bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Discharge From the Newborn Nursery—Effect on Scheduling of Follow-up Visits by Pediatricians
Authors: Maisels M. Jeffrey , Kring Elizabeth 
Published: August 2004

Objective. To evaluate the impact of shorter hospital stays on the follow-up scheduling of newborn infants by private pediatricians.Design. Five surveys over a period of 18 months with educational intervention.Setting. Large community hospital well baby nursery.Participants. Twenty private pediatricians who cared for at least 20 newborn infants in the well baby nurseries during 1995.Intervention. Oral and written communications to pediatricians emphasizing the importance of evaluating infants within 2 to 3 days of discharge if the hospital stay was less than 48 hours.Main outcome measure. Interval between discharge from the nursery and the scheduled follow-up visit to the pediatrician.Results. In the first two surveys (September 1994 and March 1995) there was no significant difference in follow-up scheduling by pediatricians for those infants discharged &lt;48 hours vs ≥48 hours. Differences were significant in July and November 1995, and in the final survey in March 1996. Nevertheless, in March 1996, 38% of short-stay infants were scheduled to be seen 4 or more days after discharge, and 33% 14 days after discharge.Conclusion. Although follow-up practices have changed in response to shorter newborn hospital stays, a significant proportion of pediatricians are not following the American Academy of Pediatrics guidelines for the follow-up of short-stay infants. Whether or not failure to follow these guidelines will lead to an increase in morbidity is unknown.
Human Monocytic Ehrlichiosis in Children
Authors: Schutze Gordon E. , Jacobs Richard F. 
Published: August 2004

Background. Much of what is known about human monocytic ehrlichiosis (HME) is based upon studies with adult patients.Purpose. To review our experience with HME to better understand the epidemiology, clinical manifestations, and outcome of this disease in children.Methods. Demographic, clinical, and laboratory data were gathered after review of the medical records of patients identified with HME.Results. Twelve patients with an median age of 7.4 years (range, 7 months to 13.7 years) were identified with HME; 10 were white, 7 were male, and 10 were from hometowns of &lt;800 people. Eight patients presented from May through July, and 8 had a history of tick bites. Symptoms demonstrated by the patients during their illness included fever (100%), rash (67%), myalgias (58%), and vomiting, diarrhea, and headache (25%). On presentation, patients demonstrated thrombocytopenia (92%), elevated liver function tests (91%), lymphopenia (75%), hyponatremia (67%), leukopenia (58%), and anemia (42%) on the initial laboratory examination. Four patients presented in shock and 3 required blood pressure support and mechanical ventilation for a median of 10 days (8 to 37 days). These complicated patients required longer hospitalization (19.5 days vs 5.5 days) and attained higher blood urea nitrogen levels (42.5 mg/dL vs 10 mg/dL) than the patients not presenting with shock. Morbidity associated with HME patients included a decrease in cognitive and neurologic performance.Conclusions. More information and long-term follow-up is required to understand the full spectrum of disease and morbidity associated with HME in children.
Surgical Treatment of Craniosynostosis: Outcome Analysis of 250 Consecutive Patients
Authors: Sloan Gerald M. , Wells Karin C. , Raffel Corey , McComb J. Gordon 
Published: August 2004

