bluuebunny/crossref_metadata_2025_split huggingface dataset:
CandidaSepsis and Association With Retinopathy of Prematurity
Authors: Mittal Madhur , Dhanireddy Ramasubbareddy , Higgins Rosemary D. 
Published: August 2004

Objective. To assess the association of Candida sepsis with retinopathy of prematurity (ROP) in extremely low birth weight infants.Methods. We prospectively identified 253 infants admitted to the Critical Care Nursery at Georgetown University Hospital with birth weights ≤1000 g born between January 1, 1994, and June 30, 1996. Of these 253 infants, 62 died and 55 were transferred to other institutions before ophthalmologic screening for ROP. Clinical data on 98% (133/136) infants were reviewed. Candida sepsis was defined as a positive blood culture for Candida species. Severity of ROP was staged by the International Classification for ROP. Data were analyzed using the χ2 test for nominal data, unpaired t test for continuous data, Mann-WhitneyU test for ordinal data, and logistic regression.Results. The mean birth weight (±SD) of the population studied was 777 g (±136 g), and the mean gestational age at birth was 26.0 weeks (±1.8 weeks). The overall incidence of ROP was 74%, and it correlated significantly with birth weight, gestational age, days on supplemental oxygen, and 5-minute Apgar scores. The incidence of ROP was significantly higher in the infants who hadCandida sepsis (21/22 [95%]) compared with those who did not (77/111 [69%]). Using logistic regression to control for the influence of birth weight, gestational age, days on supplemental oxygen, and 5-minute Apgar scores, Candida sepsis was an independent predictor of stage 3 or worse ROP. In addition, 9 (41%) of 22 infants with Candida sepsis required laser surgery compared with 10 (9%) of 111 infants without Candidasepsis. This difference was significant independent of birth weight, gestational age, days on supplemental oxygen, and 5-minute Apgar scores.Conclusions. Candida sepsis is independently associated with increased severity of ROP and the need for laser surgery in extremely low birth weight infants.
The Growth Pattern and Final Height of Girls With Turner Syndrome With and Without Human Growth Hormone Treatment
Authors: Dacou-Voutetakis Catherine , Karavanaki-Karanassiou Kiki , Petrou Vasilis , Georgopoulos Neoklis , Maniati-Christidi Maria , Mavrou Ariadni 
Published: August 2004

Background. Shortness is the most frequent and quite disturbing characteristic of girls with Turner syndrome (TS). Human growth hormone administration (hGH) to girls with TS increases growth velocity (GV), but a favorable effect on final height (FH) has not been documented. The aim of this study was to evaluate the effect of hGH administration on the growth pattern and FH in girls with TS.
Methods. The study group was comprised of 123 girls with TS who were cared for in our center. Eighty-two of these girls received hGH (mean dose, 0.78 ± 0.12 IU/kg/week), given subcutaneously 5 to 7 times per week for a period of 2.2 ± 1.2 years (hGH group). The mean chronological age (CA) and bone age (BA) at hGH initiation were 11.5 ± 2.5 years and 9.7 ± 2.3 years, respectively. The remaining 41 girls did not receive hGH and are designated as the untreated control group. In both groups, gonadal steroids were given for pubertal initiation and maintenance.
Results. The GV during the first year of hGH therapy (GV1) was higher than the year before hGH (6.3 cm/year vs 4.0 cm/year) and higher than the GV of the untreated group at a similar CA (4.4 cm/year). The GVs during the second (GV2) and third (GV3) year of hGH treatment (5.4 and 4.9 cm/year, respectively) were lower, but still higher in the hGH group, in comparison with the untreated group (GV2, 4.2 cm/year; GV3, 3.4 cm/year). GV1, GV2, and GV3 were negatively related to age and to BA at hGH initiation. The FH of the 35 hGH-treated girls was not significantly different from the FH of the 27 untreated girls (146.1 cm vs 144.0 cm). The Δ target height-FH was not significantly different in the two groups. The FH standard deviation score of the hGH-treated group was positively related to height standard deviation score for CA at treatment initiation (r = +0.73), maternal height (r = +0.57), target height (r = + 0.66), and birth weight (r = +0.54), but was unrelated to CA or BA at start of therapy or to hGH dose.
Conclusions. hGH therapy in girls with TS, in the dose and duration of treatment applied in this study, significantly accelerated GV but did not significantly improve FH.
Medical Necessity for the Hospitalization of the Abused and Neglected Child
Authors:   Committee on Hospital Care and Committee on Child Abuse and Neglect
Published: August 2004

