bluuebunny/crossref_metadata_2025_split huggingface dataset:
Attitudes, Practices, and Preferences of Pediatricians Regarding Initiation of Hepatitis B Immunization at Birth
Authors: Cooper Amanda , Yusuf Hussain , Rodewald Lance , Malik Tasneem , Pollard Robert , Pickering Larry 
Published: August 2004

Objectives. To explore practices and attitudes of pediatricians toward administration of the first dose of hepatitis B vaccine to infants, and to identify factors influencing the decision of pediatricians to initiate immunization at birth versus at 1 to 2 months of age.
Methods. A random sample of 600 pediatricians obtained from the American Academy of Pediatrics membership database was surveyed by mail.
Results. Three hundred eighty (68%) of the 563 pediatricians who were located responded to the survey. Of these 380 pediatricians, 279 provided routine immunizations to children. Of the 270 pediatricians who vaccinated children with hepatitis B vaccine and indicated their practice regarding the birth dose, 50% offered the first dose of hepatitis B vaccine at birth to all infants; the rest either offered the vaccine at birth only to infants of hepatitis B surface antigen-positive mothers and mothers whose serostatus is unknown, or did not offer the birth dose to any infants at all. Practicing in the inner city, working for a medical school or government hospital, and living in a state with universal immunization supply policies were associated with the respondent giving the birth dose. The strongest perceived barriers to giving the birth dose in the hospital were the difficulty tracking these vaccines (39%), the increased cost (27%), and the lack of reimbursement from insurance companies (26%). If a combination vaccine that includes hepatitis B; diphtheria, tetanus, pertussis (diphtheria and tetanus toxoids and acellular pertussis vaccine); and polio (inactivated poliovirus vaccine) antigens become available in the near future, then 38% of physicians who currently give the birth dose to all infants would prefer to wait until 2 months of age to initiate hepatitis B immunization.
Conclusions. Efforts to achieve high implementation of hepatitis B birth dose administration may falter once a hepatitis B-containing pentavalent combination vaccine becomes available. Programmatic efforts should ensure prevention of perinatal hepatitis B virus transmission through universal prenatal hepatitis B surface antigen screening and immunoprophylaxis of high-risk newborn infants.
Epidemiological, Clinical, and Microbiological Characteristics of Late-Onset Sepsis Among Very Low Birth Weight Infants in Israel: A National Survey
Authors: Makhoul Imad R. , Sujov Polo , Smolkin Tatiana , Lusky Ayala , Reichman Brian ,   in Collaboration With the Israel Neonatal Network
Published: August 2004

Objective. Nosocomial infections are a serious problem among very low birth weight (VLBW) infants. We studied the association between late-onset sepsis (LOS) and mortality and morbidity in VLBW infants.
Methods. From a national cohort of 5555 VLBW infants born in Israel during 1995 through 1998, 4829 survived at least 3 days and composed the study population. Maternal, perinatal, or postnatal variables that showed a significant association with LOS in a univariate analysis were tested in a bivariate analysis (adjusted for gestational age). Variables with P ≤ .1 were then tested by a multiple logistic regression for assessing the net effect of each variable on the risk for LOS.
Results. One or more episodes of bloodstream-proven LOS occurred in 1453 infants (30%). Gram-positive and Gram-negative bacteria accounted for 55.4% and 31.2% of microbes, respectively, mainly coagulase-negative Staphylococci and Klebsiella. Compared with those without LOS, infants with LOS had a significantly higher mortality rate (16.9% vs 8.6%). Mortality after Gram-negative LOS (26.2%) and Candida LOS (27.6%) was similar and significantly higher than with Gram-positive LOS (8.7%). Significant independent predictors of LOS were decreasing gestational age, cesarean section, mechanical ventilation, patent ductus arteriosus, necrotizing enterocolitis, and bronchopulmonary dysplasia.
Conclusions. LOS occurred in 30% of Israeli VLBW infants. Six strong independent predictors for LOS were identified. Recognition and awareness of the epidemiologic, clinical, and microbiologic characteristics of LOS remain the keystones for management of this nosocomial infection.
Growth, Systemic Safety, and Efficacy During 1 Year of Asthma Treatment With Different Beclomethasone Dipropionate Formulations: An Open-Label, Randomized Comparison of Extrafine and Conventional Aerosols in Children
Authors: Pedersen Søren , Warner John , Wahn Ulrich , Staab Doris , Le Bourgeois Muriel , Van Essen-Zandvliet Elisabeth , Arora Sujata , Szefler Stanley J. ,   on behalf of the Pediatric Study Group
Published: August 2004