Objective. Surgery for craniosynostosis has evolved rapidly over the past two decades, with increased emphasis on early, extensive operations. Older published series may not accurately reflect more recent experience. Our study was designed to analyze outcome in a large series of consecutive patients treated recently at a single center.Methods. We reviewed 250 consecutive patients who underwent surgical treatment of craniosynostosis between January 1, 1987 and December 31, 1992. They were divided into nine groups by suture involvement: sagittal, unilateral coronal, bilateral coronal, unilateral lambdoid, bilateral lambdoid, metopic, multiple suture, the Klee-blattschädel deformity (cloverleaf skull), and acquired craniosynostosis. Outcome was analyzed in terms of residual deformities and irregularities, complications, mortality, as well as the need for additional surgery.Results. There were 157 males (62.8%) and 93 females (37.2%), with most of the male preponderance accounted for by the large sagittal synostosis group, which consisted of 82 males and 25 females. Median age at first operation was 147 days. A named syndrome was present in 23 patients (9.2%) and was more common than expected with bilateral and unilateral coronal synostosis, the Kleeblattschädel deformity, and multiple suture synostosis. There were two deaths (0.8%), both with Klee-blattschädel patients, and 17 other complications (6.8%). Morbidity and mortality were significantly associated with secondary vs primary operations and syndromic vs nonsyndromic patients. Outcome analysis revealed the best surgical results with metopic synostosis and significantly less good results with the Kleeblattschädel deformity, multiple suture synostosis, and bilateral coronal synostosis.Conclusions. Using modern surgical techniques, craniosynostosis can be corrected with good outcomes and relatively low morbidity and mortality, particularly for otherwise healthy, nonsyndromic infants.
Why Would You Remove Half a Brain? The Outcome of 58 Children After Hemispherectomy—The Johns Hopkins Experience: 1968 to 1996
Authors: Vining Eileen P. G. , Freeman John M. , Pillas Diana J. , Uematsu Sumio , Carson Benjamin S. , Brandt Jason , Boatman Dana , Pulsifer Margaret B. , Zuckerberg Aaron 
Published: August 2004

Purpose. To report the outcomes of the 58 hemispherectomies performed at Johns Hopkins between 1968 and January 1996.
Methods. Charts were reviewed of the 58 hemispherectomies performed at Johns Hopkins Medical Institutions by the Pediatric Epilepsy Group during the years 1968 to 1996. Twenty-seven operations were done for Rasmussen's syndrome, 24 operations for cortical dysplasias/hemimegalencephalies, and 7 for Sturge-Weber syndrome or other congenital vascular problems. Seizure control alone did not seem to adequately describe the outcomes of the procedure. Therefore, a score was constructed that included seizure frequency, motor disability, and intellectual handicap. This burden of illness score better described the child's handicap before and after surgery.
Results. Perioperative death occurred in 4 out of 58 children. Of the 54 surviving children, 54% (29/54) are seizure-free, 24% (13/54) have nonhandicapping seizures, and 23% (12/54) have residual seizures that interfere to some extent with function. Reduction in seizures was related to the etiology of the unilateral epilepsy. Eighty-nine percent of children with Rasmussen's, 67% of those with dysplasias, and 67% of the vascular group are seizure-free, or have occasional, nonhandicapping seizures. All operations were considered by the parents and the physicians to have been successful in decreasing the burden of illness. In 44 the procedure was very successful, in 7 it was moderately successful, and in 3 it was minimally successful. Success was related to the etiology, and early surgery was preferable.
Conclusion. Hemispherectomy can be a valuable procedure for relieving the burden of seizures, the burden of medication, and the general dysfunction in children with severe or progressive unilateral cortical disease. Early hemispherectomy, although increasing the hemiparesis in children with Rasmussen's syndrome, relieves the burden of constant seizures and allows the child to return to a more normal life. In children with dysplasias, early surgery can allow the resumption of more normal development.
End-of-Life Care in Cystic Fibrosis
Authors: Robinson Walter M. , Ravilly Sophie , Berde Charles , Wohl Mary Ellen 
Published: August 2004

Objective. End-of-life clinical care in cystic fibrosis (CF) differs substantially from terminal care in childhood cancer. To examine this difference, we reviewed the medical care of a cohort of CF patients treated at Children's Hospital, Boston, to document the use of preventive, therapeutic, and palliative care in the month preceding death.Patients. We reviewed the medical records of 44 patients older than 5 years who died of CF-related respiratory failure for the years 1984 to 1993.Results. Thirty-eight patients (86%) received opiates for the treatment of severe dyspnea and pain; the duration of opiate use varied from less than 1 hour to greater than 1 month. The dose of opiates varied from less than 5 mg per hour to greater than 30 mg per hour. Thirty-three patients (75%) continued to receive intravenous antibiotics in the last 12 hours of life; 32 (72%) continued to receive preventive or therapeutic oral medications in the last 12 hours of life. All patients were designated as do not resuscitate at the time of death; 43 of the patients died in the hospital with 1 patient dying at home under hospice care.Conclusions. The model of comfort care developed in childhood cancer does not adequately describe the combination of preventive, therapeutic, and palliative care given at the end of life for CF at our institution. The majority of CF patients continued to receive intravenous antibiotics and/or oral vitamin preparations while being treated with opiates for terminal pain and dyspnea. Small doses of opiates seem to be effective in the treatment of the pain and dyspnea at the end of life in CF.
Strategies to Increase Adherence With Tuberculosis Test Reading in a High-risk Population
Authors: Cheng Tina L. , Ottolini Mary C. , Baumhaft Kalanit , Brasseux Cynthia , Wolf Muriel D. , Scheidt Peter C. 
Published: August 2004

