bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinically Significant Upper Gastrointestinal Bleeding Acquired in a Pediatric Intensive Care Unit: A Prospective Study
Authors: Chaı̈bou Mahamadou , Tucci Marisa , Dugas Marc-André , Farrell Catherine Ann , Proulx François , Lacroix Jacques 
Published: August 2004

Objectives.
To determine the incidence, risk factors, and complications associated with or attributable to clinically significant upper gastrointestinal (GI) bleeding acquired in a pediatric intensive care unit (ICU).

Methods.
Prospective, descriptive epidemiologic study in a multidisciplinary pediatric ICU of a tertiary-care university hospital. Upper GI bleeding was considered to be present if hematemesis occurred or blood was present in the gastric tube. An upper GI bleed was qualified as clinically significant if two or three reviewers independently assessed that at least one of the six complications considered for analysis was attributable to the upper GI bleed.

Results.
A cohort of 1114 consecutive admissions was enrolled; 108 (9.7%) were excluded mostly (37.0%) because they already had an upper GI bleed at entry to the pediatric ICU. The final sample included 1006 admissions (881 patients); 103 upper GI bleeds (10.2%) were diagnosed, including 16 clinically significant upper GI bleeds (1.6%). Complications attributed to an upper GI bleed included: decreased hemoglobin concentration (10 cases), transfusion (10), hypotension (3), and surgery (1). Three independent risk factors for clinically significant upper GI bleeding were retained by multivariate analysis: respiratory failure, coagulopathy, and pediatric risk of mortality score ≥10. Nine of the 16 cases (56.3%) with clinically significant upper GI bleeding had three risk factors, 14 (87.5%) had two, and 1 (6.3%) had none.

Conclusions.
Clinically significant upper GI bleeds are rare in critically ill children. Prophylaxis to prevent them may be limited to patients who present with at least two risk factors.
Comparison of Fentanyl/Midazolam With Ketamine/Midazolam for Pediatric Orthopedic Emergencies
Authors: Kennedy Robert M. , Porter Fran L. , Miller J. Philip , Jaffe David M. 
Published: August 2004

Objective.Emergency management of pediatric fractures and dislocations requires effective analgesia, yet children's pain is often undertreated. We compared the safety and efficacy of fentanyl- versus ketamine- based protocols.Methodology.Patients 5 to 15 years of age needing emergency fracture or joint reduction (FR) were randomized to receive intravenous midazolam plus either fentanyl (F/M) or ketamine (K/M). Measures of efficacy were observational distress scores and self- and parental-report. Measures of safety were frequency of abnormalities in and need for support of cardiopulmonary function and other adverse effects.Results.During FR, K/M subjects (n = 130) had lower distress scores and parental ratings of pain and anxiety than did F/M subjects (n = 130). Although both regimens equally facilitated reductions, deep sedation, and procedural amnesia, orthopedists favored K/M. Recovery was 14 minutes longer for K/M.Fewer K/M subjects had hypoxia (6% vs 25%), needed breathing cues (1% vs 12%), or required oxygen (10% vs 20%) than did F/M subjects. Two K/M subjects required assisted ventilation briefly. More K/M subjects vomited. Adverse emergence reactions were rare but equivalent between regimens.Conclusions.During emergency pediatric orthopedic procedures, K/M is more effective than F/M for pain and anxiety relief. Respiratory complications occurred less frequently with K/M, but respiratory support may be needed with either regimen. Both regimens facilitate reduction, produce amnesia, and rarely cause emergence delirium. Vomiting is more frequent and recovery more prolonged with K/M.
Detection ofMycobacterium tuberculosisin Gastric Aspirates Collected From Children: Hospitalization Is Not Necessary
Authors: Lobato Mark N. , Loeffler Ann M. , Furst Karen , Cole Barbara , Hopewell Philip C. 
Published: August 2004