Objective. To assess the long-term safety of hydrofluoroalkane 134a (HFA)-beclomethasone dipropionate (BDP) extrafine aerosol administered by the Autohaler compared with chlorofluorocarbon (CFC)-BDP administered by a press-and-breathe metered-dose inhaler (pMDI) and spacer (+S) in the treatment of children with asthma.
Methods. This 12-month, open-label, randomized, multicenter study enrolled 300 children who were aged 5 to 11 years and had well-controlled asthma on inhaled CFC-BDP or budesonide; 256 patients were using doses within the recommended range (200–400 μg) and were analyzed separately. Patients were randomized in a 1:3 ratio to continue on CFC-BDP+S at approximately the same dose as they were using before study entry or switch to HFA-BDP at half the daily dose.
Results. Asthma control was well maintained in the HFA-BDP group as evidenced by lung function tests and asthma symptoms compared with CFC-BDP+S at approximately twice the dose. There were no significant differences between the HFA-BDP 100 to 200 μg and CFC-BDP+S 200 to 400 μg treatment groups in mean change from baseline in height (5.23 cm vs 5.66 cm at month 12, respectively) or mean growth velocity from day 1 to month 12 (5.27 cm/y vs 5.71 cm/y, respectively). There were no significant differences between groups in adrenal function tests or markers of bone metabolism.
Conclusions. In this long-term study in children with asthma, extrafine HFA-BDP provided long-term maintenance of asthma control at approximately half the dose compared with CFC-BDP+S. There were no clinically meaningful differences between HFA-BDP extrafine aerosol and conventional CFC-BDP+S with regard to growth or other systemic effects.
Technical Report: Reduction of the Influenza Burden in Children
Authors: Rennels Margaret B. , Meissner H. Cody ,   Committee on Infectious Diseases
Published: August 2004

This Technical Report was retired January 2009.
Epidemiologic studies have shown that children of all ages with certain chronic conditions, such as asthma, and otherwise healthy children younger than 24 months (6 through 23 months) are hospitalized for influenza and its complications at high rates similar to those experienced by the elderly. Annual influenza immunization is already recommended for all children 6 months and older with high-risk conditions. By contrast, influenza immunization has not been recommended for healthy young children. To protect children against the complications of influenza, increased efforts are needed to identify and recall high-risk children. In addition, immunization of children between 6 through 23 months of age and their close contacts is now encouraged to the extent feasible. Children younger than 6 months may be protected by immunization of their household contacts and out-of-home caregivers. The ultimate goal is universal immunization of children 6 to 24 months of age. Issues that need to be addressed before institution of routine immunization of healthy young children include education of physicians and parents about the morbidity caused by influenza, adequate vaccine supply, and appropriate reimbursement of practitioners for influenza immunization. This report contains a summary of the influenza virus, protective immunity, disease burden in children, diagnosis, vaccines, and antiviral agents.
High Rates of Behavioral Problems in Perinatally HIV-Infected Children Are Not Linked to HIV Disease
Authors: Mellins Claude A. , Smith Renee , O’Driscoll Peter , Magder Lawrence S. , Brouwers Pim , Chase Cynthia , Blasini Ileana , Hittleman Joan , Llorente Antolin , Matzen Elaine ,   for the NIH NIAID/NICHD/NIDA-Sponsored Women and Infant Transmission Study Group
Published: August 2004

Objective. Descriptive studies and clinical reports have suggested that human immunodeficiency virus (HIV)-positive children are at risk for behavioral problems. Inadequate control groups and sample sizes have limited the ability of investigators to consider multiple influences that place HIV-positive children at risk for poor behavioral outcomes. We examined the unique and combined influences of HIV, prenatal drug exposure, and environmental factors on behavior in children who were perinatally exposed to HIV.Methods. Participants included 307 children who were born to HIV-positive mothers (96 HIV infected and 211 seroreverters) and enrolled in a natural history, longitudinal study of women to infant HIV transmission. Caregivers completed parent behavioral rating scales, beginning when the children were 3 years old. Data were also collected on prenatal drug exposure; child age, gender, and ethnicity; caregiver relationship to child; and birth complications.Results. Multivariate analyses comparing the HIV-infected children with perinatally exposed but uninfected children from similar backgrounds failed to find an association between either HIV status or prenatal drug exposure and poor behavioral outcomes. The strongest correlates of increased behavioral symptoms were demographic characteristics.Conclusions. This study suggests that although a high prevalence of behavioral problems does exist among HIV-infected children, neither HIV infection nor prenatal drug exposure is the underlying cause. Rather, other biological and environmental factors are likely contributors toward poor behavioral outcomes.
Association Between Peak Serum Bilirubin and Neurodevelopmental Outcomes in Extremely Low Birth Weight Infants
Authors: Oh William , Tyson Jon E. , Fanaroff Avroy A. , Vohr Betty R. , Perritt Rebecca , Stoll Barbara J. , Ehrenkranz Richard A. , Carlo Waldemar A. , Shankaran Seetha , Poole Kenneth , Wright Linda L. ,   for the National Institute of Child Health and Human Development Neonatal Research Network
Published: August 2004