Objective. To determine the most effective strategy to encourage adherence with tuberculosis test reading in a high-risk population.Design. Prospective randomized controlled trial.Setting/Participants. Consecutive sample of 627 children ages 1 to 12 years due for a tuberculosis (TB) test in an urban children's hospital outpatient department. One child per family was enrolled.Intervention. All families received education regarding the importance of skin testing for TB and the need for follow-up, and written and verbal instructions regarding test reading. Families were randomly assigned to one of five strategies for follow-up TB test reading at 48 to 72 hours: 1) routine verbal and written instructions, 2) reminder phone call, 3) transportation tokens and toy on return, 4) withholding of school forms until time of reading and need to repeat TB test if not timely read, 5) parents taught to read induration with nurse home visit. Those who did not have tests read at 48 to 72 hours by a trained professional were phoned 1 week later.Results. The five groups did not differ with regard to TB risk factor score, maternal education, transportation source, or perceived importance of TB testing. Before the study the follow-up rate of TB test reading by a trained professional was 45%. Reading rates in this study were 58%, 70%, 67%, 70%, and 72% for groups 1 to 5, respectively. In group 4, only 39% had school forms to be completed and their adherence rate was 84% (53/63). Compared to group 1, the only statistically significant improvement was in group 4, especially for those who needed school forms completed, and in group 5. Those not adhering in groups 1 to 4 did not differ from returnees with regard to TB risk factors, maternal education, transportation, or perceived importance of testing. The most common reasons for failing to return included forgetfulness, transportation, and time constraints. Group 5 was stopped early because of difficulty with nurse visits (N = 98). When told of the nurse visit, 9% (9/98) families could not find a time for the visit. Seventeen percent (17/98) were visited but the child was not home, and 7% (7/98) were not visited because of a nurse scheduling problem.Conclusions. In a high-risk population, adherence with TB test reading is poor. However, education and return of school forms at reading time can significantly improve adherence. Although requiring larger investment in resources, visiting nurses may also aid in test reading.
Bedsharing Promotes Breastfeeding
Authors: McKenna James J. , Mosko Sarah S. , Richard Christopher A. 
Published: August 2004

Objective. Because breastfeeding is thought to be protective against sudden infant death syndrome (SIDS), environmental or child care factors that promote breastfeeding might reduce infant vulnerability to SIDS. The effect of mother-infant bedsharing on nocturnal breastfeeding behavior was studied in 20 routinely bedsharing and 15 routinely solitary sleeping Latino mother-infant pairs when the infants were 3 to 4 months old.
Methodology.  All pairs were healthy and exclusively breastfeeding at night. The videotape portion of all-night laboratory polysomnographic studies was used for the analyses. For each pair, an adaptation night was followed by one night each of bedsharing and solitary sleeping.
Results. The most important finding is that when tested in their usual sleeping conditions, routinely bedsharing infants breastfed approximately three times longer during the night than infants who routinely slept separately: this reflected a two-fold increase in the number of breastfeeding episodes and 39% longer episodes. Breastfeeding was also facilitated on the bedsharing night relative to the solitary night within the routinely bedsharing group: the number and total duration of breastfeeding episodes were significantly larger on the bedsharing night.
Conclusions. We suggest that, by increasing breastfeeding, bedsharing might be protective against SIDS, at least in some contexts. Furthermore, maternal reproductive physiology could be impacted because nursing frequency affects ovulation. This is the first study to directly measure nocturnal breastfeeding behavior in any cultural group.
Babywalker-related Injuries Continue Despite Warning Labels and Public Education
Authors: Smith Gary A. , Bowman Mary Jo , Luria Joseph W. , Shields Brenda J. 
Published: August 2004

