bluuebunny/crossref_metadata_2025_split huggingface dataset:
Continuous Subcutaneous Glucose Monitoring in Children With Type 1 Diabetes
Authors: Chase H. Peter , Kim Laura M. , Owen Susie L. , MacKenzie Todd A. , Klingensmith Georgeanna J. , Murtfeldt Robert , Garg Satish K. 
Published: August 2004

Purpose.
To determine whether the use of continuous subcutaneous glucose monitoring will help in detecting unrecognized nocturnal hypoglycemia and in lowering hemoglobin A1c (HbA1c) levels (without increasing the risk for severe hypoglycemia) in children with type 1 diabetes.

Methods.
Eleven children with type 1 diabetes and HbA1c values consistently &gt;8.0% were randomized either to the Continuous Glucose Monitoring System (CGMS) group or to the control group. The CGMS group used 6 3-day sensors within a 30-day period. Both groups self-monitored their blood glucose levels a minimum of 4 times daily. HbA1c levels were measured at the start, at 1-month, and after 3 months of study.

Results.
The 5 children using the CGMS had 17 asymptomatic episodes (85%) of glucose levels below 60 mg/dL (3.25 mmol/L) and 3 symptomatic episodes (15%) during the night in the study month. The 6 control children had 4 symptomatic nocturnal low episodes during the month. After the 30-day period of wearing the CGMS, the 5 children had a significantly lower mean HbA1c value compared with their initial value (mean ± standard error of the mean [SEM] decrease = .36% ± .07%). The mean decrease for the controls was .2% ± .2%. After 3 months, 4 of the 5 children who used the CGMS continued to have lower HbA1c values in comparison to their initial values (mean ± SEM decrease = 1.04% ± .43%). Three of the 6 control participants also had lower HbA1c values at 3 months (mean ± SEM decrease for the group = .62% ± .44%). No severe hypoglycemic events occurred in either the CGMS or the control groups.

Conclusion.
In this pilot trial, continuous subcutaneous glucose monitoring was helpful in detecting asymptomatic nocturnal hypoglycemia as well as in lowering HbA1c values without increasing the risk for severe hypoglycemia in children with type 1 diabetes.
Routine Chest Radiographs in Pediatric Intensive Care Units
Authors: Quasney Michael W. , Goodman Denise M. , Billow Michael , Chiu Hsiaoting , Easterling Larry , Frankel Lorry , Habib David , Heitschmidt Mary , Kurachek Stephan , Moler Frank , Montgomery Vicki , Moss Michele , Murman Sheila , Rice Thomas , Richman Barbara , Tilden Samuel 
Published: August 2004

Objectives.To determine whether interventions were performed based on portable routine morning chest x-rays (CXRs) in pediatric intensive care unit (PICU) patients and to identify patient subgroups for whom the routine CXR is most useful.Design.Prospective multiinstitutional study.Setting.PICUs of 15 tertiary care hospitals.Patients.PICU patients who received a routine morning CXR were included in the study.Outcome Measures.Recorded data included: weight, diagnosis, presence of active cardiopulmonary problems, length of stay, and number and type of devices. The number and types of interventions based on the interpretation of the CXR were recorded.Results.Five hundred twelve routine CXRs were evaluated. The majority of the routine chest radiographs were obtained on patients who were admitted for cardiovascular disease (195/512; 38%) or respiratory failure (186/512; 36%), and 465/512 of the routine CXRs (91%) were performed on patients with one or more devices. Two hundred thirty-one of the 512 routine CXRs (45%) resulted in 1 or more interventions. One hundred fifty-five of the 284 routine CXRs (55%) obtained in children ≤10 kg resulted in one or more interventions, compared with 61/152 (40%) and 15/76 (20%) of routine CXRs obtained in children 10 to 40 kg and ≥40 kg, respectively. The frequency of interventions increased from 19% in children with no devices to &gt;50% in children with 2 or more devices. One or more interventions were performed in 27% of routine CXRs when no active cardiopulmonary problems were present, compared with 51% of routine CXRs when active cardiopulmonary problems were present. Diagnosis and length of intensive care unit stay at the time the routine CXR was obtained did not affect the percentage of CXRs that resulted in interventions.Conclusions.Routine CXRs are more likely to result in interventions in the smaller, critically ill child with one or more devices and if active cardiopulmonary problems are present.
Who's Teaching Neonatal Resuscitation to Housestaff?: Results of a National Survey
Authors: Halamek Louis P. , Kaegi David M. 
Published: August 2004

Objective.
This study was designed to investigate current patterns of training in neonatal resuscitation in US residency programs in general pediatrics.

