bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of Neonatal Intensive Care for Extremely Low Birth Weight Infants in Victoria Over Two Decades: II. Efficiency
Authors: Doyle Lex W. ,   the Victorian Infant Collaborative Study Group
Published: August 2004

Context. Although the increasing effectiveness of neonatal programs for extremely low birth weight (ELBW, birth weight &lt;1000 g) infants has been established from cohort studies, there is a paucity of data on the relationship between the costs and the consequences of neonatal intensive care.
Objective. To determine the changes in the efficiency of neonatal intensive care for ELBW infants in Victoria, Australia over 2 decades.
Design. Economic evaluation (cost-effectiveness and cost-utility analyses) in a population-based cohort study of consecutive ELBW infants born during 4 distinct eras (1979–1980, 1985–1987, 1991–1992, and 1997) followed to at least 2 years of age.
Setting. The state of Victoria.
Patients. All ELBW live births of birth weight 500 to 999 g in the state in the calendar years indicated (1979–1980: n = 351; 1985–1987: n = 560; 1991–1992: n = 429; 1997: n = 233).
Main Outcome Measures. Costs were assessed primarily by the consumption of hospital resources. The consequences included survival and quality-adjusted survival rates at 2 years of age.
Results. The cost-effectiveness ratios (expressed in Australian dollars for 1997) were similar between successive eras at $5270, $3130, and $4050 per life-year gained, respectively. The cost-utility ratios were similar between successive eras at $5270, $3690, and $5850 per quality-adjusted life-year gained, respectively, and were similar to the cost-effectiveness ratios. The cost-effectiveness and cost-utility ratios were generally higher in lower birth-weight subgroups, but there were consistent gains in efficiency over time in infants of lower birth weight.
Conclusions. As there have been large increases in effectiveness from the late 1970s to the late 1990s, the efficiency of neonatal intensive care for ELBW infants in Victoria has remained relatively stable.
Neurodevelopment in Children Born Small for Gestational Age: A Randomized Trial of Nutrient-Enriched Versus Standard Formula and Comparison With a Reference Breastfed Group
Authors: Morley Ruth , Fewtrell Mary S. , A. Abbott Rebecca , Stephenson Terence , MacFadyen Una , Lucas Alan 
Published: August 2004

Objective. Many studies have shown that children born small for gestational age (SGA) are at a neurodevelopmental disadvantage. We have shown that nutrient enrichment of formula fed to term SGA infants improves their growth and hypothesized that it also would improve their neurodevelopmental outcome.
Design. A randomized, controlled trial of standard term-infant (n = 147) or nutrient-enriched (n = 152) formula for the first 9 months. A reference group of 175 breastfed SGA infants was also recruited.
Setting. Subjects were recruited in 5 maternity hospitals in Cambridge, Nottingham, and Leicester, all in the United Kingdom.
Participants. Healthy, term infants (gestation: ≥37 weeks) with birth weight &lt;10th centile.
Outcome Measures. Bayley mental and psychomotor scores at 18 months (primary) and developmental scores from Knobloch, Pasamanick, and Sherrard’s developmental screening inventory at 9 months (secondary).
Results. There was no significant intergroup difference in Bayley Mental Development Index (MDI) or Psychomotor Development Index (PDI) scores at 18 months. However, at 9 months, children fed the enriched formula had a significantly lower developmental quotient (99.5 vs 102.0; 95% confidence interval [CI] for difference: −4.6, −0.4). A significant disadvantage was seen in girls (−5.1; 95% CI: −7.8, −2.4) but not in boys (0.9; 95% CI: −2.4, 4.2).
Breastfed infants had significantly higher MDI and PDI scores at 18 months than formula-fed infants. Confounding factors accounted for ∼34% of the observed association between breastfeeding and MDI score and none of the association between breastfeeding and PDI score.
Conclusions. The previously reported enhanced linear growth in SGA children fed enriched formula was not matched by a neurodevelopmental advantage. At 9 months, girls fed the enriched formula had a significant developmental disadvantage, although this was not seen at 18 months. Later follow-up will determine any long-term effects on health or development. Meanwhile, use of enriched formula for term SGA children should not be promoted.
It seems that breastfeeding may be especially beneficial for neurodevelopment in children born SGA.
Patterns of Injury in Children: A Population-Based Approach
Authors: Spady Donald William , Saunders Duncan Leslie , Schopflocher Donald Peter , Svenson Lawrence Walter 
Published: August 2004

