bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Critical Appraisal of the Role of Dietary Long-Chain Polyunsaturated Fatty Acids on Neural Indices of Term Infants: A Randomized, Controlled Trial
Authors: PhD Maria Makrides , Neumann Mark A. , Simmer Karen , Gibson Robert A. 
Published: August 2004

Objective.
To determine whether dietary long-chain polyunsaturated fatty acids (LCPUFA), such as docosahexaenoic acid (DHA) and arachidonic acid, affect visual evoked potential (VEP) acuity of formula-fed infants, relative to breastfed infants. A secondary objective was to assess the effect of LCPUFA on Bayley's mental developmental index (MDI) and psychomotor developmental index (PDI).

Methods.
Formula-fed infants were randomly allocated, in a double-blind manner, to either a placebo (no LCPUFA;n = 21), DHA supplemented (n = 23), or DHA+arachidonic acid supplemented formula (n = 24). Infants were fed their assigned formula from the first week of life until 1 year of age. A parallel reference group of breastfed infants was recruited and followed (n = 46). Infant VEP acuity was assessed at 16 and 34 weeks, and Bayley's MDI and PDI were assessed at 1 and 2 years of age.

Results.
There were no differences among the randomized formula groups for VEP acuity at either 16 or 34 weeks of age. Breastfed infants had better VEP acuity at 34 weeks of age, but not at 16 weeks, compared with all formula-fed infants. Bayley's MDI and PDI were similar in the 3 formula-fed groups at 1 and 2 years. Breastfed infants had higher MDI scores than formula-fed infants at 2 years of age even after adjusting for environmental variables.

Conclusions.
LCPUFA supplementation did not influence VEP acuity development in these well-nourished, formula-fed infants.
Effects of Prenatal Cocaine/Crack and Other Drug Exposure on Electroencephalographic Sleep Studies at Birth and One Year
Authors: Scher Mark S. , Richardson Gale A. , Day Nancy L. 
Published: August 2004

Objective.Little is known about the neurophysiologic effects of prenatal cocaine/crack use. The aim of this study, designed to overcome methodologic limitations of previous research, was to investigate the effects of prenatal cocaine use on electroencephalographic (EEG) sleep patterns, a marker of central nervous system development.Methods.In a longitudinal study of prenatal cocaine/crack exposure, women were interviewed at the end of each trimester about cocaine, crack, alcohol, tobacco, marijuana, and other drug use. Two-hour paper- and computer-generated EEG sleep recordings were obtained on a sample of the full-term infants on the second day of life and at 1 year postpartum. Eligible newborns were full-term, had received no general anesthesia, and had a 5-minute Apgar score &gt;5. All infants whose mothers used one or more lines of cocaine during their first trimester or any crack (n = 37) were selected. A comparison group was chosen randomly from the group of women who did not use cocaine or crack during their pregnancy (n = 34).Results.Women who used cocaine/crack during the first trimester were older, less educated, less likely to be working, and used more tobacco, alcohol, marijuana, and other illicit drugs than women who did not use cocaine/crack during the first trimester. There were no differences in infant birth weight, length, head circumference, or gestational age between the two exposure groups. After controlling for the significant covariates, prenatal cocaine exposure was associated with less well developed spectral correlations between homologous brain regions at birth, and with lower spectral EEG power values at 1 year of age. Prenatal alcohol, marijuana, and tobacco use were found to affect state regulation and cortical activities.Conclusions.These results indicate that the neurotoxic effects of prenatal cocaine/crack use can be detected with quantitative EEG measures.
Nutritional Status of Patients With Cystic Fibrosis With Meconium Ileus: A Comparison With Patients Without Meconium Ileus and Diagnosed Early Through Neonatal Screening
Authors: Lai Hui-Chuan , Kosorok Michael R. , Laxova Anita , Davis Lisa A. , FitzSimmon Stacey C. , Farrell Philip M. 
Published: August 2004

Objective.
This study was pursued as an extension of a randomized clinical investigation of neonatal screening for cystic fibrosis (CF). The objective was to determine if CF patients with meconium ileus (MI) were more likely to be malnourished compared with those without MI who were diagnosed during early infancy through neonatal screening.

Methodology.
Nutritional status was evaluated from early infancy to 13 years of age based on anthropometric, biochemical, and dietary assessments.