Objective. To describe the epidemiology of babywalker-related injuries to children treated in a pediatric emergency department despite current prevention efforts, and to investigate the beliefs of parents regarding babywalker use.Design. A descriptive study of a consecutive series of patients.Setting. The emergency department of a large, academic children's hospital.Participants. Children treated for babywalker-related injuries during the 3-year period of March 1993 through February 1996.Results. There were 271 children treated for babywalker-related injuries. The mean age was 9.2 months, and 62% of patients were boys. Ninety-six percent of children were injured when they fell down stairs in their babywalker. The number of stairs that a child fell down was significantly associated with skull fracture and admission to the hospital, and a fall down more than 10 stairs had a relative risk (RR) of skull fracture = 3.28 (95% confidence interval, 1.35 &lt; RR &lt; 7.98). There were 159 children with contusions/abrasions (58.6%), 35 concussions/head injuries (12.9%), 33 lacerations (12.2%), 26 skull fractures (9.6%), 9 epistaxis (3.3%), 4 nonskull fractures (1.5%), 4 avulsed teeth (1.5%), and 1 burn (0.4%). Three of the skull fractures were depressed, and three also had accompanying intracranial hemorrhage. Ten patients (3.7%) were admitted to the hospital, and all had skull fractures resulting from falls down stairs. Supervision was present in 78% of cases, including supervision by an adult in 69% of cases. Forty-five percent of families kept the walker, and 32% used the walker again for the study patient or another child after the injury episode. Fifty-nine percent of parents acknowledged that they were aware of the potential dangers of babywalkers before the injury event. Fifty-six percent of parents favored a national ban on the sale of walkers, and 20% were opposed.Conclusion. Despite the currently used prevention strategies, including adult supervision, warning labels, care giver education programs, and stairway gates, serious injuries associated with babywalkers continue to occur to young children. The US Consumer Product Safety Commission should promulgate a rule, similar to the voluntary standard adopted in Canada, regarding design requirements for babywalkers that will prevent their passage through household doorways at the head of stairs. The manufacture and sale of mobile babywalkers that do not meet this new standard should be banned in the US. A recall or trade-in campaign should be conducted nationally to decrease the number of existing babywalkers.
Auxiliary Liver Transplant in Fulminant Failure
Authors: Rosenthal Philip , Roberts John P. , Ascher Nancy L. , Emond John C. 
Published: August 2004

Fulminant hepatic failure (FHF) is defined as a syndrome of acute liver failure with the development of hepatic encephalopathy and severe hypoprothrombinemia occurring within 2 months of the onset of symptoms or jaundice in a person without preexisting liver disease.1 Total orthotopic liver transplantation (OLTX) is a lifesaving therapeutic option for patients with FHF, but currently requires lifelong immunosuppression to maintain the graft.2 Auxiliary partial orthotopic liver transplantation (A-OLTX) is a procedure whereby only a portion of the native liver is removed, and the remainder of the native liver is left in situ.3 A-OLTX provides temporary support until the native liver recovers and immunosuppression can be withdrawn.
We describe the successful application of emergency A-OLTX in a young girl who accidentally ingested Amanita phalloidesmushrooms and developed FHF.
Escalator-related Injuries in Children
Authors: Platt Shari L. , Fine Jeffrey S. , Foltin George L. 
Published: August 2004

