighed between 500 g and 1500 g, received surfactant therapy, and were at significant risk for CLD or death using a model to predict CLD or death at 24 hours of life, were enrolled in the trial. Infants randomized to receive early dexamethasone were given 6 doses of dexamethasone at 12-hour intervals beginning at 24 to 48 hours of life. The primary outcomes compared were survival without CLD and CLD. CLD was defined by the need for supplemental oxygen at the gestational age of 36 weeks. Complication rates and adverse effects of study drug therapy were also compared.Results.Neonates randomized to early dexamethasone treatment were more likely to survive without CLD (RR: 1.3; 95% CI: 1.03, 1.7) and were less likely to develop CLD (RR: 0.6; CI: 0.3, 0.98). Mortality rates were not significantly different. Subsequent dexamethasone therapy use was less in early dexamethasone-treated neonates (RR: 0.8; CI: 0.7, 0.96). Very early (≤7 days of life) intestinal perforations were more common among dexamethasone-treated neonates (8% vs 1%).Conclusion.We conclude that an early 3-day course of dexamethasone therapy increases survival without CLD, reduces CLD, and reduces late dexamethasone therapy in high-risk, low birth weight infants who receive surfactant therapy for respiratory distress syndrome. Potential benefits of early dexamethasone therapy at the dosing schedule used in this trial need to be weighed against the risk for early intestinal perforation.
The Beneficial Effects of Weekly Low-dose Vitamin A Supplementation on Acute Lower Respiratory Infections and Diarrhea in Ecuadorian Children
Authors: Sempértegui Fernando , Estrella Bertha , Camaniero Verónica , Betancourt Valeria , Izurieta Ricardo , Ortiz Wilma , Fiallo Elizabeth , Troya Sheyla , Rodrı́guez Alicia , Griffiths Jeffrey K. 
Published: August 2004

Background.
Previous studies of large-dose vitamin A supplementation on respiratory morbidity have produced conflicting results in a variety of populations. The influence of malnutrition has not been examined in the majority of these trials. We hypothesized that weekly low-dose vitamin A supplementation would prevent respiratory and diarrheal disease morbidity and that malnutrition might influence the efficacy of vitamin A supplementation.

Methods.
In a randomized, double-blind, placebo-controlled field trial of 400 children, 6 to 36 months of age in a high Andean urban slum, half of the children received 10 000 IU of vitamin A weekly and half received placebo for 40 weeks. Children were visited weekly at home by physicians and assessed for acute diarrheal disease and acute respiratory infections.

Results.
Acute diarrheal disease and acute respiratory infection did not differ globally or by severity between supplement-treated and placebo groups. However, the incidence of acute lower respiratory infection (ALRI) was significantly lower in underweight (weight-for-age z score [WAZ] &lt;−2 SD) supplement-treated children than in underweight children on placebo (8.5 vs 22.3 per 103 child-weeks; rate ratio: 0.38 [95% CI: 0.17–0.85]). ALRI incidence was significantly higher in normal-weight (WAZ &gt;−2 SD) supplement-treated children than in normal-weight children on placebo (9.8 vs 4.4 per 103 child-weeks; rate ratio: 2.21 [95% CI: 1.24–3.93]). By logistic regression analysis the risk of ALRI was lower in underweight supplement-treated children than in underweight children on placebo (point estimate 0.148 [95% CI: 0.034–0.634]). In contrast, risk of ALRI was higher in normal-weight supplement-treated children (WAZ &gt;−1 SD to mean) than in normal-weight children on placebo in the same WAZ stratum (point estimate: 2.51 [95% CI: 1.24–5.05]). The risk of severe diarrhea was lower in supplement-treated children 18 to 23 months of age than in children on placebo in this age group (point estimate: 0.26 [95% CI: 0.06–1.00]).