Methods.
A questionnaire was mailed to the chief residents and directors of all US residency programs in general pediatrics to determine who provides supervision and teaching of neonatal resuscitation in the delivery room and neonatal intensive care unit. This questionnaire also inquired as to the use within these residency programs of standardized resuscitation training courses such as Pediatric Advanced Life Support and Neonatal Resuscitation Program.

Results.
Residents in their third and second years of training are most often cited as responsible for supervision and teaching of neonatal resuscitation in the delivery room, whereas attending neonatologists are cited most frequently as being responsible for these tasks in the neonatal intensive care unit. Pediatric Advanced Life Support is required by virtually all US residency programs, followed in frequency by Neonatal Resuscitation Program and Advanced Cardiac Life Support.

Conclusions.
Because those in training collectively provide much of the supervision and teaching of neonatal resuscitation, vigilance is required so that appropriate resuscitation skills are developed and maintained. Objective performance markers may be useful in assessing competency in caring for sick newborns. neonatal resuscitation, delivery room, Neonatal Resuscitation Program, Pediatric Advanced Life Support, Advanced Cardiac Life Support.
Prospective Study of Children With Cyanotic and Pallid Breath-Holding Spells
Authors: DiMario Francis J. 
Published: August 2004

Objective.
In this investigation, we sought to prospectively document the natural history of severe breath-holding spells (BHS) among children with both cyanotic and pallid BHS who were referred for neurologic consultation.

Design.
Prospective cohort study.

Methods.
A structured interview was undertaken at the time of initial consultation and at subsequent 1-year intervals regarding type of BHS, frequency of spells, associated phenomenon, sequelae, family history, and age at termination of spells.

Results.
A total of 95 children (48 boys, 47 girls) with BHS were identified and followed over a 9-year interval. There were no significant differences between genders. Median onset age was between 6 and 12 months old with 15% presenting younger than 6 months. A median frequency of spells was weekly with 30% experiencing 1 or more spells per day. The median age at peak frequency was between 12 and 18 months old with a range extending from 6 months to 4 years of age. Of the patients whose BHS had remitted for &gt;12 months' time (n = 67), the last spell occurred at a median age of 37 to 42 months. Of those children whose BHS were still occurring, the oldest age at time of latest spell was at 7 years old. Hypoxic convulsions were associated with BHS in ≤15% of all participants. A positive family history of BHS was identified in 34% of all families with equal frequency distributed between paternal and maternal sides.

Conclusions.
In this study, new data concerning the natural history of BHS have been determined. The information is important for family counseling and identifying intervention strategies, and serves as baseline data to evaluate the efficacy of future treatment approaches.
Postnatal Malnutrition and Growth Retardation: An Inevitable Consequence of Current Recommendations in Preterm Infants?
Authors: Embleton Nicolas E. , Pang Naomi , Cooke Richard J. 
Published: August 2004

