bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neurologic Disorders After Measles-Mumps-Rubella Vaccination
Authors: Mäkelä Annamari , Nuorti J. Pekka , Peltola Heikki 
Published: August 2004

Objective. The possibility of adverse neurologic events has fueled much concern about the safety of measles-mumps-rubella (MMR) vaccinations. The available evidence concerning several of the postulated complications is controversial. The aim of this study was to assess whether an association prevails between MMR vaccination and encephalitis, aseptic meningitis, and autism.Methods. A retrospective study based on linkage of individual MMR vaccination data with a hospital discharge register was conducted among 535 544 1- to 7-year-old children who were vaccinated between November 1982 and June 1986 in Finland. For encephalitis and aseptic meningitis, the numbers of events observed within a 3-month risk interval after vaccination were compared with the expected numbers estimated on the basis of occurrence of encephalitis and aseptic meningitis during the subsequent 3-month intervals. Changes in the overall number of hospitalizations for autism after vaccination throughout the study period were searched for. In addition, hospitalizations because of inflammatory bowel diseases were checked for the children with autism.Results. Of the 535 544 children who were vaccinated, 199 were hospitalized for encephalitis, 161 for aseptic meningitis, and 352 for autistic disorders. In 9 children with encephalitis and 10 with meningitis, the disease developed within 3 months of vaccination, revealing no increased occurrence within this designated risk period. We detected no clustering of hospitalizations for autism after vaccination. None of the autistic children made hospital visits for inflammatory bowel diseases.Conclusions. We did not identify any association between MMR vaccination and encephalitis, aseptic meningitis, or autism.
Unlicensed and Off-Label Drug Use in an Australian Neonatal Intensive Care Unit
Authors: O’Donnell Colm P. F. , Stone Robyn J. , Morley Colin J. 
Published: August 2004

Objectives. To determine the extent of unlicensed and off-label drugs prescribed in the level 3 neonatal intensive care unit (NICU) at the Royal Women’s Hospital, Melbourne, Australia.
Methods. A prospective cohort study was conducted of all infants who were admitted to the NICU during a 10-week period. Each drug prescribed was evaluated in relation to the licensed approved uses to determine whether the drug was administered in a licensed manner or was unlicensed or used in an off-label manner.
Results. There were a total of 101 admissions involving 97 infants. A total of 1442 prescriptions were administered; 42% were licensed, 11% were unlicensed, and 47% were off-label. Twenty-one percent were off-label for 2 or more reasons. Eighty percent of infants received either an unlicensed or an off-label prescription or both; this proportion rose to 93% of extremely low birth weight infants.
Conclusions. This is the largest study performed of unlicensed and off-label drug use in the NICU. This practice remains widespread despite clear recommendations to improve this undesirable situation. The attendant risks to infants and prescribers remain. It is time for legislation to be introduced to govern this area.
Reported Adverse Drug Events in Infants and Children Under 2 Years of Age
Authors: Moore Thomas J. , Weiss Sheila R. , Kaplan Sigal , Blaisdell Carol J. 
Published: August 2004

Objective. To characterize risks to infants and young children from drugs and biological products that were identified in spontaneous adverse event reports submitted to the US Food and Drug Administration.Methods. Of &gt;500 000 MedWatch adverse event reports received by the Food and Drug Administration from November 1997 through December 2000, we identified 7111 reports about infants and children younger than age 2. The reports were analyzed for health outcome (eg, death, hospitalization, congenital anomaly), principal suspect drug, and whether the route of drug exposure was direct administration or through the mother in the perinatal period.Results. Drug therapy was associated with an average of 243 reported deaths annually over the 38-month study period, with 100 (41%) occurring during the first month of life and 204 (84%) during the first year. In 1432 (24%) reported adverse event cases of all levels of severity, exposure to the drug was from the mother during pregnancy, delivery, or lactation. Although 1902 different drugs, biological products, and other chemicals were identified in the reports, only 17 drugs or biological products were a suspect in 54% of all serious and fatal adverse events in drugs administered directly.Conclusion. Adverse reactions to drug therapy are a significant cause of death and injury in infants and children under 2 years of age. Drugs administered to the mother in the perinatal period constituted a major route of exposure to adverse drug advents. These results underscore the need for additional drug testing in the youngest pediatric patients and for carefully weighing the risks versus benefits of medication.
Obesity Development During Adolescence in a Biracial Cohort: The NHLBI Growth and Health Study
Authors: Kimm Sue Y. S. , Barton Bruce A. , Obarzanek Eva , McMahon Robert P. , Kronsberg Shari S. , Waclawiw Myron A. , Morrison John A. , Schreiber George B. , Sabry Zak I. , Daniels Stephen R. 
Published: August 2004