Results.
MI patients (n = 32) were smaller at birth (3117 g compared with 3413 g) and were shorter (22nd percentile compared with 48th percentile) and thinner (24th percentile compared with 49th percentile) compared with non-MI early diagnosed patients (n = 50) up to 13 years of age. Poor growth was particularly evident in 26 MI patients who required surgery for MI (height and weight at the 20th percentile), whereas those treated without surgery (n = 6) showed better height (45th percentile) and weight (37th percentile). Abnormal essential fatty acid profiles were significantly more prevalent in MI compared with non-MI early-diagnosed patients before 3 years of age. Daily intakes of calorie (130% compared with 111% recommended dietary allowances) and protein (339% compared with 279% recommended dietary allowances) were higher but the percentage of fat (37% compared with 38%) and linoleic acid (4.5% compared with 4.7%) in the diet were similar between the two groups.

Conclusions.
These results demonstrated a clear association of MI with malnutrition in CF. The observed poor growth among our MI patients was not because of poor dietary intakes, but was related to surgical treatment for MI and poor essential fatty acid status. These findings present new challenges regarding the optimal medical treatment and nutritional intervention for CF patients with MI.
A Randomized, Controlled Trial to Evaluate the Effects of the Newborn Individualized Developmental Care and Assessment Program in a Swedish Setting
Authors: Westrup Björn , Kleberg Agneta , von Eichwald Kristina , Stjernqvist Karin , Lagercrantz Hugo 
Published: August 2004

Background and Objective.Family-centered developmentally supportive care of very low birth weight infants, provided by the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) has been reported to have positive medical and economic impacts. Our aim was to investigate its effect on need of ventilatory assistance, growth, and hospitalization in a Swedish setting.Methods.Preterm infants born between September 1994 and April 1997 with a gestational age &lt;32 weeks and with a need of ventilatory assistance at 24 hours were randomly assigned to either NIDCAP (n = 12) or conventional care (n = 13). The 2 groups were comparable (median [range]) with respect to birth weight (1083 [630–1411] vs 840[636–1939 g]), head circumference (24.0 [22.3–26.5] vs 24.0 [21.1–30.0 cm]), gestational age (27.6 [24.0–28.7] vs 26.1 [23.9–30.3] weeks), female/male ratio (3/9 vs 9/8) and Clinical Risk Index for Babies (4.0 [0–11] vs 6.0 [2–15]). The infants in the intervention group were cared for in a separate room by a group of specially trained nurses. Formal weekly observations of these infants starting within 3 days after birth and continuing until 36 weeks postconception were used to develop individualized care plans. These plans provided recommendations as to how care might be attuned to the current developmental stage of the infant and how the family might be supported and stimulated to participate in this care. The treatment of the 2 groups was in all other respects identical.Results.The duration of mechanical ventilation (median [range] was 2.8 [0–36.7] days in the intervention group vs 4.8 [.1–29.8] days; not significant [NS]) among the controls and continuous positive airway pressure was applied for 26.1 (6.9–52.0) vs 43.9 (5.0–65.1) days. Supplementary oxygen was withdrawn at 33.0 (29.3–35.7) vs 38.1 (33.1–44.9) weeks of postconceptional age (PCA). The weight gain up to 35 weeks of PCA was 13.0 (6.7–21.0) vs 9.8 (6.8–16.6) g/day (NS). The head growth up to 35 weeks of PCA was .73 (.56–1.3) vs .63 (.56-.77) cm/week (NS). The age of the infant at discharge was 38.3 (36.1–57.7) vs 41.0 (36.9–48.4) weeks of PCA (NS).Conclusions.NIDCAP does not seem to have detrimental effects on Swedish very low birth weight infants in comparison with conventional care. Indeed, NIDCAP might even be advantageous.
Intrapartum Maternal Fever and Neonatal Outcome
Authors: Lieberman Ellice , Lang Janet , Richardson Douglas K. , Frigoletto Fredric D. , Heffner Linda J. , Cohen Amy 
Published: August 2004

Objective.
Much of fever during term labor may not be infectious but rather a consequence of the use of epidural analgesia. Therefore, we investigated the association of elevated maternal intrapartum temperature with neonatal outcome when the infant does not develop an infection.