This Policy Statement was retired October 2007.
The child suspected of being abused or neglected demands prompt evaluation in a protective environment where knowledgeable consultants are readily available. In communities without specialized centers for the care of abused children, the hospital inpatient unit becomes an appropriate setting for their initial management. Medical, psychosocial, and legal concerns may be assessed expeditiously while the child is housed in a safe haven awaiting final disposition by child protective services. The American Academy of Pediatrics recommends that hospitalization of abused and neglected children, when medically indicated or for their protection/diagnosis when there are no specialized facilities in the community for their care, should be viewed as medically necessary by both health professionals and third-party payors.
Cardiovascular Disease Insulin Risk in Mexican-American and Anglo-American Children and Mothers
Authors: Reaven Peter , Nader Philip R. , Berry Charles , Hoy Tricia 
Published: August 2004

Objective. To evaluate the relationship between insulin levels and cardiovascular risk factors in children and determine whether it varies among ethnic groups.
Methods. Cardiovascular risk factors and insulin levels were compared in 144 Mexican-American and Anglo-American mother-child pairs, when the children were 11 years of age.
Results. Although mean age did not differ between ethnicities, Mexican-American mothers and children both had a greater body mass index (mothers: 29.2 ± 6.2 vs 27.2 ± 7.9; children: 21.7 ± 4.7 vs 19.7 ± 4.6) and sum of skinfolds than did Anglo-Americans. Triglycerides, very low-density lipoprotein cholesterol, fasting insulin, and cholesterol/high-density lipoprotein ratio were higher, while high-density lipoprotein cholesterol was lower in both Mexican-American adults and children compared with Anglo-Americans. After adjusting for measures of obesity, only high-density lipoprotein cholesterol levels remained significantly lower in Mexican-Americans. For both adults and children, higher quartiles of insulin levels were associated with significantly higher triglycerides, blood pressure and lower high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol/apolipoprotein B levels (estimate of dense low-density lipoprotein size). A summary variable representing cardiovascular risk factors present in adult syndrome X patients was higher in both Mexican-American adults and children than in Anglo-Americans.
Conclusion. Mexican-American children and adults have higher levels of many cardiovascular risk factors, and this appears related to higher insulin levels and overweight. Appropriate nutrition, weight control, and exercise at early ages could be important in slowing the development of atherosclerosis.
Long-term Outcome After Neonatal Meconium Obstruction
Authors: Fuchs Julie R. , Langer Jacob C. 
Published: August 2004

Objective. It is unclear whether children with cystic fibrosis (CF) who present with neonatal meconium ileus have a different long-term outcome from those presenting later in childhood with pulmonary complications or failure to thrive. We examined a cohort of patients with meconium ileus, and compared their long-term outcome with children who had CF without meconium ileus and neonates who had meconium obstruction without CF (meconium plug syndrome).Study Design. Comparative study using retrospective and follow-up interview data.Patients. Group 1 consisted of 35 surviving CF patients who presented with meconium ileus between 1966 and 1992. Two control groups were also studied: 35 age- and sex-matched CF patients without meconium ileus (group 2), and 12 infants presenting with meconium plug syndrome during the same time period (group 3).Outcome Measures. Pulmonary, gastrointestinal, nutritional, and functional status were reviewed, and surgical complications were recorded.Results. Mean follow-up was 12.6 ± 6, 12.6 ± 6, and 9.3 ± 4 years in groups 1, 2, and 3, respectively. Patients without CF (group 3) demonstrated better growth and functional status, and had a lower incidence of pulmonary and gastrointestinal problems. Although the presence of meconium ileus among CF patients was associated with an earlier diagnosis, there were no significant differences between groups 1 and 2 with respect to hepatobiliary, nutritional, functional, or respiratory status. Meconium ileus was associated with a higher risk of meconium ileus equivalent (20% vs 6%), although this difference was not statistically significant. Long-term surgical complications (adhesive small bowel obstruction and blind loop syndrome) were seen in 27% of children with meconium ileus; there were no long-term surgical complications in groups 2 or 3, because these infants did not have any neonatal surgical procedures. Children presenting with complicated meconium ileus had a higher rate of long-term surgical complications than those with uncomplicated meconium ileus (36% vs 17%), and those managed with resection or enterostomy had more complications than those treated by enterotomy and lavage (33% vs 0%).Conclusions. Long-term outcome is similar in CF patients who present with meconium ileus and those who do not, except for a slightly higher incidence of meconium ileus equivalent, and a significantly higher rate of surgical complications. The risk of surgical complications is highest in those presenting with complicated meconium ileus and those undergoing resection or enterostomy. Patients with meconium obstruction who do not have CF have an excellent long-term prognosis. This information will be useful in counseling the families of infants presenting with neonatal meconium obstruction.
Accuracy of a Polymerase Chain Reaction-based Assay for Detection of Pneumococcal Bacteremia in Children
Authors: Isaacman Daniel J. , Zhang Yingze , Reynolds Ellen A. , Ehrlich Garth D. 
Published: August 2004