Objective. The National Heart, Lung, and Blood Institute Growth and Health Study (NGHS) is a 10-year study to investigate the development of obesity in black and white girls during adolescence and its environmental and psychosocial correlates. The purpose of this report was to examine changes in the annual prevalence rates of overweight and obesity in the NGHS cohort from ages 9 to 19 years.
Participants and Setting. A total of 2379 black and white girls, aged 9 to 10 years, were recruited from schools in Richmond, California, and Cincinnati, Ohio, and from families enrolled in a health maintenance organization in the Washington, DC area. Participant eligibility was limited to girls and their parents who declared themselves as being either black or white and who lived in racially concordant households.
Design and Statistical Analysis. The NGHS is a multicenter prospective study of a biracial cohort followed annually from ages 9 to 10 years through 18 to 19 years. The prevalence of overweight and obesity was based on age-specific ≥85th and ≥95th percentile values, respectively, for body mass index based on the 1960–1965 National Health Examination Survey reference population.
Main Outcome Measures. The main outcome measures were body mass index (weight in kilograms divided by height in meters, squared) and proportions of girls who were “overweight” and “obese” by age and race.
Results. The prevalence of overweight was 37% higher in blacks as compared with whites (30.6% vs 22.4%) even by age 9. The rate of overweight almost doubled in both groups during the 10-year period. By age 19, the rate of overweight was 56.9% in black and 41.3%, in white girls. The prevalence of obesity was 17.7% in black and 7.7% in white girls at 9 years old, and the rates also doubled during the study period.
Conclusions. The doubling in the prevalence of overweight and obesity during adolescence in black and white NGHS girls was surprising. By age 19, more than half of black girls were overweight and more than one third were obese. Almost half of white girls were overweight and almost 1 of 5 girls were obese. These findings should sound an alarm for all primary care physicians and public health professionals to take heed of what is happening to our youth.
Omalizumab Improves Asthma-Related Quality of Life in Children With Allergic Asthma
Authors: Lemanske Robert F. , Nayak Anjuli , McAlary Margaret , Everhard Francois , Fowler-Taylor Angel , Gupta Niroo 
Published: August 2004

Background and Objective. Omalizumab is a recombinant, humanized, monoclonal anti-immunoglobulin E (IgE) antibody, developed for the treatment of IgE-mediated diseases. In children with allergic asthma, it was shown to reduce the requirement for inhaled corticosteroids while protecting against disease exacerbation. Here we report the effects of treatment with omalizumab on asthma-related quality of life (AQoL) in children with allergic asthma.
Methods. This evaluation was part of a previously reported 28-week, randomized, double-blind, placebo-controlled study to assess the efficacy, safety, and tolerability of omalizumab (at least 0.016 mg/kg/IgE [IU/mL] per 4 weeks) in children with allergic asthma who were well controlled on daily treatment with inhaled corticosteroids. Dosage of beclomethasone dipropionate was kept constant for 16 weeks (steroid-stable phase), then reduced over 8 weeks to the minimum effective dose (steroid-reduction phase). This dose was then maintained for the final 4 weeks. The Pediatric Asthma Quality of Life Questionnaire (PAQLQ) was administered at baseline, week 16, and week 28.
Results. Baseline demographics, PAQLQ scores, and other data were comparable for the 2 treatment groups. At the end of the steroid-reduction phase, patients in the omalizumab-treated group reported significant improvements in the “activities” and “symptoms” domain scores as well as overall AQoL compared with placebo. More patients in the omalizumab group achieved clinically relevant (≥0.5) changes in PAQLQ scores during the course of the study, and this difference was significant for activities and overall AQoL.
Conclusion. Omalizumab improves AQoL in children with allergic asthma.
Marked Dyslipidemia in Human Immunodeficiency Virus-Infected Children on Protease Inhibitor-Containing Antiretroviral Therapy
Authors: Lainka Elke , Oezbek Selda , Falck Manfred , Ndagijimana Jennifer , Niehues Tim 
Published: August 2004