Objective. To assess the association between peak total serum bilirubin (PSB) levels during the first 2 weeks of life and neurodevelopmental outcomes of extremely low birth weight (ELBW) infants at 18 to 22 months’ postmenstrual age.Methods. A retrospective analysis was conducted of a cohort of ELBW infants (401–1000 g) who survived to 14 days of age in the 12 participating centers of the National Institute of Child Health and Human Development Neonatal Research Network between January 1, 1994, and December 31, 1997. Demographic and clinical risk factors and PSB levels during the first 14 days were analyzed with reference to death or adverse neurodevelopmental outcomes at 18 to 22 months’ postmenstrual age. The neurodevelopmental variables considered were Psychomotor Developmental Index (PDI) &lt;70, Mental Developmental Index (MDI) &lt;70, moderate or severe cerebral palsy (CP), hearing impairment (needs hearing aids), and a composite category designated as neurodevelopmental impairment (NDI). The NDI is defined as infants with any 1 or more of the following: PDI &lt;70, MDI &lt;70, moderate to severe CP, bilateral blindness, or bilateral hearing impairment requiring amplification.Results. The subjects of this cohort analysis are infants who were admitted to the Network centers during calendar years 1994–1997 and survived beyond 14 days and had PSB recorded during the 14-day period. From this cohort, 3246 infants survived at discharge, 79 died after discharge, and 592 were lost to follow-up. Thus, 2575 of 3167 infants were seen in the follow-up clinics with a compliance rate of 81%. Logistic regression analysis showed that various demographic and clinical variables are associated with poor neurodevelopmental outcomes. After adjustment for these risk factor, significant association were found between PSB (mg/dL) and death or NDI (odds ratio: 1.068; 95% confidence interval [CI]: 1.03–1.11); PDI &lt;70 (R = 1.057; 95% CI: 1.00–1.12), and hearing impairment requiring hearing aids (odds ratio: 1138; 95% CI: 1.00–1.30). There was no significant association between PSB (mg/dL) and CP, MDI &lt;70, and NDI.Conclusions. PSB concentrations during the first 2 weeks of life are directly correlated with death or NDI, hearing impairment, and PDI &lt;70 in ELBW infants. The statistical association based on retrospective analysis of observational data and relatively small effect size should be interpreted with caution. Furthermore, because of the possibility of compounding effects of variables on outcome, the potential benefits of moderate hyperbilirubinemia and the potential adverse effects of phototherapy, a randomized, controlled trial of aggressive and conservative phototherapy is needed to address this controversial issue.
Parenteral Glutamine Supplementation Does Not Reduce the Risk of Mortality or Late-Onset Sepsis in Extremely Low Birth Weight Infants
Authors: Poindexter Brenda B. , Ehrenkranz Richard A. , Stoll Barbara J. , Wright Linda L. , Poole W. Kenneth , Oh William , Bauer Charles R. , Papile Lu-Ann , Tyson Jon E. , Carlo Waldemar A. , Laptook Abbot R. , Narendran Vivek , Stevenson David K. , Fanaroff Avroy A. , Korones Sheldon B. , Shankaran Seetha , Finer Neil N. , Lemons James A. ,   for the National Institute of Child Health and Human Development Neonatal Research Network
Published: August 2004