Objective.To compare the yields of gastric aspirates collected for culture of Mycobacterium tuberculosis from children evaluated as outpatients versus inpatients and to determine factors associated with a positive culture.Methods.Retrospective study of 100 children &lt;12 years of age with tuberculosis diagnosed at a pediatric referral hospital or in one of two tuberculosis control programs in California.Results.Of the 100 children who had tuberculosis, 80 had at least one gastric aspirate collected. M tuberculosis was isolated from 33 (41%) of the 80 children who had a gastric aspirate; 4 children had a positive culture from an aspirate subsequent to the first. Inpatients had a higher proportion of positive gastric aspirates than that of children who had aspirates collected as outpatients (48% vs 37%); however, this difference was not statistically significant. Resistance to isoniazid was found in three isolates (9%) of children all of whose presumptive source case had a susceptible strain ofM tuberculosis. Characteristics that were associated with an ∼50% yield from gastric aspirates were identification of a source case, age &lt;2 years, birth in the United States, symptomatic tuberculosis, and pulmonary disease.Conclusions.The culture of M tuberculosisfrom gastric aspirates of children in the outpatient setting has a yield comparable to aspirates collected from hospitalized children. Collection of gastric aspirates in the outpatient setting will reduce both the cost and the inconvenience of the procedure. Although the yield from gastric aspirates is relatively low, important information including drug susceptibility patterns may be obtained. tuberculosis, gastric aspirate, children.
Limited Evaluation of Microscopic Hematuria in Pediatrics
Authors: Feld Leonard G. , Meyers Kevin E. C. , Kaplan Bernard S. , Stapleton F. Bruder 
Published: August 2004

Objective.The purpose was to determine the value of the standard laboratory and radiologic evaluation of microscopic hematuria in children, and to determine the prevalence of idiopathic hypercalciuria in those children referred for evaluation of unexplained microscopic hematuria.Methods.This was a retrospective study of 325 children referred from 1985 to 1994 for the evaluation of asymptomatic microscopic hematuria. The diagnostic studies reviewed included serum creatinine, blood urea nitrogen, serum electrolyte studies, serum complement concentration, antinuclear antibody, urinalysis, urine calcium to creatinine ratios, urinary protein to creatinine ratio and/or 24-hour urinary protein excretion, renal ultrasounds, intravenous pyelograms, voiding cystourethrograms, and historical information.Results.All creatinine and electrolyte values were normal for age, and none of the biochemical tests obtained in the children with hypercalciuria was abnormal. Of the 325 patients with idiopathic microscopic hematuria, only 18 had abnormal renal ultrasound examinations and 9 voiding cystourethrograms showed low-grade reflux. Hypercalciuria was found in 29 patients. The family history was positive for urolithiasis in 16% of patients without hypercalciuria compared with 14% of patients with hypercalciuria. A positive family history of hematuria was reported in 25% of patients; 62 patients did not have hypercalciuria and 4 of the patients had hypercalciuria. Microscopic hematuria in children is a benign finding in the vast majority of children.Conclusions.Our data demonstrate that a renal ultrasound, voiding cystourethrogram, cystoscopy, and renal biopsy are not indicated in the work-up of microscopic hematuria, and microhematuria in the otherwise healthy child is a minimal health threat, rarely indicative of serious illness.
Language of Early- and Later-identified Children With Hearing Loss
Authors: Yoshinaga-Itano Christine , Sedey Allison L. , Coulter Diane K. , Mehl Albert L. 
Published: August 2004

Objective.
To compare the language abilities of earlier- and later-identified deaf and hard-of-hearing children.

Method.
We compared the receptive and expressive language abilities of 72 deaf or hard-of-hearing children whose hearing losses were identified by 6 months of age with 78 children whose hearing losses were identified after the age of 6 months. All of the children received early intervention services within an average of 2 months after identification. The participants' receptive and expressive language abilities were measured using the Minnesota Child Development Inventory.

Results.
Children whose hearing losses were identified by 6 months of age demonstrated significantly better language scores than children identified after 6 months of age. For children with normal cognitive abilities, this language advantage was found across all test ages, communication modes, degrees of hearing loss, and socioeconomic strata. It also was independent of gender, minority status, and the presence or absence of additional disabilities.