Objective. To assess the effects of antiretroviral combination therapy that contains protease inhibitor (PI) on carbohydrate and lipid metabolism in human immunodeficiency virus (HIV)-infected children.
Methods. A cross-sectional, descriptive clinical study was conducted in an outpatient clinic. Thirty-seven HIV-infected children who ranged from 1 to 17 years of age received nucleoside reverse transcriptase inhibitor treatment together with PI (PI group, n = 25) or without PI (non-PI group, n = 12). Age, gender, weight, length, CD4 cell count, and viral load did not differ between groups. Nonfasting total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein (LDL) cholesterol, glucose, lactate, and blood gases were determined. In addition, c-peptide, insulin, hemoglobin A1c, free fatty acids, lipoprotein a, and apolipoproteins A1 and B were evaluated after fasting. PI and non-PI group values were compared with normal values taken from healthy children.
Results. In nonfasting and fasting conditions, children of the PI group had higher total cholesterol (fasting PI group: 235 ± 71 mg/dL; non-PI group: 176 ± 25 mg/dL, mean ± standard deviation), triglycerides (156 ± 89 vs 87 ± 31 mg/dL), and LDL cholesterol levels (159 ± 58 vs 113 ± 23 mg/dL) compared with the non-PI group. High-density lipoprotein cholesterol and apolipoprotein A1 levels did not differ in both groups; there was a trend toward higher apolipoprotein B levels in the PI group. After fasting, 8 (47%) of 17 patients in the PI group presented with hypercholesterolemia as a result of an increase of LDL cholesterol and 11 (65%) had hypertriglyceridemia. It is interesting that the non-PI group showed no pathologic deviations. Compared with normal values, lipoprotein a and free fatty acids were increased in the PI and non-PI groups. Glucose, lactate, blood gases, c-peptide, insulin, and hemoglobin A1c were normal in both groups.
Conclusion. PI-containing antiretroviral treatment of HIV-infected children was associated with hypercholesterolemia, hypertriglyceridemia, and an increase of LDL cholesterol. The long-term complications of dyslipidemia are of major concern in the growing HIV-infected child.
Effect of an Educational Intervention About Breastfeeding on the Knowledge, Confidence, and Behaviors of Pediatric Resident Physicians
Authors: Hillenbrand Karin M. , Larsen Pamela G. 
Published: August 2004

Objective. Breastfeeding is the preferred nutrition for infants, but many pediatricians report inadequate training to advise mothers who breastfeed. This study was designed to examine the effect of an educational intervention on pediatric residents’ knowledge about breastfeeding, their confidence in addressing lactation issues, and their management skills during clinical encounters with breastfeeding mothers.
Design. An interactive multimedia curricular intervention was designed for pediatric residents to increase their knowledge about common lactation issues. The residents completed questionnaires before and after the intervention to measure knowledge and confidence. Resident behaviors in the clinical setting were measured before and after the intervention using telephone surveys of breastfeeding mothers after a clinic visit with a pediatric resident.
Results. Forty-nine pediatric residents participated in the study. Mean knowledge scores increased from 69% before the intervention to 80% after the intervention. Significant increases in knowledge included advising mothers about low milk supply, mastitis, abscess, or using medication, and in recognizing the benefit of the decreased risk of maternal cancer. Management skills with breastfeeding mothers and infants in the clinical setting improved significantly. Before the intervention residents performed an acceptable number of behaviors 22% of the time, while after the intervention their performance was acceptable 65% of the time. Particular behaviors that showed significant improvement after the intervention included discussing signs of breastfeeding adequacy with the mother and correct management of lactation problems.
Conclusions. These results indicate that not only breastfeeding knowledge and confidence, but most importantly clinical behaviors of pediatric residents can be enhanced through innovative educational opportunities. Appropriate counseling for breastfeeding mothers by pediatricians might contribute to an increase in the duration of breastfeeding.
Child Safety Seat Knowledge Among Parents Utilizing Emergency Services in a Level I Trauma Center in Southern California
Authors: Vaca Federico , Anderson Craig L. , Agran Phyllis , Winn Diane , Cheng George 
Published: August 2004