Methods.
We studied 1218 nulliparous women with singleton, term pregnancies in a vertex presentation and spontaneous labor. Women were excluded if their temperature was &gt;99.5°F at admission for delivery, if they were diabetic or had an active genital herpes infection or if their infant developed a neonatal infection, had a congenital infection, or had a major malformation. Maximum intrapartum temperature was categorized as: ≤100.4°F (afebrile), 100.5°F to 101°F, and &gt;101°F.

Results.
During labor, 123 women (10.1%) developed a fever &gt;100.4°F; 62 (5.1%) women had a maximum temperature of 100.5°F to 101°F and 61 (5.0%) women had a maximum temperature &gt;101°F. Of febrile women, 97.6% had received epidural analgesia for pain relief. Infants of women developing a fever &gt;100.4°F were more likely to have a 1-minute Apgar score &lt;7 (22.8% for &gt;100.4°F vs 8.0% for afebrile) and to be hypotonic after delivery (4.8% for &gt;100.4°F vs .5% for afebrile). Compared with infants of afebrile women, infants whose mothers' maximum temperature was &gt;101°F were more likely to require bag and mask resuscitation (11.5% vs 3.0%) and to be given oxygen therapy in the nursery (8.2% vs 1.3%). We also found a higher rate of neonatal seizure with fever (3.3% vs .2%), but the number of infants with seizure was small (n = 4). All associations remained essentially the same after controlling for confounding in logistic regression analyses.

Conclusions.
Intrapartum maternal fever, particularly if &gt;101°F, was associated with a number of apparently transient adverse effects in the newborn. Larger studies are needed to investigate the association of intrapartum fever with neonatal seizures and to determine whether any lasting injury to the fetus may occur.
Postexposure Effectiveness of Varicella Vaccine
Authors: Watson Barbara , Seward Jane , Yang Alice , Witte Patricia , Lutz James , Chan Christopher , Orlin Sandra , Levenson Robert 
Published: August 2004

Objective.1) To describe the postexposure effectiveness of varicella vaccine in a homeless shelter; and 2) to demonstrate an effective public health intervention and its implications.Design.A prospective observational study.Setting.A women and children's shelter in Philadelphia with 2 cases of varicella before intervention.Outcome Measures.Varicella in vaccinated and unvaccinated shelter residents; vaccine effectiveness for prevention of varicella when administered after exposure among children &lt;13 years of age.Results.Sixty-seven shelter residents received varicella vaccine after exposure, including 42 children &lt;13 years of age. One child who was unvaccinated developed varicella, but no vaccinated child developed typical disease. Vaccine effectiveness was 95.2% (95% CI, 81.6%–98.8%) for prevention of any disease and 100% for prevention of moderate or severe disease among the children &lt;13 years of age.Conclusion.When used within 36 hours after exposure to varicella in a setting where close contact occurred, varicella vaccine was highly effective in preventing further disease. This study provides support for the recent recommendation by the Advisory Committee on Immunization Practices to administer varicella vaccine after exposure: this practice should minimize the number of moderate or severe cases of disease and prevent prolonged outbreaks.
Carbohydrate Absorption From Fruit Juices in Infants
Authors: Lifschitz Carlos H. 
Published: August 2004

Objective.To compare the absorption of carbohydrate in particular from a lower (10 mL/kg−1) quantity than that previously tested, of white grape juice and pear juice after a single feeding and after ingestion twice daily for 2 weeks, and determine their respective effects on stool water content, in healthy infants.Study Participants.Twelve healthy, well-nourished infants, 5 to 9 months of age, who were recruited from the general population.Design/Methods.Infants underwent a breath hydrogen test after a serving of pear juice. Three to 5 days later, the test was repeated after a serving of white grape juice. Infants were randomly assigned to receive a 10 mL/kg−1 serving of grape juice or pear juice twice daily for 2 weeks. The breath tests were repeated after the ingestion of the juices in the same sequence. With the second breath test with pear juice, a charcoal marker and 20 mg13C fructose, a stable, nonradioactive isotope, were mixed with the juice. Water content of the stools was compared before and after the 2-week feeding of the juice, and fecal samples were analyzed for 13C enrichment by mass spectrometry.Results.After the ingestion of the fruit juices, only 1 infant had an abnormal peak hydrogen (H2; ≥10 ppm), which followed the pear juice. That same infant was the only one who had H2 levels ≥10 ppm after grape juice. There was no significant difference in the peak breath H2 levels after grape juice and pear juice either at the beginning of the study or 2 weeks after taking the juice assigned (2.8 ppm ± 2.9 vs 6.2 ppm ± 9, respectively). The difference in breath H2response before and after the 2 weeks of fruit juice intake was not significant. Mean (±standard deviation) fecal 13C enrichment at baseline was 3.0 Δ%o (±2.4), which was not significantly different from after 2 weeks of juice intake (2.4 Δ%o [±1.5]), regardless of the juice assigned: 2.7 Δ%o (±1.6) for grape juice and 2.2 Δ%o (±1.5) for pear juice. Mean (±standard deviation) percentage of fecal water at baseline was 24.1% (±5.1), which was not significantly different from after 2 weeks of juice (22.5% [±6]), regardless of the juice received: 21.8% (±5.8) for grape juice and 23.2% (±6.7) for pear juice.Conclusion.When either grape or pear juice is administered in a dosage of 10 mL/kg/day, the carbohydrate is well absorbed, produces no adverse gastrointestinal symptoms, and has no effect on stool water in healthy infants.
Four Strategies for the Management of Esophageal Coins in Children
Authors: Soprano Joyce V. , Mandl Kenneth D. 
Published: August 2004