Objective. We describe the frequency and patterns of injury affecting 96 359 children between 0 and 10 years old and living in Alberta, Canada.
Design. This population-based, longitudinal study involved children born in the 3 fiscal years of April 1, 1985 to March 31, 1988, recruited before age 1, and who remained in the study until at least age 5. We used the International Classification of Diseases, Ninth Revision, Clinical Modification chapter-17 diagnostic codes provided by physicians. Codes were grouped into 17 categories; injury episodes were calculated, and age- and gender-specific incidence rates for each category were calculated. The age, pattern, times of greatest risk, and the effect of gender on the type and incidence of injury were determined.
Setting. Health care administrative data were obtained from all fee-for-service health care venues in Alberta between April 1, 1985 and March 31, 1998 providing services to children registered with the Alberta Health Care Insurance Plan and otherwise meeting entrance criteria.
Results. Nearly 84% of children received care for an injury during the study period, and in any given year ∼21% of the population studied had at least 1 injury. Repeat injury was common (73%), and boys were more likely than girls to be injured and to have repeat injury. The most common injuries were dislocations and sprains, open wounds, and superficial injuries and contusions. Burns, poisoning, intracranial injury, and foreign bodies were the next most common, and fractures were least common. Approximately 10% of injuries were multiple-category injuries. Rates varied greatly by injury category, age, and gender. Hospitalization rates varied in a similar manner and commonly accounted for ∼10% of all services. Males were most likely to have an injury, and aboriginal children or children who had received welfare at some time were at greatest risk.
Conclusions. Administrative data can be used to estimate the incidence of injury in a pediatric population. Distinct patterns of injury occur at different ages. Recurrent injury is common. Almost identical proportions of injury (46%) are treated in emergency departments and physicians’ offices.
Predictors of Future Fight-Related Injury Among Adolescents
Authors: Borowsky Iris Wagman , Ireland Marjorie 
Published: August 2004

Objective. Nonfatal fight-related injuries among youths result in lost capacity and high costs of medical care and rehabilitation and constitute a major public health problem. This study identifies factors that predict the occurrence of a fight-related injury that requires medical attention among boys and girls.
Methods. We analyzed data from 14 787 adolescents who completing 2 interviews, approximately 1 year apart, in the National Longitudinal Study of Adolescent Health, a nationally representative, school-based sample of youths. We identified time 1 factors at the community, family, and individual levels that predicted any self-reported fight-related injury that required medical treatment at time 2.
Results. Factors that predict future injury among both boys and girls in multivariate models were violence-related factors: witnessing or being a victim of violence (odds ratio [OR]: 3.69; 95% confidence interval [CI]: 1.81–7.49 for boys; OR: 5.13; 95% CI: 1.25–21.09 for girls), history of a violence-related injury (OR: 2.30; 95% CI: 1.60–3.29 for boys; OR: 3.18; 95% CI: 1.87–5.41 for girls), and physical fighting (OR: 2.02; 95% CI: 1.44–2.84 for boys; OR: 5.15; 95% CI: 3.18–8.34 for girls). Among boys, illicit drug use was also an independent predictor of future injury (OR: 1.72; 95% CI: 1.24–2.37), whereas excellent perceived general health (OR: 0.48; 95% CI: 0.25–0.93) and a high grade point average (OR: 0.52; 95% CI: 0.29–0.95) were significant protective factors against fight-related injury. Girls who reported a high level of depressive symptoms were much more likely to report fight-related injury than nondepressed girls (OR: 8.98; 95% CI: 2.43–33.25).
Conclusions. Factors related to violence, substance use, school achievement, and physical and mental health predicted a future fight-related injury that required medical treatment. The results could assist health and social service providers, educators, and others in identifying youths who are at high risk for fight-related injury and may benefit from appropriate intervention.
Utility of Follow-up Renal Sonography in Children With Vesicoureteral Reflux and Normal Initial Sonogram
Authors: Lowe Lisa H. , Patel Manish N. , Gatti John M. , Alon Uri S. 
Published: August 2004