Objective. To evaluate the utility of a polymerase chain reaction (PCR)-based assay for identifying pneumococcal DNA in the blood of pediatric patients with suspected bacteremia.
Methods. Children evaluated at the Children's Hospital of Pittsburgh who were having blood drawn for culture had an additional 2 to 3 mL of blood (from the same sampling) obtained and placed in a sodium citrate tube for PCR processing (study group). The control group for this study consisted of children having blood drawn for biochemical analysis who were afebrile, well-appearing, and had no recent illnesses. Specimens were frozen at −70°C and then batch-processed for PCR-based analyses with the JM201/202–204 primer/probe set. Amplified products were detected after liquid hybridization format wherein a 32P end-labeled probe was annealed to the amplified DNA and visualized by autoradiographic analysis after gel retardation.
Results. Four hundred eighty study group patients and 103 controls had specimens tested by both PCR and blood culture. Twenty-six (5%) patients had a positive blood culture for a pathogenic organism (21 of which were Streptococcus pneumoniae). Twelve (57%) of the 21 patients with blood cultures positive for S pneumoniae also were positive by PCR. In addition, 206 study group patients and 16 controls with negative blood cultures had positive PCR results. A greater proportion of study group patients were PCR-positive/culture-negative than were controls (206/459 vs 16/103).
Conclusion. Although this assay currently lacks adequate sensitivity and specificity for clinical use, the high frequency of PCR-positive cases in patients with suspected bacteremia may indicate a greater role for S pneumoniae than had previously been appreciated. Further refinement of this assay as well as the development of a rapid PCR-based assay appears warranted.
Intervention to Improve Physician Documentation and Knowledge of Child Sexual Abuse: A Randomized, Controlled Trial
Authors: Socolar Rebecca R. S. , Raines Byron , Chen-Mok Mario , Runyan Desmond K. , Green Cynthia , Paterno Steven 
Published: August 2004

Objective. To determine if written feedback improves the chart documentation and knowledge of physicians doing evaluations for child sexual abuse and to learn what other factors are associated with better documentation and knowledge.Design. Randomized, controlled trial.Setting. A statewide network of physicians performing child abuse evaluations.Participants. All physicians who performed evaluations for sexual abuse during 1991 to 1992. One hundred forty-seven physicians were randomized to control (n = 75) and intervention (n = 72) groups, 122 (83%) remained at follow-up, and 87 of the 122 (71%) had done evaluations for child sexual abuse.Interventions. Tailored written feedback based on chart reviews and relevant articles were sent to a randomly selected one-half of the physicians during a 3-month period.Main Outcome Measures. The quality of documentation and physician knowledge before and after the intervention.Results. Documentation by chart review of up to five randomly chosen records per physician (preintervention, n = 552; postintervention, n = 259) by reviewers blinded to intervention status and physician knowledge was assessed by survey (78% completion). Change in documentation and knowledge for physicians in the intervention group was not statistically significant compared with the control group. The risk ratio for a mean overall history rating of excellent/good was 0.89 (0.63, 1.25) and for a mean overall physical examination rating of excellent/good was 1.03 (0.73, 1.45). Both groups improved significantly during the time period. The largest improvements in the time period were in documenting the history of where abuse occurred, in the physical examination position, hymenal description, penile findings, and knowing that chlamydia infection should be assessed by culture. A structured medical record, female physicians, and credits in continuing medical education were associated with better documentation.Conclusions. Tailored feedback to the physician with directed educational materials did not seem to improve most aspects of documentation and knowledge of child sexual abuse, although notable improvement was seen during the time period studied. This study suggests that chart audits may not be the best use of resources for trying to improve physician behavior; credits in continuing medical education and use of structured records may be more likely to be beneficial.
Increasing Breastfeeding Rates to Reduce Infant Illness at the Community Level
Authors: Wright Anne L. , Bauer Mark , Naylor Audrey , Sutcliffe Emily , Clark Larry 
Published: August 2004