Conclusions.
Significantly better language development was associated with early identification of hearing loss and early intervention. There was no significant difference between the earlier- and later-identified groups on several variables frequently associated with language ability in deaf and hard-of-hearing children. Thus, the variable on which the two groups differed (age of identification and intervention) must be considered a potential explanation for the language advantage documented in the earlier-identified group.
Central Nervous System Tuberculosis in Children: A Review of 214 Cases
Authors: Yaramiş Ahmet , Gurkan Fuat , Elevli Murat , Söker Murat , Haspolat Kenan , Kirbaş Gökhan , Taş M. Ali 
Published: August 2004

Objective.
To study the clinical, laboratory, and treatment features observed in pediatric patients with tuberculous meningitis in Turkey.

Study Design.
Retrospective case review study.

Methods.
Review of medical records for demographic data, medical history, clinical manifestations, auxiliary test results, complications, and treatment of 214 children with central nervous system tuberculosis (TB) admitted to Dicle University's hospital between August 1988 and February 1996.

Results.
Of the 214 patients with tuberculous meningitis, 112 (52%) were male. The mean age at presentation was 4.1 years, with 165 patients (77%) younger than 5 years. Twenty-two patients (10%) were in the first stage of the disease, 120 (56%) in the second, and 72 (34%) in the third. Our epidemiologic data showed that 141 (66%) of the patients had a family history of TB, and 64 (30%) had a Mantoux skin test result of &gt;10 mm of induration. Radiographic studies demonstrated abnormal chest findings in 187 patients (87%) (hilar adenopathy, 33%; infiltrates, 33%; miliary pattern, 20%; and pleural effusions, 1%, and 172 (80%) cases with hydrocephalus, 26% with parenchymal disease, 15% with basilar meningitis, and 2% with tuberculomas. Only 22 (13%) of 164 children had a positive acid-fast bacilli smear in cerebrospinal fluid, andMycobacterium tuberculosis was isolated in 49 patients (30%). All the patients were treated with Isoniazid, rifampin, and streptomycin or pyrazinamide for 2 months, followed by 10 months of Isoniazid and rifampin alone. Also, all the patients received adjuvant treatment with steroids early in the course of treatment, and 140 of 172 cases with hydrocephalus had surgical intervention. The overall mortality rate was 23%.

Conclusion.
One or more of these findings: a family history of TB, positive tuberculin skin test results, abnormal cranial computed tomography, and/or cerebrospinal fluid analysis compatible with TBM were found in all but 3 children in our study. central nervous system, tuberculous meningitis, diagnosis, hydrocephalus, children.
National Trends in the Management of Cardiovascular Disease Risk Factors in Children: Second NHLBI Survey of Primary Care Physicians
Authors: Kimm Sue Y. S. , Payne Gerald H. , Stylianou Mario P. , Waclawiw Myron A. , Lichtenstein Carolyn 
Published: August 2004

Background.
The evidence that atherosclerosis begins during adolescence has led to the belief that primary prevention of cardiovascular disease (CHD) should commence in childhood. Although several national guidelines have been issued for the detection and treatment of CHD risk factors in children, concerns continue to be expressed regarding what constitutes appropriate measures and when to institute such measures in children. A 1988 national survey of primary care physicians revealed variation in the management of CHD risk factors in children by physician categories, which suggested the underlying quandary among physicians regarding CHD risk factors in children.

Objective.
To assess current clinical management of pediatric CHD risk factors in the primary care setting and also to evaluate time trends between the current and 1988 surveys.

Methods.
A 25-minute telephone survey was conducted with 1036 of eligible physicians (ie, &gt;20 hours per week direct patient care including at least five pediatric patient contacts) selected from a national probability sample in three practice categories (family practitioners, pediatricians, and general practitioners). The questionnaire assessed the current practice of these physicians in the primary care setting regarding cholesterol and blood pressure (BP) screening and treatment, both nonpharmacologic and pharmacologic, and physician attitude and knowledge.