Objective. The purpose of this study was to determine the value of follow-up renal sonography in children who presented with urinary tract infection and were found to have a voiding cystogram diagnosis of vesicoureteral reflux while having a normal initial renal sonogram.
Methods. We retrospectively reviewed the medical records of 64 consecutive children who presented for follow-up renal sonography with a voiding cystogram diagnosis of vesicoureteral reflux and a normal initial sonogram conducted as part of the routine evaluation after urinary tract infection. Data recorded included gender, age, initial grade of reflux, time to follow-up sonogram, and abnormalities on follow-up sonogram. Children with conditions that may predispose to vesicoureteral reflux were excluded.
Results. Children who were studied (7 boys, 57 girls) ranged in age from 1 month to 10 years, 10 months (mean: 35.6 months; median: 24 months). Ninety-four (73.4%) of 128 renal units demonstrated vesicoureteral reflux on voiding cystogram; 89 (94.7%) of 94 of them were grade 1 to 3. The mean time to follow-up was 22 months (range: 4 months to 5 years, 2 months; median: 18 months). All 128 (95% confidence interval: 0%–2.8%) renal units were normal on follow-up sonography.
Conclusion. Routine performance of repeat sonography seems unnecessary among children, particularly girls, with low- to medium-grade vesicoureteral reflux, who have had a previous normal sonogram and no conditions that predispose to vesicoureteral reflux.
Detection of Postpartum Depressive Symptoms by Screening at Well-Child Visits
Authors: Chaudron Linda H. , Szilagyi Peter G. , Kitzman Harriet J. , Wadkins Holly I.M. , Conwell Yeates 
Published: August 2004

Objective. To assess 1) the feasibility of universal postpartum depression screening during well-child visits in the first year of life, 2) the prevalence of postpartum depressive symptoms among mothers who attend first-year well-child visits, 3) detection of postpartum depressive symptoms in a pediatric clinic before and after universal screening at each first-year well-child visit, and 4) social work referrals before and after universal screening.
Methods. The practice instituted universal screening for postpartum depressive symptoms during first-year well-child visits using the Edinburgh Postnatal Depression Scale (EPDS). We randomly selected 110 infant medical records before (cohort 1) and 110 after (cohort 2) screening was initiated. Measures included demographics, notation of depression or depressive symptoms in the well-child visit note, and referral for depression. EPDS scores were collected for cohort 2 only. Before-after comparisons were made for detection of depression or depressive symptoms and mental health referrals.
Results. The EPDS was included in the medical record in 46% of well-child visits. Eighty-eight percent of these forms were completed. Twenty-one percent of completed EPDS forms had scores ≥10, and 27% of women who completed the EPDS had scores ≥10 sometime during the postpartum year. There was a significant increase in documentation of depressive symptoms with the EPDS after initiation of universal screening (1.6% of visits [cohort 1] vs 8.5% [cohort 2]). Social work referrals for mental health reasons increased significantly (0.2% of visits [cohort 1] to 3.6% [cohort 2]).
Conclusions. Women with high levels of postpartum depressive symptoms are common in an urban population and can be detected at well-child visits throughout the first postpartum year by pediatricians using a standardized screening tool. Because screening for depression during well-child visits is feasible using a standardized screening instrument, pediatricians can play an active role in early detection and referral for postpartum depression.
Behavioral Differences Among Subjects With Prader-Willi Syndrome and Type I or Type II Deletion and Maternal Disomy
Authors: Butler Merlin G. , Bittel Douglas C. , Kibiryeva Nataliya , Talebizadeh Zohreh , Thompson Travis 
Published: August 2004