Objective. Although breastfeeding is associated with lower rates of a variety of infant illnesses, skeptics have suggested that much of the association is attributable to confounding, even after appropriate statistical adjustment. This article utilizes a novel design to investigate changes in infant illness at the community level after a successful breastfeeding promotion program.Methods. In this population-based cohort study, the medical records of all infants born in one Navajo community the year before a breastfeeding promotion program (n = 977) and the year during the intervention (n = 858) were reviewed. Outcomes assessed include changes after the intervention in: proportion breastfeeding and/or breastfeeding exclusively; incidence of common infant illnesses in the first year of life; and feeding-group specific incidence of illness.Results. The proportion of women breastfeeding exclusively for any period of time increased from 16.4% to 54.6% after the intervention. The percent of children having pneumonia and gastroenteritis declined 32.2% and 14.6%, respectively, after the intervention. Feeding-group specific rates of these illnesses were unchanged, indicating that the decline observed was attributable to the increased proportion of infants breastfeeding. In contrast, rates of croup and bronchiolitis increased after the intervention among those fed formula from birth, suggesting a viral epidemic which was limited to those never exclusively breastfed. Finally, sepsis declined in both formula-fed and breastfed infants after the intervention, suggesting that other factors affected this illness outcome after the intervention.Conclusions. Increasing the proportion of exclusively breastfed infants seems to be an effective means of reducing infant illness at the community level. The experimental design suggests that the increased incidence of illness among minimally breastfed infants is causally related to lack of breast milk, rather than being attributable to confounding.
Adverse Asthma Outcomes Among Children Hospitalized With Asthma in California
Authors: Calmes Daphne , Leake Barbara D. , Carlisle David M. 
Published: August 2004

Objective. To use administrative data to determine whether adverse asthma outcomes for pediatric asthma hospitalizations are related to specific clinical and nonclinical patient characteristics.Design. Cross-sectional study.Setting. All pediatric (0 to 17 years of age) asthma-related hospital discharges, 1986 to 1993, in California.Patients. A total of 113 974 eligible patients with asthma-related discharges.Main Outcome Measure. Adverse asthma outcomes (intubation, cardiopulmonary arrest, and death).Results. Adverse asthma outcomes occurred in 0.48% of subjects. The frequency of adverse asthma outcomes increased during the 1990s compared with 1986. After controlling for differences in gender, age, specific comorbid conditions, year, race, and insurance type, adverse asthma outcomes were more likely to occur in the 5- to 11-year-old group (odds ratio [OR]: 1.39; 95% confidence interval [CI]: 1.13–1.69) and in the 12- to 17-year-old group (OR: 4.48; CI: 3.20–6.21) compared with those children in the 0 to 4-year-old age group. Asian Pacific-American children were more likely (OR: 1.59; CI: 1.24–2.59) than were white children to experience an adverse asthma outcome. Children who had a secondary diagnoses of pneumonia (OR: 1.54; CI: 1.19–2.00) also were more likely to experience an adverse asthma outcome. The odds of an adverse outcome increased progressively after 1986, becoming significant after 1989. Gender and insurance type were not associated with increased odds of experiencing an adverse asthma outcome.Conclusions. Adverse asthma outcomes among hospitalized children are increasing in the 1990s and are associated with specific clinical and nonclinical patient characteristics.
Buccal Cell DNA Mutation Analysis for Diagnosis of Cystic Fibrosis in Newborns and Infants Inaccessible to Sweat Chloride Measurement
Authors: Parad Richard B. 
Published: August 2004