Background.Nutrient intakes meeting recommended dietary intakes (RDIs) take time to establish and once established are rarely maintained throughout hospital stay in preterm infants. A nutrient deficit, therefore, accrues. RDI are based on needs for maintenance and growth, with no provision to replace this deficit. We, therefore, hypothesized that postnatal malnutrition and growth retardation were inevitable in infants fed current RDI.Methodology.Dietary intakes were prospectively collected, by a single observer (N.P.), on a daily basis in a group of preterm infants (n = 105; birth weight ≤1750 g; gestational age ≤34 weeks) admitted to neonatal intensive care unit over a 6-month period. Actual was subtracted from recommended energy (120 kcal/kg/day) and protein (3 g/kg/day) intakes and nutritional deficits calculated. Infants were weighed on admission and throughout hospital stay. The data were analyzed using a combination of repeated measures analysis of variance and stepwise regression analysis.Results.Nutrient intakes meeting current RDIs were rarely achieved during early life. By the end of the first week, cumulative energy and protein deficits were 406 ± 92 and 335 ± 86 kcal/kg and 14 ± 3 and 12 ± 4 g/kg in infants ≤30 and those at ≥31 weeks. By the end of the fifth week, cumulative energy and protein deficits were 813 ± 542 and 382 ± 263 kcal/kg and 23 ± 12 and 13 ± 15 g/kg and the zscores were −1.14 ± .6 and −.82 ± .5 for infants at ≤30 and ≥31 weeks. Stepwise regression analysis indicated that variation in dietary intake accounted for 45% of the variation in changes inz score.Conclusions.Preterm infants inevitably accumulate a significant nutrient deficit in the first few weeks of life that will not be replaced when current RDIs are fed. This deficit can be directly related to subsequent postnatal growth retardation. postnatal growth retardation, preterm infants.
Improving Adolescent Preventive Care in Community Health Centers
Authors: Klein Jonathan D. , Allan Marjorie J. , Elster Arthur B. , Stevens David , Cox Christopher , Hedberg Viking A. , Goodman Rita A. 
Published: August 2004

Objective.To evaluate implementation of the Guidelines for Adolescent Preventive Services (GAPS) in Community and Migrant Health Centers (CMHCs).Design.Before and after comparison of health center policy, clinician and adolescent self-report, and chart reviews in 5 CMHCs.Participants.Eighty-one preintervention and 80 one-year postintervention providers and 318 preintervention and 331 postintervention 14- to 19- year-old adolescent patients being seen for well visits at 5 CMHCs.Intervention.Health center staff were trained to implement GAPS and were provided resource materials, patient questionnaires, and clinician manuals.Main Outcome Measures.Delivery of and receipt of preventive services and perceived access to care.Results.CMHC systems changes were related to stronger leadership commitment to adolescent care. Providers reported high levels of preventive services delivery before and after guideline implementation. After guideline implementation, adolescents reported increases in having discussed prevention content with providers in 19 of 31 content areas, including increased discussion of physical or sexual abuse (10% before to 22% after), sexual orientation (13% to 27%), fighting (6% to 21%), peer relations (37% to 52%), suicide (7% to 22%), eating disorders (11% to 28%), weapons (5% to 22%), depression (16% to 34%), smokeless tobacco (10% to 29%), and immunizations (19% to 48%). Adolescents were also more likely to report knowing where to get reproductive or mental health services and were more likely to have received health education materials. Implementation also increased documentation of recommended screening and counseling in 51 of 79 specific content areas assessed in chart reviews.Conclusion.Implementing GAPS increased the receipt of preventive services at these health centers. Adolescents received more comprehensive screening and counseling, more health education materials, and had greater access to care after implementation. GAPS implementation may help improve the quality of care for adolescents.
Human Immunodeficiency Virus-Related Mortality in Infants and Children: Data From the Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV (P2C2) Study
Authors: Langston Claire , Cooper Ellen R. , Goldfarb Johanna , Easley Kirk A. , Husak Scott , Sunkle Susan , Starc Thomas J. , Colin Andrew A. ,   for the P2C2 HIV Study Group
Published: August 2004