Background. Glutamine is one of the most abundant amino acids in both plasma and human milk, yet it is not included in standard intravenous amino acid solutions. Previous studies have suggested that parenteral nutrition (PN) supplemented with glutamine may reduce sepsis and mortality in critically ill adults. Whether glutamine supplementation would provide a similar benefit to extremely low birth weight (ELBW) infants is not known.
Methods. We performed a multicenter, randomized, double-masked, clinical trial to assess the safety and efficacy of early PN supplemented with glutamine in decreasing the risk of death or late-onset sepsis in ELBW infants. Infants 401 to 1000 g were randomized within 72 hours of birth to receive either TrophAmine (control) or an isonitrogenous study amino acid solution with 20% glutamine whenever they received PN up to 120 days of age, death, or discharge from the hospital. The primary outcome was death or late-onset sepsis.
Results. Of the 721 infants who were assigned to glutamine supplementation, 370 (51%) died or developed late-onset sepsis, as compared with 343 of the 712 infants (48%) assigned to control (relative risk: 1.07; 95% confidence interval: 0.97–1.17). Glutamine had no effect on tolerance of enteral feeds, necrotizing enterocolitis, or growth. No significant adverse events were observed with glutamine supplementation.
Conclusions. Parenteral glutamine supplementation as studied did not decrease mortality or the incidence of late-onset sepsis in ELBW infants. Consequently, although no harm was demonstrated, routine use of parenteral glutamine supplementation cannot be recommended in this population.
Telemedicine: Pediatric Applications
Authors: Spooner S. Andrew , Gotlieb Edward M. ,   the Steering Committee on Clinical Information Technology and Committee on Medical Liability
Published: August 2004

This Policy Statement was retired May 2012.
The newly developing field of telemedicine has the potential to benefit pediatric care by in creasing access to pediatric specialists and services. This report explores the current uses and limitations of telemedicine in pediatrics.
Are Chest Radiographs and Electrocardiograms Still Valuable in Evaluating New Pediatric Patients With Heart Murmurs or Chest Pain?
Authors: Swenson Jeanine M. , Fischer Donald R. , Miller Susan A. , Boyle Gerard J. , Ettedgui José A. , Beerman Lee B. 
Published: August 2004

Objectives. To determine the usefulness of electrocardiography (ECG) and chest radiography (CXR) in evaluation of patients referred to the pediatric cardiologist for the evaluation of heart murmur or chest pain.
Design. In this prospective study, 106 consecutive outpatients were categorized with no heart disease, possible heart disease, or definite heart disease based on history and physical examination; they then underwent ECG and CXR. Studies were reviewed and the examining cardiologist could change the diagnosis and order an echocardiogram.
Setting. Academic pediatric cardiology practice.
Results. In patients thought to have no heart disease, the diagnosis was changed to definite heart disease in four solely on the basis of abnormal CXR or ECG. In 25 patients thought to have possible heart disease, the diagnosis was changed to no heart disease (7) or definite heart disease (5) after review of the CXR and ECG. All 25 patients diagnosed with definite heart disease had this confirmed by abnormal CXR (2), ECG (3), both abnormal CXR and ECG, or echocardiogram (18).
Conclusions. ECG and CXR helped diagnose heart disease in four patients thought to have no heart disease, helped to rule out lesions in seven patients with possible heart disease, helped diagnose heart disease in five patients thought to have possible heart disease, and helped confirm heart disease in nine patients. In these days of cost containment, routine ECG and CXR continue to be valuable tools for the pediatric cardiologist in evaluation of patients with heart murmurs or chest pain.
Guidelines for the Pediatric Cancer Center and Role of Such Centers in Diagnosis and Treatment
Authors:   Section on Hematology/Oncology
Published: August 2004

This Policy Statement was revised. See https://doi.org/10.1542/peds.2014-1526.
The intent of this statement is to delineate those personnel and facilities that are essential to provide state-of-the-art care for children and adolescents with cancer. This statement emphasizes the importance of a board-eligible or board-certified pediatric hematologist-oncologist and pediatric subspecialty consultants overseeing the care of all pediatric and adolescent cancer patients, and the need for facilities available only at a tertiary center as essential for the initial management and much of the follow-up for pediatric and adolescent cancer patients. In 1986, the Section on Oncology/Hematology of the American Adacemy of Pediatrics outlined the “Guidelines for the Pediatric Cancer Center and Role of Such Centers in Diagnosis and Treatment.” Since that statement was published, significant changes in medical care reimbursement have prompted a review of the role of tertiary medical centers in the care of pediatric patients. The potential impact of these developments on the treatment of children with cancer led to a revision of the previous statement with the goal of delineating those elements that are necessary to ensure that current childhood cancer survival rates are not adversely impacted by requirements for care to be given at sites lacking essential personnel or equipment.
Evidence From Proton Magnetic Resonance Spectroscopy for a Metabolic Cascade of Neuronal Damage in Shaken Baby Syndrome
Authors: Haseler Luke J. , Arcinue Edgardo , Danielsen Else R. , Bluml Stefan , Ross Brian D. 
Published: August 2004