Objectives. To assess the application of DNA-based cystic fibrosis transmembrane conductance regulator (CFTR) gene mutation analysis as a primary cystic fibrosis (CF) diagnostic test in preterm and term newborns and infants for whom the quantitative pilocarpine iontophoresis test (QPIT) cannot be used.
Design. Retrospective survey.
Setting. DNA Diagnostic Laboratory, Children's Hospital, Boston, Massachusetts. Buccal cell DNA samples were received from inpatients, outpatients, and three neonatal intensive care units.
Outcome Measure. Detection of at least 1 of 12 CFTR mutations.
Patients. Between November 1, 1992, and April 30, 1994, 28 newborns and infants under 12 months of age at risk for CF had CFTR DNA mutation analysis performed because a sweat chloride (SC) value could not be obtained. QPIT was either not performed (infant weight &lt;2 kg, QPIT not available at site of hospitalization, or infant not accessible to QPIT laboratory) or was inconclusive (sweat volume &lt;75 mg or indeterminate SC [≥40, &lt;60 mEq/L]). The postnatal age at time of testing ranged from 1 day to 11 months, and gestational age at birth from 25 to 40 weeks.
Results. Six (21%) of 28 infants with unobtainable or indeterminate QPIT had 1 or 2 CFTR mutations detected. Immediate CF diagnosis by direct detection of 2 CFTR mutations was made in 5 of these 6 patients. Definitive CF diagnosis in the infant with 1 CFTR mutation was delayed until an elevation in SC could be documented. The patients with no CFTR mutations detected had a low likelihood of CF.
Conclusions. For infants in whom CF is suspected but QPIT cannot be obtained, buccal cell DNA-based CFTR mutation analysis can be used as a rapid, noninvasive primary diagnostic test. This simple mode of DNA collection may aid in the diagnosis of other inherited disorders in newborns.
Serum Cholesterol and Triglyceride Distribution in 7767 School-aged Greek Children
Authors: Schulpis Kleopatra , Karikas George A. 
Published: August 2004

Objective. To elucidate associations of age and sex with serum cholesterol and triglyceride levels and to provide for the first time percentile distribution data for pediatric lipids.Participants and Methods. A high sample of 7767 (3980 boys, 3787 girls) fasting schoolchildren, 6 to 14 years of age, were studied in Athens, Greece.Results. The mean cholesterol ranged from 157 to 174 mg/dL for boys and from 158 to 172 mg/dL for girls peaking at 9 years of age for both sexes. Triglyceride levels also tended to increase gradually and to peak at 11 years of age for both sexes. The high-density lipoprotein cholesterol levels were highest at 9 years of age for both sexes and the low-density lipoprotein cholesterol levels also tended to peak at 9 years of age for boys and at 8 years of age for girls. Atherogenic indices ranged from 1.54 to 1.68 for boys and 1.51 to 1.85 for girls.Conclusion. According to these findings, it could be suggested that diet changes in the Greek population, especially in children and adolescents, living in big cities is significantly influencing their total cholesterol profiles throughout the last 10 years.
Somatosensory Evoked Potentials in Very Preterm Infants in Relation to l-Thyroxine Supplementation
Authors: Smit Bert J. , Kok Joke H. , de Vries Linda S. , van Wassenaer Aleid G. , Dekker Friedo W. , Ongerboer de Visser Bram W. 
Published: August 2004

Objective. To study the effect ofl-thyroxine supplementation on neurologic maturation in very preterm infants with transient hypothyroxinemia.
Design. Randomized, double-blind, placebo-controlled,l-thyroxine supplementation trial.
Setting. Level III neonatal intensive care unit.
Subjects. A total of 200 infants &lt;30 weeks' gestational age.
Intervention. Subjects were randomly assigned to receivel-thyroxine (8 μg/kg birth weight per day) or a placebo during the first 6 weeks of life.
Methods. Median nerve somatosensory evoked potentials were recorded, measuring cortical N1 peak latency at 2 weeks of age, at term, and at 6 months (corrected) age.
Results. Cortical N1 peak latency was not decreased significantly in the l-thyroxine group compared with the placebo group throughout the study period.
Conclusion. l-Thyroxine supplementation during the first 6 weeks of life did not decrease cortical N1 peak latency in infants of &lt;30 weeks' gestational age.