Conclusions.
Weekly low-dose (10 000 IU) vitamin A supplementation in a region of subclinical deficiency protected underweight children from ALRI and paradoxically increased ALRI in normal children with body weight over −1 SD. Protection from severe diarrhea was consistent with previous trials. Additional research is warranted to delineate potential beneficial and detrimental interactions between nutritional status and vitamin A supplementation regarding ALRI.
Kawasaki Disease: More Patients Are Being Diagnosed Who Do Not Meet American Heart Association Criteria
Authors: Witt Mark T. , Minich L. LuAnn , Bohnsack John F. , Young Paul C. 
Published: August 2004

Objective.To determine the frequency of Kawasaki disease (KD) diagnosis in patients who did and did not meet American Heart Association (AHA) diagnostic criteria and to examine the clinical findings, the time to treatment, and the outcomes of the two groups.Design.Retrospective review of all patients with a discharge diagnosis of KD at a tertiary care children's hospital (1991–1997).Results.A total of 127 patients were identified. All received intravenous immune globulin (IVIG) and had complete echocardiographic studies. AHA criteria were met in 81 (63.8%). More patients who did not meet criteria (9 of 46, 20%) had coronary artery abnormalities (CAA), compared with those who had the complete clinical picture (6 of 81, 7%). The 15 patients with CAA received IVIG later (12.4 ± 7.4 days) from onset of symptoms compared with those with no CAA (8.2 ± 4.6). The time period was the same for patients with CAA who met the criteria, (11.8 ± 5.8 days) as for patients who did not meet AHA criteria (12.8 ± 8.6 days). Infants were more likely than were older children to develop CAA, to receive IVIG later, and to be diagnosed with an incomplete clinical picture.Conclusion.Physicians are increasingly likely to diagnose KD in patients who do not meet complete AHA criteria. Despite the potential risks of overdiagnosis and overtreatment, this practice seems justified because the complete criteria are an insensitive indicator of having or developing CAA.
Rollover Injuries in Residential Driveways: Age-related Patterns of Injury
Authors: Silen Mark L. , Kokoska Evan R. , Fendya Diana G. , Kurkchubasche Arlet G. , Weber Thomas R. , Tracy Thomas F. , MD Jr, 
Published: August 2004

Background.The major objective of the present study was to determine the severity of nonfatal injuries sustained by children (&lt;16 years old) when a motor vehicle rolls over them. We also sought to determine whether younger children (&lt;24 months old) demonstrated different patterns of injury and/or a worse outcome, compared with older children (&gt;24 months old).Methods.We reviewed the medical records of 3971 consecutive admissions to a single trauma service at an urban children's hospital between March 1990 and October 1994. During this time period, 26 (0.7%) children presented with rollover injuries incurred by motor vehicles in residential driveways. Outcome was measured by length of both intensive care unit admission and hospitalization.Results.Two children died shortly after admission and were excluded from the remainder of the study. Younger children (&lt;24 months old) had significantly higher injury severity scores and lower pediatric trauma scale scores. Both the duration in the intensive care unit and the length of hospitalization were significantly longer in younger children, compared with children &gt;24 months old. One explanation for these observations was that younger children had a significantly higher incidence of both head and neck and extremity injury but a similar incidence and severity of chest and abdominal trauma, compared with older children. Injuries requiring operative intervention were rare.Conclusion.Younger patients sustaining rollover injuries in the residential driveway have a worse outcome, in part, because of the head and neck or extremity injures that they incur. The majority of rollover injuries can be managed conservatively. pediatric trauma, driveway, pedestrian events, rollover injuries, injury severity score, pediatric trauma scale.
Adolescent Health Insurance Coverage: Recent Changes and Access to Care
Authors: Newacheck Paul W. , Brindis Claire D. , Cart Courtney Uhler , Marchi Kristen , Irwin Charles E. , MD Jr, 
Published: August 2004