Objective. The purpose of this study was to use proton magnetic resonance spectroscopy (MRS) as a metabolic assay to describe biochemical changes during the evolution of neuronal injury in infants after shaken baby syndrome (SBS), that explain the disparity between apparent physical injury and the neurological deficit after SBS.
Methodology. Three infants [6 months (A), 5 weeks (B), 7 months (C)] with SBS were examined repeatedly using localized quantitative proton MRS. Examinations were performed on days 7 and 13 (A), on days 1, 3, 5, and 12 (B), and on days 7 and 19 (C) posttrauma. Long-term follow-up examinations were performed 5 months posttrauma (A) and 4.6 months posttrauma (B). Data were compared to control data from 52 neurologically normal infants presented in a previous study.
Results. Spectra from parietal white matter obtained at approximately the same time after injury (5 to 7 days) showed markedly different patterns of abnormality. Infant A shows near normal levels of the neuronal marker N-acetyl aspartate, creatine, and phosphocreatine, although infant C shows absent N-acetyl aspartate, almost absent creatine and phosphocreatine, and a great excess of lactate/lipid and lipid. Analysis of the time course in infant B appears to connect these variations as markers of the severity of head injury suffered in the abuse, indicating a progression of biochemical abnormality. The principal cerebral metabolites detected by MRS that remain normal up to 24 hours fall precipitately to ∼40% of normal within 5 to 12 days, with lactate/lipid and lipid levels more than doubling concentration between days 5 and 12.
Conclusions. A strong impression is gained of MRS as a prognostic marker because infant A recovered although infants B and C remained in a state consistent with compromised neurological capacity. Loss of integrity of the proton MR spectrum appears to signal irreversible neurological damage and occurs at a time when clinical and neurological status gives no indication of long-term outcome. These results suggest the value of sequential MRS in the management of SBS.
Percutaneous Transluminal Angioplasty for Renovascular Hypertension in Children: Initial and Long-term Results
Authors: Tyagi Sanjay , Kaul Upkar A. , Satsangi Deepak K. , Arora Ramesh 
Published: August 2004

Objective. To evaluate the efficacy and safety of percutaneous transluminal renal angioplasty (PTRA) in children.
Methods. We performed aortography and attempted PTRA in 35 consecutive children (age 5 to 14 years, mean 10.8 ± 2.5 years) with severe hypertension having ≥75% renal artery stenosis (RAS).
Results. The stenosis was caused by aortoarteritis in 31 (88.6%) cases and by juvenile idiopathic fibromuscular disease (FMD) in four (11.4%) cases. Twenty-seven (77.1%) patients, including three having RAS of solitary functioning kidney with total occlusion of contralateral renal artery, had bilateral RAS and eight (22.9%) had unilateral RAS. PTRA was technically successful in 54 (91.5%) of 59 stenotic lesions in 31 (88.6%) of 35 patients. Both aortoarteritis and FMD patients had significant decrease in RAS after PTRA. One patient had acute reocclusion of one renal artery after bilateral PTRA, which could be successfully opened by reangioplasty. Postangioplasty angiographic restudy performed in 18 patients at 4 to 72 months (mean 23.1 ± 27.9 months) after successful angioplasty showed restenosis in 8 (25.8%) of 31 lesions initially dilated and de novo lesions of aorta in two patients. All seven restenotic renal artery lesions attempted and both stenosis of aorta were successfully dilated. Twenty-nine of 31 patients with successful PTRA have been followed up from 4 to 108 months (mean 41.0 ± 29.3 months). Mean systolic blood pressure decreased from 185.1 ± 27.4 to 120.6 ± 19.2 mm Hg and mean diastolic blood pressure decreased from 118.4 ± 13.2 to 84.6 ± 10.4 mm Hg after PTRA. Twenty seven (93.1%) of these 29 patients had benefical blood pressure response. Seventeen (58.6%) patients improved, 10 (34.5%) were cured, although 2 (6.9%) patients failed to respond to PTRA. Blood pressure response was better in FMD as compared to aortoarteritis group. Patients with unilateral RAS, discrete stenosis, and post-PTRA stenosis ≤20% also identified good blood pressure response.
Conclusion. Aortoarteritis is the most common cause of renovascular hypertension in South Asian children. PTRA is safe and highly effective and therefore should be the treatment of choice in pediatric renovascular hypertension.