Objective. To determine whether phenotypic differences exist among individuals with Prader-Willi syndrome with either type I or type II deletions of chromosome 15 or maternal disomy 15 leading to a better understanding of cause and pathophysiology of this classical genetic syndrome.
Methods. We analyzed clinical, anthropometric, and behavioral data in 12 individuals (5 men, 7 women; mean age: 25.9 ± 8.8 years) with PWS and a type I (TI) deletion, 14 individuals (6 men, 8 women; mean age: 19.6 ± 6.5 years) with PWS and a type II (TII) deletion, and 21 individuals (10 men, 11 women; mean age: 23.6 ± 9.2 years) with PWS and maternal disomy 15 (UPD). The deletion type was determined by genotyping of DNA markers between proximal chromosome 15 breakpoints BP1 and BP2. TI deletions are ∼500 kb larger than TII deletions. Several validated psychological and behavioral tests were used to assess phenotypic characteristics of individuals with PWS representing the 3 genetic subtypes.
Results. Significant differences were found between the 2 deletion groups and those with UPD in multiple psychological and behavorial tests, but no differences were observed in other clinical or anthropometric data studied. Adaptive behavior scores were generally worse in individuals with PWS and the TI deletion, and specific obsessive-compulsive behaviors were more evident in the TI individuals compared with those with UPD. Individuals with PWS with TI deletions also had poorer reading and math skills as well as visual-motor integration.
Conclusions. Our study indicates that individuals with TI deletion generally have more behavioral and psychological problems than individuals with the TII deletion or UPD. Four recently identified genes have been identified in the chromosome region between BP1 and BP2 with 1 of the genes (NIPA-1) expressed in mouse brain tissue but not thought to be imprinted. It may be important for brain development or function. These genes are deleted in individuals with TI deletion and are implicated in compulsive behavior and lower intellectual ability in individuals with TI versus TII.
Predictors of Urban Fathers’ Involvement in Their Child’s Health Care
Authors: Moore Trevena , Kotelchuck Milton 
Published: August 2004

Objective. Fathers make important contributions to many aspects of children’s well-being, but relatively few studies have evaluated father involvement in their child’s health care. The objective of this study was to explore the extent to which fathers are involved in their children’s health care and identify those factors that are associated with greater involvement.Methods. A convenience sample of 104 English-speaking, urban fathers with children younger than 7 years were recruited to complete an anonymous, structured interview. Fathers self-reported the number of well-child visits (WCVs) that they had ever attended and which factors had influenced their attendance. Bivariate and multivariate analyses were used to identify those factors that predicted greater involvement.Results. Eighty-nine percent of the fathers had attended at least 1 WCV. Fifty-three percent had high involvement, ie, had attended ≥40% of the American Academy of Pediatrics recommended visits for their child’s age. In multivariate modeling, factors that were significantly associated with high involvement in attending WCVs included attendance at the child’s delivery (odds ratio [OR]: 7.3 [1.7–30.4]), younger child age (OR: 0.96 [0.94–0.99]), older father age (OR: 1.2 [1.2–1.3]), the child’s having health insurance (OR: 4.1 [1.3–12.0]), and having &gt;1 child (OR: 0.22 [0.06–0.72]).Conclusions. The factors identified suggest ways that pediatric providers can support fathers’ involvement in their children’s health care. Providers should focus on encouraging greater involvement early, especially for younger fathers and those with older children. In addition, support of universal health coverage for children might, in addition to other obvious benefits, enhance a father’s engagement with his child’s health care.
Teen Home Pregnancy Test Takers: More Worried or More Wishful?
Authors: Kelly Lisa , Sheeder Jeanelle , Stevens-Simon Catherine 
Published: August 2004

Objective. To test the hypothesis that teenagers who have taken home pregnancy tests are more ambivalent about remaining nonpregnant than those who have not and, for this reason, use contraceptives less consistently.
Methods. A racially diverse group of 340 inadequately contracepting, nulligravida teens, 94 (28%) of whom had taken a home pregnancy test, was studied. At enrollment, participants completed a self-administered questionnaire, were counseled about contraceptive options, and were given the opportunity to initiate their method of choice. The enrollment tool assessed traditional teen-pregnancy risk factors, expectations about the effects of childbearing, common deterrents to contraceptive use, the desirability of remaining nonpregnant, and contraceptive use and plans.
Results. Home pregnancy test takers were more apt to be unsure that they wanted to remain nonpregnant (relative risk [RR]:1.3; 95% confidence interval [CI]:1.1–1.6), principally because they were more likely to lack negative expectations about the effects of childbearing on their lives (odds ratio: 2.2; 95% CI = 1.2–4.0). Although no more likely to perceive deterrents to contraceptive use, pregnancy-test-kit users were more apt to have had unprotected sexual intercourse in the past (RR:1.3; 95% CI:1.1–1.5) and to plan to do so in the future (RR:1.7; 95% CI:1.1–3.3). Group differences in the desire to remain nonpregnant accounted for differences in contraceptive behavior and plans.
Conclusion. Home pregnancy test taking should be regarded as a red flag by those who care for adolescents; although they are as capable of using contraceptives as their peers, test takers are less apt to do so because they expect less negative consequences from childbearing and, for this reason, may benefit more from discussing childbearing expectations than contraceptive options.
Health Status and Health-Related Quality of Life in a Population-Based Sample of Neonatal Intensive Care Unit Graduates
Authors: Klassen Anne F. , Lee Shoo K. , Raina Parminder , Chan Herbert W.P. , Matthew Derek , Brabyn David 
Published: August 2004