Objectives.To identify the causes of mortality in children with vertically transmitted human immunodeficiency virus (HIV) infection and to study age-related mortality trends.Methods.In the multicenter P2C2HIV Study, 816 children born to HIV-infected mothers were followed for a median of 3.6 years. Two hundred five study participants with HIV infection were enrolled at a median age of 23 months; 611 were enrolled either prenatally or in the neonatal period before their HIV infection status was known. There were 121 deaths in study patients. The cause of death for all patients, its relationship to HIV infection, and pulmonary or cardiac involvement were determined. Age trends in disease-specific mortality were summarized for the HIV-related deaths.Results.Ninety-three children died of HIV-related conditions. Infection was the most prevalent cause of death for children under 6 years of age with 32.3% caused by pulmonary infection and another 16.9% caused by nonpulmonary infection. The frequency of pulmonary disease as the underlying cause of death decreased significantly with increasing age: 5/9 (55.6%) by age 1, 1/12 (8.3%) after age 10 years. The frequency of chronic cardiac disease as the underlying cause increased with age—0% by age 1 year, 3/12 (25.0%) after age 10 years, as did the frequency of wasting syndrome with disseminated Mycobacterium avium complex—0% by age 1 year, 6/12 (50.0%) after age 10 years.Conclusions.Children with HIV who survive longer are less likely to die of pulmonary disease or infection and more likely to die of cardiac causes or with wasting syndrome. pediatric acquired immunodeficiency syndrome, mortality, human immunodeficiency virus.
Continuous Subcutaneous Insulin Infusion Therapy for Children and Adolescents: An Option for Routine Diabetes Care
Authors: Maniatis Aristides K. , Klingensmith Georgeanna J. , Slover Robert H. , Mowry Cathy J. , Chase H. Peter 
Published: August 2004

Objective.The purpose of this study was to determine the feasibility of continuous subcutaneous insulin infusion (CSII) (insulin pump) therapy in routine pediatric diabetes care by comparing the HbA1c, body mass index (BMI), and hypoglycemic episodes before and after initiation of CSII therapy.Research Design and Methods.Data from 56 patients (7–23 years old) were collected during regularly scheduled visits at a frequency similar to non-CSII patients.Results.The data were analyzed for the entire cohort and 3 subgroups (decreased, stable, or increased HbA1c) stratified according to a ≥0.5% change in HbA1c. The total cohort demonstrated a decrease in HbA1c from 8.5% to 8.3%. The decreased cohort (39.4% of the total cohort) demonstrated a significant decrease in HbA1c from 8.6% to 7.6%. The mean HbA1c of the stable cohort (41.0%) was 8.7%. The increased cohort (19.6%) had an increase in HbA1c from 7.8% to 8.8%. Thirty-six patients (64.3%) maintained or achieved a HbA1c &lt;8.0% or achieved a HbA1c at least 1% lower than their pre-CSII level. Of concern, 6 patients (10.7%) demonstrated a clinically significant increase in HbA1c from 8.3% to 9.6%. For the entire cohort, the rate of severe hypoglycemia before and on CSII therapy was 12.3 and 9.5 events per 100 patient-years, respectively. A statistically significant proportion of patients reported a decrease in seizure frequency versus an increase (17.9% vs 1.8%) as well as a decrease in overall hypoglycemic frequency versus an increase (41.1% vs 17.9%). There was not a clinically significant increase in BMI, even in the decreased HbA1c cohort.Conclusions.CSII therapy is an appropriate option for some children in routine pediatric diabetes care. It can effectively decrease the HbA1c and reduce hypoglycemic episodes, without producing an abnormal increase in BMI.
Thrombus in the Left Ventricle of a Child With Systemic Emboli: An Unusual Presentation of Hereditary Protein C Deficiency
Authors: Matitiau Abraham , Tabachnik Elvan , Sthoeger Dalia , Birk Einat 
Published: August 2004

We present a case of left ventricular thrombus in a child with a normal functioning left ventricle. The diagnosis was made by 2-dimensional echocardiography after 2 episodes of systemic emboli.Hereditary protein C deficiency diagnosed in the patient provides the probable pathogenesis of the thrombus formation.Systemic emboli necessitates cardiac examination, and in cases of unusual thrombi, hereditary or acquired thrombophilic risk factors should be considered.
Abused Boys, Battered Mothers, and Male Involvement in Teen Pregnancy
Authors: Anda Robert F. , Felitti Vincent J. , Chapman Daniel P. , Croft Janet B. , Williamson David F. , Santelli John , Dietz Patricia M. , Marks James S. 
Published: August 2004