Results.
Cholesterol screening in children was performed by 75.7% of all physicians. Nonscreening was highest among general practitioners (38%) and lowest among pediatricians (12%). BP was measured by almost all physicians. The majority of physicians (71%) prescribed diet as the first cholesterol-lowering step, but ∼16% also used pharmacologic therapy. Cholesterol synthesis inhibitors and bile acid sequestrants were the drugs used most commonly. Approximately 25% of physicians have used drugs in children to treat high BP. Diuretics and β-blockers were used most frequently. More than one fourth of the physicians had some concern about identifying and treating children for CHD risk factors. There was slightly less cholesterol measurement in 1995 compared with 1988, and no notable increase in the knowledge regarding major CHD risk factors.

Conclusion.
The results of the second National Heart, Lung, and Blood Institute survey of primary care physicians suggest that additional inroads need to be made in the dissemination of the national guidelines for the management of CHD risk factors in children, including appropriate use of pharmacologic agents.
Exposure to and Compliance With Pediatric Injury Prevention Counseling—United States, 1994
Authors: Quinlan Kyran P. , Sacks Jeffrey J. , Kresnow Marcie-jo 
Published: August 2004

Background.Because injuries are the leading cause of death in children, injury prevention counseling is recommended as part of routine pediatric care. Increasing such counseling is a national health objective. Estimating the proportion of US children who receive such counseling and assessing their compliance with safety recommendations may help improve counseling efforts.Methods.Respondents to a 1994 random digit-dial telephone survey of the US population were asked about receipt of age-appropriate injury prevention counseling at a medical visit and related safety practices for a randomly selected child 0 to 14 years of age in the household (N = 1596).Results.Receiving any injury prevention counseling was reported for 39.3% of children 0 to 14 years old who had a medical visit in the past year and was more common among children who were younger, lived in urban areas, and lived in poverty. In general, receiving counseling was associated with safer behaviors. Counseling about ipecac was reported for 17.2% of children 0 to 6 years old; having ipecac in the home was more likely for those counseled (73.4% vs 32.0%). Counseling about posting the poison control number was reported for 24.9% of children 0 to 6 years old; posting this number was more common among those counseled (79.3% vs 52.6%). Counseling about bicycle helmets was reported for 18.6% of children 5 to 14 years old; a report of always wearing a helmet was more common among those counseled (43.9% vs 19.1%). Counseling about car seats and safety belts was reported for 25.4% of children 0 to 14 years old; a report of always using occupant restraints was more common among those counseled (89.0% vs 78.2%).Conclusions.Injury prevention counseling is associated with reported preventive safety practices among US children, but a relatively small proportion of households with young children report receiving such counseling. Health care providers should increase efforts to provide injury prevention counseling. counseling, wounds and injuries, child, accident prevention.
Dad, May I Have the Keys? Factors Influencing Which Vehicles Teenagers Drive
Authors: Rivara Frederick P. , Rivara Matthew B. , Bartol Keith 
Published: August 2004

Objective.
To determine the role of vehicle safety features, particularly vehicle size and weight, compared with other factors in parental decisions about choosing vehicles for teens to drive.

Methods.
Written questionnaire to parents of teenagers attending drivers education training.

Results.
The response rate to the survey was 62.6%. Two thirds reported that the teen would drive an existing family vehicle, 10.5% would buy an additional vehicle, and 20.3% would buy another vehicle as well as have the teen drive an existing family vehicle. Large size was important to only ∼40% of families purchasing a car for the teen or families in which the teen would use an existing family vehicle. Gas mileage and other safety features were ranked as more important even in families in which a large car was available in the household.

Conclusions.
Families did not rank vehicle size and weight as important as other, less effective safety features in choosing cars for their teens. Information about vehicle crash-worthiness should be incorporated into drivers education and other programs reaching new teen drivers and their families.
Otoacoustic Emissions as a Screening Test for Hearing Impairment in Children Recovering From Acute Bacterial Meningitis
Authors: Richardson Martin P. , Williamson Timothy J. , Reid Andrew , Tarlow Michael J. , Rudd Peter T. 
Published: August 2004

Objectives.
To study the efficacy of otoacoustic emissions (OAEs) as a screening test for hearing impairment in children with acute bacterial meningitis. Hearing tests were performed before discharge from the hospital in an attempt to improve coverage and avoid delays in the diagnosis of postmeningitic hearing loss.