Objective. To determine the level of child safety seat (CSS) and airbag safety knowledge in parents who utilize emergency care services for their children and to determine factors that influence knowledge of safe transportation of children.
Methods. A prospective survey study was conducted in a 42 000-visit-per-year Level I trauma center and emergency department (ED) in Southern California from May through October 2000. Subjects were parents of ED-registered children (≤6 years). Research assistants administered the survey in the subject’s native language. Parent knowledge of age-appropriate restraint use and airbag safety was collected.
Results. Six hundred fifty-five subjects were enrolled. Most parents (97%) reported a regular source of pediatric medical care, and 57% had a previous ED visit. Eighty-six percent reported owning a CSS or booster seat. Eighty-one percent were aware that infants in rear-facing CSSs should never be placed in front of an airbag. Only 46% knew that a child weighing 40 to 60 lb should travel in a booster seat, and 59% knew that the State law required CSS use for children up to 4 years and weighing up to 40 lb. When knowledge scores were examined by ethnicity, fluency in English, income, and years of education, fluency was found to have the greatest influence on both CSS and airbag knowledge.
Conclusions. Although nearly all of our subjects admitted that their children had a regular source of care, many parents showed evidence of lack of knowledge of CSS and airbag safety. Furthermore, many parents were not familiar with the state law regarding child restraints. Our findings suggest that parents of small children who utilize emergency care services could benefit from child passenger safety education during their ED visit and that non-English media and materials may be important to reaching this population.
Incidence and Description of Stroller-Related Injuries to Children
Authors: Powell Elizabeth C. , Jovtis Edward , Tanz Robert R. 
Published: August 2004

Objective. To describe the incidence, circumstances, and types of stroller-related injuries among US children.
Design. Retrospective review of data for children 3 years old and younger from the National Electronic Injury Surveillance System of the United States Consumer Product Safety Commission for 1994–1998.
Results. There were an estimated 64 373 stroller-related injuries (95% confidence interval [CI]: 49 223–79 514) to children 3 years old and younger treated in hospital emergency departments in the United States during the 5-year study period. The median age at the time of the injury was 11 months; 51% were males. The annual rate of injury among children &lt;1 year old was 184.4 per 100 000. Seventy-six percent of injuries resulted from a fall from the stroller. A motor vehicle was involved in &lt;1% of cases. Most injuries involved the head (44%) or face (43%). Injury diagnoses included contusions or abrasions (38%), lacerations (24%), closed head injury (22%), and extremity fractures (3%). Two percent of injured children, an estimated 992 (95% CI: 428–1556), were admitted to the hospital during the study period, an annual admission rate of 1.3 per 100 000. Seventy percent of admissions were for head trauma.
Conclusions. Injuries related to strollers are common, particularly among children in the first year of life. They often result from falls from the stroller. The data suggest that restraint use would prevent many stroller-related injuries.
Ankyloglossia: Assessment, Incidence, and Effect of Frenuloplasty on the Breastfeeding Dyad
Authors: Ballard Jeanne L. , Auer Christine E. , Khoury Jane C. 
Published: August 2004