Background.The relationship between boyhood exposure to physical abuse, sexual abuse, or to a battered mother and subsequent risk of impregnating a teenage girl has not previously been examined.Methods.In a retrospective cohort study set in a primary care clinic for adult members of a large health maintenance organization, questionnaire responses from 4127 men were analyzed. Respondents provided the age of the youngest female whom they had impregnated, their own ages at the time, and information regarding childhood exposure to physical or sexual abuse and battered mothers. We calculated the prevalence and adjusted odds ratio (OR) for having impregnated a teenage girl according to these 3 adverse childhood experiences, regardless of the male's age at the time of impregnation. Using logistic regression, ORs were adjusted for the male's age at time of survey, race, and education.Results.Nineteen percent of the men reported that they had ever impregnated a teenage girl. During childhood, 32% of respondents had been physically abused, 15% sexually abused, and 11% had battered mothers. Compared with respondents reporting no abuse, frequent physical abuse or battering of mothers increased the risk of involvement in teen pregnancy by 70% (OR: 1.7; 95% confidence interval [CI]: 1.2–2.5) and 140% (OR: 2.4; 95% CI: 1.1–5.0), respectively. Sexual abuse as a boy at age 10 years or younger increased the risk of impregnating a teenage girl by 80% (OR: 1.8; 95% CI: 1.3–2.4); sexual abuse with violence increased the risk by 110% (OR: 2.1; 95% CI: 1.2–3.4). We found a dose–response relationship between the number of types of exposures and the risk of impregnating a teenage girl; men who reported all 3 types of exposures were more than twice as likely to have been involved than those with no exposures (OR: 2.2; 95% CI: 1.4–3.5).Conclusions.Boyhood exposure to physical or sexual abuse or to a battered mother is associated with an increased risk of involvement in a teen pregnancy—during both adolescence and adulthood. Because these exposures are common and interrelated, boys and adult men who have had these experiences should be identified via routine screening by pediatricians and other health care providers and counseled about sexual practices and contraception. Such efforts may prevent teen pregnancy and the intergenerational transmission of child abuse and domestic violence.
Hopkins Teen Central: Assessment of an Internet-Based Support System for Children With Cystic Fibrosis
Authors: Johnson Kevin B. , Ravert Russell D. , Everton Andrea 
Published: August 2004

Support groups are an important therapeutic intervention for patients with chronic debilitating illnesses. Patients who are difficult to assemble in one physical location may benefit from participating in an electronic support group (ESG). ESGs for adolescents have not been evaluated, although studies have shown a benefit to adult ESGs. Our goals were to create a web-based support service for adolescents with cystic fibrosis (CF) and to qualitatively and quantitatively measure the effects that such a support site could have on patients' relationships with the clinic faculty and staff, access to and interaction with peers with CF, and understanding of CF.
Methods. A highly interactive ESG was developed after discussions with a team of CF specialists and patients. Eighteen of 37 teenagers with CF agreed to use this site. Each patient was asked to assess his or her perceived availability of and comfort with the clinic staff and faculty, perceived support available through peers, knowledge about CF, and perceived usefulness of the Internet as a support tool.
Results. Participants logged into the site an average of 4 times each month. Teens who owned home computers accessed the site somewhat more frequently than did teens who were provided with home Internet access for the study. Most activity occurred in those sections of the site that described the participants and that allowed them to socialize. Over one half of the participants e-mailed each other at least once a week, with 77% e-mailing peers at least every other week. There was no significant difference in the participants' scores on a quiz about CF at the beginning and the end of the study; however, there was a significant decrease in perceptions about their knowledge about CF. At the conclusion of the study, participants believed that they had more friends who they could relate to than they did at the beginning of the study. Clinic staff noticed an increase in references to peers among the group who were using the site. In addition, 4 of the teens expressed a desire to get together to meet each other as a result of their interactions on the web site. There was no significant change in perceptions about the perceived availability and comfort with the clinic staff and faculty, support available through peers, knowledge about CF, and the usefulness of the Internet as a support environment. Managing the project was extremely easy, with virtually no technical or procedural issues arising during the study.
Conclusions. Teenagers with a chronic disease will actively participate in an ESG. The social and expressive aspects of their involvement with this support group hold much promise.