Objective. To measure the health status (HS) and health-related quality of life (HRQL) of preschoolers who were admitted to a neonatal intensive care unit (NICU) at birth and their family caregivers and to investigate differences in HS and HRQL in relation to gestational age and major morbidity experienced during the NICU stay.Methods. Retrospective cross-sectional survey was conducted in the province of British Columbia, Canada. A total of 1140 of 2221 children who were admitted at birth to the 3 tertiary care NICUs in the province and 393 of 718 healthy full-term children recruited from 2 of these hospitals were studied. The main outcome measures were Infant and Toddler Quality of Life Questionnaire (ITQOL), Health Status Classification System Preschool Version (HSCS-PS), and Child Behavior Checklist/1.5–5 (CBCL)Results. The overall response rate was 55%; the response rate for families that we located was 67.1%. NICU children differed from healthy children on the ITQOL in physical abilities, growth and development, temperament/moods, behavior, and general health perceptions, and caregivers differed on both parent-impact scales. On the HSCS-PS, proportionally more NICU children had a health problem in the following areas: sight, speech, getting around, using hands and fingers, taking care of self, learning and remembering, thinking and solving problems, pain and discomfort, general health, and behavior. The NICU sample reported more behavioral problems on the CBCL/1.5–5. Poorer HS and HRQL were reported for infants who were born at &lt;27 weeks’ gestation and for children who experienced ≥1 major morbidities during their NICU stay.Conclusions. Preschool-aged children with conditions that require NICU care and their family caregivers had poorer HS and HRQL in a range of domains compared with healthy children. There were also differences within the sample by gestational age and major morbidity. The differences in health were small using the ITQOL and CBCL/1.5–5 but larger using the HSCS-PS.
Not All Child Safety Seats Are Created Equal: The Potential Dangers of Shield Booster Seats
Authors: Edgerton Elizabeth A. , Orzechowski Kelly M. , Eichelberger Martin R. 
Published: August 2004

Objective. Children are safest when traveling in a child safety seat appropriate for their age and size. Previous research indicates that children are often transitioned to shield booster seats (SBSs) before reaching the 40-lb weight limit for their forward-facing child safety seat (FFCSS). These children could have otherwise been restrained in a FFCSS as is currently recommended by the American Academy of Pediatrics and the National Highway Traffic Safety Administration. The objective of this study was to compare the injury patterns among children who were restrained in SBSs and FFCSSs. Children in FFCSSs were chosen as a comparison group because SBS are predominately used to restrain children who are &lt;40 lb and could have been restrained in an FFCSS, and SBSs are no longer certified for use in children who are &gt;40 lb.Methods. This is a cohort study involving restrained crash victims who were admitted to a level 1 pediatric trauma center between 1991 and 2003. Patients were older than 1 year, weighed between 20 and 40 lb, and were restrained in an SBS (N = 16) or an FFCSS (N = 30). Injury Severity Score, Abbreviated Injury Scale, Glasgow coma score, intensive care admission, length of stay, and acute care charges served as outcomes of interest.Results. No significant differences regarding crash and occupant characteristics were found (mean Delta V, crash type, passenger compartment intrusion, driver restraint use). Odds of severe injury were greater for children in SBSs compared with children in FFCSSs as measured by Injury Severity Score &gt;15 (odds ratio [OR]: 8.3; 95% confidence interval [CI]: 2.1–33.6), intensive care admission (OR: 5.5; 95% CI: 1.5–20.5), length of stay &gt;2 days (OR: 6.3; 95% CI: 1.6–24.6), and Abbreviated Injury Scale ≥3 (OR: 4.4; 95% CI: 1.2–16.1). Furthermore, SBS cases had greater odds of head (OR: 4.5; 95% CI: 1.2–17.3), chest (OR: 29.0; 95% CI: 3.1–267.3), and abdominal/pelvic injury (25% vs 0%).Conclusion. This study provides information about the increased risk of injury associated with shield boosters when compared with FFCSSs. The challenge for pediatricians is not only to promote the use of child restraints but also to ensure that parents use the most appropriate restraint for their child’s age and weight.