Objective. Ankyloglossia in breastfeeding infants can cause ineffective latch, inadequate milk transfer, and maternal nipple pain, resulting in untimely weaning. The question of whether the performance of a frenuloplasty benefits the breastfeeding dyad in such a situation remains controversial. We wished to 1) define significant ankyloglossia, 2) determine the incidence in breastfeeding infants, and 3) measure the effectiveness of the frenuloplasty procedure with respect to solving specific breastfeeding problems in mother-infant dyads who served as their own controls.
Methods. We examined 2763 breastfeeding inpatient infants and 273 outpatient infants with breastfeeding problems for possible ankyloglossia and assessed each infant with ankyloglossia, using the Hazelbaker Assessment Tool for Lingual Frenulum Function. We then observed each dyad while breastfeeding. When latch problems were seen, we asked the mother to describe the sensation and quality of the suck at the breast. When pain was described, we asked the mother to grade her pain on a scale of 1 to 10. When lingual function was impaired, we discussed the frenuloplasty procedure with the parent(s) and obtained informed consent. After the procedure, the infants were returned to their mothers for breastfeeding. Infant latch and maternal nipple pain were reassessed at this time.
Results. Ankyloglossia was diagnosed in 88 (3.2%) of the inpatients and in 35 (12.8%) of the outpatients. Mean Hazelbaker scores were similar for the presenting symptoms of poor latch and nipple pain. Median infant age (25th and 75th percentiles) at presentation was lower for poor latch than for nipple pain: 1.2 days (0.7, 2.0) versus 2.0 days (1.0, 12.0), respectively. All frenuloplasties were performed without incident. Latch improved in all cases, and maternal pain levels fell significantly after the procedure: 6.9 ± 2.31 down to 1.2 ± 1.52.
Conclusion. Ankyloglossia is a relatively common finding in the newborn population and represents a significant proportion of breastfeeding problems. Poor infant latch and maternal nipple pain are frequently associated with this finding. Careful assessment of the lingual function, followed by frenuloplasty when indicated, seems to be a successful approach to the facilitation of breastfeeding in the presence of significant ankyloglossia.
Annual Summary of Vital Statistics—2001
Authors: MacDorman Marian F. , Minino Arialdi M. , Strobino Donna M. , Guyer Bernard 
Published: August 2004

The number of births, the crude birth rate (14.5 in 2001), and the fertility rate (67.2 in 2001) all declined slightly (by 1% or less) from 2000 to 2001. Fertility rates were highest for Hispanic women (107.4), followed by Native American (70.7), Asian or Pacific Islander (69.4), black (69.3), and non-Hispanic white women (58.0). During the early to mid 1990s, fertility declined for non-Hispanic white, black, and American Indian women. Rates for these population groups have changed relatively little since 1995; however, fertility has increased for Asian or Pacific Islander and Hispanic women.
The birth rate for teen mothers continued to fall, dropping 5% from 2000 to 2001 to 45.9 births per 1000 females aged 15 to 19 years, another record low. The teen birth rate has fallen 26% since 1991; declines were more rapid (35%) for younger teens aged 15 to 17 years than for older teens aged 18 to 19 years (20%). The proportion of all births to unmarried women remained about the same at one-third. Smoking during pregnancy continued to decline; smoking rates were highest among teen mothers.
The use of timely prenatal care increased slightly to 83.4% in 2001. From 1990 to 2001, the use of timely prenatal care increased by 6% (to 88.5%) for non-Hispanic white women, by 23% (to 74.5%) for black women, and by 26% (to 75.7%) for Hispanic women. The number and rate of twin births continued to rise, but the triplet/+ birth rate declined for the second year in a row. For the first year in almost a decade, the preterm birth rate declined (to 11.6%); however, the low birth weight rate was unchanged at 7.6%. The total cesarean delivery rate jumped 7% from 2000 to 2001 to 24.4% of all births, the highest level reported since these data became available on birth certificates (1989). The primary cesarean rate rose 5%, whereas the rate of vaginal birth after a previous cesarean delivery tumbled 20%.
In 2001, the provisional infant mortality rate was 6.9 per 1000 live births, the same as in 2000. Racial differences in infant mortality remain a major public health concern, with the rate for infants of black mothers 2.5 times those for infants of non-Hispanic white or Hispanic mothers. In 2000, 66% of all infant deaths occurred among the 7.6% of infants born low birth weight. Among all states, Maine and Massachusetts had the lowest infant mortality rates. The United States continues to rank poorly in international comparisons of infant mortality.
The provisional death rate in 2001 was 8.7 deaths per 1000 population, the same as the 2000 final rate. In 2000, unintentional injuries and homicide remained the leading and second-leading causes of death for children 1 to 19 years of age, although the death rate for homicide decreased by 10% from 1999 to 2000. Among unintentional injuries to children, two-thirds were motor vehicle-related; among homicides, two-thirds were firearm-related.