Objective.To compare clinical outcomes and costs under 4 strategies for the management of esophageal coins in children.Methods.We developed a decision analysis model of 4 possible strategies for managing esophageal coins: 1) endoscopic removal under general anesthesia; 2) esophageal bougienage, 3) an outpatient 12- to 24-hour observation period to allow spontaneous coin passage; and 4) an inpatient observation period. Probabilities of success and complication rates for endoscopy and esophageal bougienage were obtained from published data. The probability of spontaneous coin passage was derived from chart review data at our institution. Costs were calculated from charges using a cost-to-charge ratio of .72. Hypothetical patients included in the model were those with a single esophageal coin presenting within 24 hours of ingestion, with no respiratory compromise on presentation and with no previous history of esophageal disease. Strategy-specific outcomes were overall complication rate and total cost in dollars per patient. Sensitivity analyses were performed to account for variations in the data.Results.The esophageal bougienage strategy resulted in no complications and a total cost per patient of $382, which represents a marginal advantage of $2915 per patient compared with the endoscopic removal strategy. On sensitivity analysis over the range of success and complication rates of bougienage, this strategy maintained a considerable decrease in both overall complications and total cost per patient compared with all other strategies. Both outpatient and inpatient observation strategies had overall complication rates of 4.2% compared with the complication rate of 5.8% for the endoscopy strategy. The total cost per patient under these strategies was $2439 for the outpatient and $3141 for the inpatient strategy, representing a marginal advantage of $858 and $156 per patient, respectively, compared with the endoscopy strategy. Both observation strategies maintained a lower overall complication rate compared with endoscopy in the sensitivity analysis. The outpatient observation strategy maintained a marginal advantage of $645 to $1257 per patient compared with endoscopy; however, the inpatient observation strategy total cost per patient surpassed that of endoscopy at a spontaneous passage rate &lt;23%.Conclusions.Given the high success and low complication rates reported for esophageal bougienage, substantial savings in overall complications and costs would be expected with the use of this procedure. With spontaneous passage rates &gt;23%, either an outpatient or an inpatient observation strategy would reduce costs and complications, compared with endoscopic removal of all esophageal coins.
Biobehavioral Pain Responses in Former Extremely Low Birth Weight Infants at Four Months' Corrected Age
Authors: Oberlander Tim F. , Grunau Ruth Eckstein , Whitfield Michael F. , Fitzgerald Colleen , Pitfield Sandy , Saul J. Philip 
Published: August 2004

Objective.
To compare biobehavioral responses to acute pain at 4 months' corrected age between former extremely low birth weight (ELBW) infants and term-born controls.

Methodology.
Measures of facial behavioral and cardiac autonomic reactivity in 21 former ELBW infants (mean birth weight = 763 g) were compared with term-born infants (n = 24) during baseline, lance, and recovery periods of a finger-lance blood collection. Further, painful procedures experienced during neonatal care were quantified in both groups.

Results.
Overall, behavioral and cardiac autonomic responses to the lance were similar between groups. However, the ELBW group seemed to have a less intense parasympathetic withdrawal in the lance period and a more sustained sympathetic response during recovery than the control group. Further, in the recovery period, two behavioral patterns (early recovery and a late recovery) were apparent among the ELBW group.