Objective. Escalator-related trauma is uncommon but can cause significant injury. This study reviewed escalator-related injuries in children to determine risk factors, types of injuries, medical interventions, and long-term outcomes.
Design and Setting. Retrospective clinical patient series, Municipal Hospital Pediatric Emergency Service.
Participants. All children less than 18 years of age who presented to the Pediatric Emergency Service with an escalator-related injury from August 1990 through February 1995.
Methods. We reviewed the chart and interviewed the parent of each child by telephone. We collected the following information: age, gender, child's supervision and activity while on the escalator, escalator location, direction of motion, presence of escalator defects, nature and extent of injury, medical interventions, and outcome.
Results. Twenty-six children had escalator-related injuries. The average age was 6 years (range, 2–16). Thirteen children (50%) were 2 to 4 years old. There were 15 (57%) boys. Eighteen children (69%) were accompanied by an adult. All children 7 years and younger were accompanied by an adult; however, 50% were not holding the hand of their guardian. Eight children (31%) were injured while riding improperly, ie, walking, running, playing, or sitting on the escalator, and among these, all who were standing fell down before the injury. Six (23%) children were injured while stepping off the escalator. Of 9 children less than 4 years old, 7 (78%) were riding the escalator properly. Of 9 children 4 years or older, only 3 (33%) were riding properly. Circumstances of injury included falling down with subsequent blunt trauma, falling down with subsequent entrapment of an extremity, and entrapment of an extremity not related to falling down. Locations of entrapment were between two steps, between a step and the side-rail, and between the last step and the comb plate. Twenty-one (81%) injuries occurred in rail or subway stations. Eight escalators were reported to have functional or structural problems.
Seventeen (65%) children sustained lower extremity injuries and 8 (31%) sustained upper extremity injuries. Injuries included lacerations, avulsions and degloving injuries of the extremities, tendon and nerve lacerations, and digit fractures and amputations. Thirteen (50%) children were admitted to the hospital for operative management; the average length of hospitalization was 13 days (range 1–29). Four children (15%) suffered significant functional loss, and 12 (46%) sustained permanent cosmetic deformities.
Conclusion. Children are at risk for sustaining severe injuries on escalators. Young age, inadequate adult supervision, improper activity while riding on the escalator, and escalator-related mechanical problems all increase the risk of injury. Public and parent education directed toward escalator safety issues may help to reduce escalator-related injuries in children.
Beyond Dorsal Penile Nerve Block: A More Humane Circumcision
Authors: Stang Howard J. , Snellman Leonard W. , Condon Lawrence M. , Conroy Mary Margaret , Liebo Rhoda , Brodersen Laurie , Gunnar Megan R. 
Published: August 2004

Objective. To explore techniques that can be utilized in addition to the dorsal penile nerve block (DPNB) to further reduce the neonate's stress and pain from routine circumcision, and thus make the procedure more humane.Setting. Level 1 nursery at a community hospital.Subjects. Eighty healthy, term, newborn male infants scheduled for routine neonatal circumcision.Study Design. Prospective and randomized; double blind and placebo controlled for the study solutions.Methods. Four statistically similar groups of 20 were studied. The control group included infants circumcised using: a) a rigid plastic restraint board; b) standard DPNB; and c) a pacifier dipped in water to comfort the infant. Each study group differed from the controls in one variable including: 1) using a specially designed, physiologic circumcision restraint chair; 2) pH buffering of lidocaine hydrochloride used for DPNB; and 3) offering a pacifier dipped in a 24% sucrose solution during the DPNB and circumcision. Behavioral observations were recorded and compared for each group starting before the injection of lidocaine hydrochloride and continuing through the completion of the circumcision. Plasma for cortisol levels were collected 30 minutes after the circumcision.Results. Neonates circumcised on the new restraint chair showed a significant decrease in distress scores (&gt;50%) compared with the control group on the rigid molded-plastic restraint. The pacifier dipped in sucrose had a distress-reducing effect during both the post-DPNB injection and circumcision periods. The infants who were injected with the buffered lidocaine showed no differences in distress from the controls. The plasma cortisol levels were not significantly affected by any additional technique and were comparable to the levels previously reported.Conclusions. When neonatal circumcisions are performed routinely, they should be done as humanely as possible. This study demonstrates that, when used in conjunction with DPNB, a pacifier dipped in 24% sucrose and a more comfortable, padded, and physiologic restraint can be useful in decreasing distress and pain.