Methods.
Children with bacterial meningitis were recruited from 21 centers. In the 48 hours before discharge from the hospital, all patients underwent a thorough audiologic assessment consisting of transient evoked OAEs, auditory brainstem responses (ABRs), otoscopy, and tympanometry. Hearing loss was defined as ABR threshold ≥30 dB. The results of OAE screening were compared with the gold standard of ABR threshold.

Results.
Of 124 children recruited, we were able to perform both OAEs and ABRs on 110 children. Seven (6.3%) of the 110 children had ABR threshold ≥30 dB; 2 had sensorineural hearing loss and 5 had conductive hearing loss. At follow-up, hearing loss persisted in both cases of sensorineural hearing loss and no new cases were identified. All 7 children with hearing loss failed the OAE screening test. Ninety-four children with normal hearing thresholds passed the test, and 9 failed. Thus, the screening test had a sensitivity of 1.00 (95% confidence interval, 0.59 to 1.00), a specificity of 0.91 (0.85 to 0.97), a positive predictive value of 0.44 (0.20 to 0.70), and a negative predictive value of 1.00 (0.96 to 1.00).

Conclusions.
OAE screening in children recovering from meningitis was found to be feasible and effective. The test was highly sensitive and reasonably specific. Inpatient OAE screening should allow early diagnosis of postmeningitic hearing loss and prompt auditory rehabilitation.
Pediatric Pneumococcal Bone and Joint Infections
Authors: Bradley John S. , Kaplan Sheldon L. , Tan Tina Q. , Barson William J. , Arditi Moshe , Schutze Gordon E. , Wald Ellen R. , Givner Laurence B. , Mason Edward O. ,   The Pediatric Multicenter Pneumococcal Surveillance Study Group (PMPSSG)
Published: August 2004

Objective.To describe the clinical and microbiological characteristics of infants and children with bone and joint infections caused by penicillin-susceptible and penicillin-nonsusceptible strains of Streptococcus pneumoniae.Design.Multicenter, prospective patient accrual; retrospective chart review of identified patients.Setting.Eight children's hospitals in the United States.Participants.Forty-two children with bone and/or joint infections prospectively enrolled in the United States Pediatric Multicenter Pneumococcal Surveillance Study from September 1, 1993 to August 31, 1996.Outcome Measures.Data were collected on multiple variables, including age, gender, race, days of symptoms before and during hospitalization, antibiotic and surgical therapy, laboratory and imaging studies.Results.Of the 42 children enrolled (21 bone, 21 joint infections), 14 had isolates that were not susceptible to penicillin. Eight of 16 (50%) strains isolated from children who received antibiotics within 4 weeks before hospitalization were not susceptible to penicillin, compared with 4 of 15 (27%) strains isolated from children without previous antibiotic exposure. Clinical response to therapy was similar between children infected by penicillin-susceptible strains compared with those infected by penicillin-nonsusceptible strains, including duration of hospitalization (9.1 days vs 11.2 days), days of intravenous antibiotic therapy (25.3 days vs 24.6 days), days of fever (3.6 days vs 3.1 days), and sequelae (14% vs 7%). The most commonly prescribed single agents for parenteral therapy in definitive treatment were ceftriaxone (36%), penicillin (15%), and clindamycin (15%). Oral therapy followed parenteral therapy in 56% of children. The mean (± standard deviation) duration of total antibiotic therapy in children with osteomyelitis was 57.5 ± 48.6 days (range, 23–196 days) and 29.2 ± 11.8 days (range, 12–67 days) for arthritis. Late sequelae (long-term destructive changes of the bone or joint) were documented in 5 (12%) children, 4 with osteomyelitis, and 1 with arthritis. Sequelae occurred in 30% of children with long bone osteomyelitis associated with infection in the adjacent joint. The age of children with sequelae was younger than those without sequelae (6.4 months vs 18.6 months).Conclusions.The demographic characteristics and anatomic sites of infection in our patients were similar to previously published series collected from single institutions before the emergence of significant antibiotic resistance in S pneumoniae. Our analysis suggests that children infected by penicillin-nonsusceptible strains have a similar clinical response to therapy when compared with children infected by penicillin-susceptible strains.