Objective.To assess the health insurance status of adolescents, the trends in adolescent health care coverage, the demographic and socioeconomic correlates of insurance coverage, and the role that insurance coverage plays in influencing access to and use of health care. Together, the results provide a current and comprehensive profile of adolescent health insurance coverage.Methods.We analyzed data on 14 252 adolescents, ages 10 to 18 years, included in the 1995 National Health Interview Survey. The survey obtained information on insurance coverage and several measures of access and utilization, including usual source of care, site of the usual source of care, indications of missed or delayed care, and use of ambulatory physician services by adolescents. We conducted multivariate analyses to assess the independent association of age, sex, race, poverty status, family structure, family size, region of residence, metropolitan resident status, and health status on the likelihood of insurance coverage. We conducted bivariate and multivariate analyses to ascertain how insurance coverage was related to each of the access and utilization measures obtained in the survey. We also examined trends in health insurance coverage using the 1984, 1989, and 1995 editions of the National Health Interview Survey.Results.An estimated 14.1% of adolescents were uninsured in 1995. Risk of being uninsured was higher for older adolescents, minorities, adolescents in low-income families, and adolescents in single parent households. Compared with their insured counterparts, uninsured adolescents were five times as likely to lack a usual source of care, four times as likely to have unmet health needs, and twice as likely to go without a physician contact during the course of a year. Between 1984 and 1995 the percentage of adolescents with some form of health insurance coverage remained essentially unchanged. During this period, the prevalence of private health insurance decreased, while the prevalence of public health insurance increased.Conclusions.This study demonstrates the critical importance of health insurance as a determinant of access to and use of health services among adolescents. It also shows that little progress has been made during the past 15 years in reducing the size of the uninsured adolescent population. The new State Children's Health Insurance Program could lead to substantial improvements in access to care for adolescents, but only if states implement effective outreach and enrollment strategies for uninsured adolescents. adolescents, health insurance, access, Medicaid, SCHIP.
Changing Epidemiology of Group B Streptococcal Colonization
Authors: Hickman Melissa E. , Rench Marcia A. , Ferrieri Patricia , Baker Carol J. 
Published: August 2004

Objectives.To define factors influencing vertical transmission of and neonatal colonization with group B streptococci (GBS) in neonates representing ethnically and economically diverse populations, and to determine the serotype distribution of isolates, especially new types IV–VIII.Study Design.Prospective, cross-sectional study of neonates born to women evaluated for GBS colonization at admission for delivery to one of four hospitals between January 1994 and February 1995. Cultures of throat, umbilicus, and rectum were obtained from 24- to 48-hour-old infants for isolation of GBS. Isolates were classified by capsular polysaccharide (I-VIII) and C protein (α and β) antigen components.Results.Colonization was detected in 28% of 546 mothers, was higher in blacks than whites (40.6% vs 20.3%) and Hispanics (26.9%), and was not influenced by socioeconomic status. Overall, ethnic origin did not seem to be related to GBS serotype, but whites were more likely to carry the new type V strain than blacks (6 out of 24 [25%] vs 1 out of 43 [2%]). Vertical transmission of GBS to neonates was significantly diminished when their mothers had intrapartum antibiotics (0% vs 52%), rupture of membranes &lt;12 hours before delivery (38.4% vs 73.3%), or delivery by cesarean section (25.9% vs 45.2%). Colonization with GBS was found in 13.8% of 549 neonates, was acquired vertically in 97%, and was less frequent in neonates at the private hospitals (4% vs 20%) where intrapartum antibiotics were given more frequently (34.7% vs 17.3%). Among isolates from neonates, serotype Ia predominated (31.6%) followed by types II (25%), III (22.4%), and V (11.8%); ∼40% of strains contained C protein antigen.Conclusions.Changes in the epidemiology of GBS colonization included diminished rates in some populations associated with use of maternal intrapartum antibiotics, and a shift in serotype prevalence, with Ia as predominant and V, in addition to II and III, as common.