Conclusions.
Biobehavioral pain responses were similar overall between both groups of infants. Subtle differences were observed in cardiac autonomic responses during the lance period and in behavioral recovery among ELBW infants. Whether these findings represent a long-term effect of early pain experience or a developmental lag in pain response remains unclear. The lack of an overall difference runs counter to previously reported findings of reduced behavioral response in former ELBW infants. biobehavioral pain response, premature infants, repetitive pain, heart rate variability.
Detection of Pathogen Transmission in Neonatal Nurseries Using DNA Markers as Surrogate Indicators
Authors: Oelberg David G. , Joyner Sarah E. , Jiang Xi , Laborde Danielle , Islam Monica P. , Pickering Larry K. 
Published: August 2004

Objective.
Nosocomial infections are a major problem confronting neonatal intensive care units (NICUs). This study was conducted to determine if DNA markers designed from the cauliflower mosaic virus (CaMV 35S DNA) can serve as surrogate indicators of nosocomial pathogen transmission in NICUs.

Methods.
Regions of cauliflower CaMV 35S promoter DNA were designed to serve as surrogate markers of microbial transmission pathways. Each of 6 pods within the NICU under study houses 8 newborn infants. DNA marker was placed on the telephone handle in only 1 of the 6 NICU pods (study pod). Bedside caregivers were blinded as to when placebo or marker were placed in the pod. Thirty-two samples were collected from predetermined sites within each pod at 0, 4, 8, 24, and 48 hours and 7 days after DNA placement. Similar sites were sampled in each of the 6 pods. Additional samples were collected concurrently from areas of the NICU segregated from direct patient care. Polymerase chain reactions were performed on collected samples, and products were analyzed by agarose gel electrophoresis.

Results.
One thousand three hundred samples of the environment and hands of personnel were collected and analyzed. Within the study pod, 58% of sites tested positive for the DNA marker throughout all time points; positive sites peaked at 8 hours (78%) and declined to 23% positive at 7 days. The other 5 pods had a mean of 18% of sites positive throughout the 7 days and exhibited a similar decline throughout time. The most consistently positive sites within all pods were the blood gas analyzers, computer mice, telephone handles, medical charts, ventilator knobs, door handles, radiant warmer control buttons, patient monitors, and personnel hands. In areas outside the pods, the nurse's station, resident physician charting area, changing room, and staff break room had a mean of 50% positive sites throughout all time points.

Conclusions.
DNA markers proved useful as safe, surrogate indicators of microorganism transmission within and outside pods in the NICU. We speculate that utilization of these techniques in the hospital environment will provide important information about transmission of pathogens in the NICU, assist in developing and enforcing cleaning procedures, and permit testing of educational intervention programs targeting a decrease in nosocomial infections. nosocomial infection, neonatal intensive care, DNA marker, polymerase chain reaction, infection control.
Links Between Early Adrenal Function and Respiratory Outcome in Preterm Infants: Airway Inflammation and Patent Ductus Arteriosus
Authors: Watterberg Kristi L. , Scott Susan M. , Backstrom Conra , Gifford Kathleen L. , Cook Kristen L. 
Published: August 2004

Objective.To investigate the relationship of cortisol concentrations during the first week of life to patent ductus arteriosus (PDA), markers of lung inflammation, and respiratory outcome in very low birth weight infants.Methods.Newborns &lt;1500 g birth weight were prospectively enrolled at 2 centers. Serum cortisol was measured 3 times during days 2 to 7 of life. Tracheal lavage was performed on intubated infants and analyzed for interleukin-1β, -6, and -8, and for total protein, albumin, and α-1 protease inhibitor. Infants receiving prenatal glucocorticoids were excluded.Results.We obtained 337 cortisol values from 125 infants. Infants treated for PDA had lower cortisol values after day 2. One hundred thirty-three tracheal fluid samples were obtained on matching days from 71 intubated infants. Cortisol correlated inversely with tracheal interleukins and proteins. Lower cortisol values during the second half of the week correlated with longer duration of supplemental oxygen therapy and with subsequent development of chronic lung disease at 28 days and at 36 weeks.Conclusion.Infants with lower cortisol values in the first week of life had an increased incidence of PDA, increased lung inflammation, and an increased incidence of chronic lung disease. These findings suggest that early adrenal insufficiency may underlie the previously observed association of increased lung inflammation and PDA with adverse respiratory outcome in this population.