bluuebunny/crossref_metadata_2025_split huggingface dataset:
Frequency, Natural Course, and Outcome of Neonatal Neutropenia
Authors: Funke Annette , Berner Reinhard , Traichel Birgit , Schmeisser Doris , Leititis Jekabs U. , Niemeyer Charlotte M. 
Published: August 2004

Objective.
We studied the frequency, onset, duration, and prognosis of neutropenia in a neonatal hospital population to define subgroups of neonates who might benefit from cytokine therapy.

Study Design.
The study comprised of 2 parts: in a first retrospective study (I), clinical data of neonates with sepsis (n = 168) were analyzed; in a second retrospective and prospective study (II), clinical data of neonates with neutropenia (n = 131) were studied. In study I, the analysis focused on septic neonates with and without neutropenia, and in study II, on neutropenic neonates with and without primary infection. In the prospective part of study II, granulocyte colony-stimulating factor (G-CSF) plasma concentrations were analyzed in neutropenic neonates (n = 32).

Results.
Thirty-eight percent of septic neonates were neutropenic. Neutropenia lasted &lt;24 hours in 75% of these patients. It was recorded before or on the day of the clinical onset of sepsis in 87% of patients. The overall incidence of neutropenia was 8.1%. Seventy-two percent of these neutropenic episodes occurred in patients without infection at the time of diagnosis of neutropenia. In the latter patients, the risk of infection secondary to neutropenia was 9%, affecting only premature neonates. Neutropenic episodes without infection were of longer duration and were accompanied by lower G-CSF plasma concentrations than were episodes associated with infection. The percentage of neutropenic episodes primarily associated with infection was higher in VLBW neonates than in term neonates. Likewise, the risk of infection secondary to neutropenia (27%) and the mortality attributable to infection and neutropenia (28%) were significantly higher than in term newborns.

Conclusion.
Considering the priming time for induction of neutrophilia, G-CSF therapy in neonates presenting with severe bacterial infection and neutropenia may be too late. In contrast, neutropenic very low birth weight neonates without primary infection might benefit from prophylactic G-CSF treatment. neonatal sepsis, neutropenia, granulocyte colony-stimulating factor.
Specialized Assessments for Children in Foster Care
Authors: Horwitz Sarah McCue , Owens Pamela , Simms Mark D. 
Published: August 2004

Objective.To investigate the differences in health problems identified and health services received by children newly entering foster care who participated in a comprehensive multidisciplinary program, compared with children newly entering foster care who received customary community-based services.Methods.Using a 2-group quasiexperimental design, 120 young children entering foster care were enrolled in a multidisciplinary intervention program (n = 62) or were followed by customary care providers (n = 58). An interview with the foster parent; a complete medical examination; and a battery of developmental, psychological, speech/language, and motor assessments were completed for each child at baseline. Children in both groups participated in follow-up assessments at 6 and 12 months.Results.No significant differences between the 2 groups existed in medical, educational, developmental, or mental health problems identified by foster mothers. However, children in the intervention group were more likely to be identified with developmental (56.5% vs 8.6%) and mental health problems (37.1% vs 13.8%) by providers than children in the comparison group. Children in the intervention group were also more likely to be referred for health services at baseline (71.0% vs 43.1%) and receive follow-up care at 6 and 12 months of age than children in the comparison group.Conclusions.Findings indicate that community providers identify medical and educational needs but do not recognize developmental and mental health needs of young children newly entering foster care. The discrepancies in the number of recommended services and follow-up care between the 2 groups make a case for the establishment of specialized services for children entering out-of-home care.
Police Enforcement as Part of a Comprehensive Bicycle Helmet Program
Authors: Gilchrist Julie , Schieber Richard A. , Leadbetter Steven , Davidson Stephen C. 
Published: August 2004

Background.Bicycle-related head injuries cause &gt;150 deaths and 45 000 nonfatal injuries among children in the United States annually. Although bicycle helmets are highly effective against head injury, only 24% of US children regularly wear one. Georgia mandated bicycle helmet use for children, effective July 1993. During that summer, 1 rural Georgia community passed an ordinance instructing police officers to impound the bicycle of any unhelmeted child. We evaluated the effect of active police enforcement of this ordinance, combined with a helmet giveaway and education program.Methods.During April 1997, ∼580 children in kindergarten through grade 7 received free helmets, fitting instructions, and safety education. Police then began impounding bicycles of unhelmeted children. We conducted an observational study, unobtrusively observing helmet use just before helmet distribution, several times during the next 5 months, and once 2 years later.Results.Before the program began, none of 97 observed riders wore a helmet. During the next 5 months, helmet use among 358 observed children averaged 45% (range: 30%–71%), a significant increase in all race and gender groups. In contrast, adult use did not change significantly. Police impounded 167 bicycles during the study, an average of 1 per day. Two years after program initiation, 21 of 39 child riders (54%) were observed wearing a helmet.Conclusions.Without enforcement, the state and local laws did not prompt helmet use in this community, yet active police enforcement, coupled with helmet giveaways and education, was effective and lasting.
Acute Appendicitis Risks of Complications: Age and Medicaid Insurance
Authors: Bratton Susan L. , Haberkern Charles M. , Waldhausen John H. T. 
Published: August 2004

Objectives.To describe the epidemiology of acute appendicitis in children from Washington State, and to determine important risk factors for complications.Design.Retrospective cohort study.Setting.All children (&lt;17 years old) treated in Washington State who were identified by hospital discharge diagnosis codes from 1987 through 1996.Methods.The hospital discharge data were reviewed for all children with a primary diagnosis code for acute appendicitis. Complicated disease was defined as perforation or abscess formation.Results.Young children (0–4 years old) had the lowest annual incidence of acute appendicitis, but they had a 5-fold increased risk of complicated disease (odds ratio: 4.9; 95% confidence interval: 4.0–5.9), compared with teenagers. Children with Medicaid insurance had a 1.3-fold increased risk of complicated disease, compared with children with commercial insurance (odds ratio: 1.3: 95% confidence interval: 1.2–1.4). Children with Medicaid insurance had significantly longer average length of stay (4.0 ± 3.7 days) than all other payers (commercial insurance: 3.3 ± 4.0 days; health maintenance organization: 3.5 ± 3.1 days; and self-insured: 3.7 ± 5.8 days).Conclusions.Very young children had the greatest risk of complicated disease. Children with Medicaid insurance had increased risk of complicated disease, compared with children with commercial health insurance and longer length of stay. Additional studies are needed to evaluate barriers to care for children with Medicaid insurance.
Short- and Long-Term Outcome of Children With Congenital Complete Heart Block Diagnosed In Utero or as a Newborn
Authors: Eronen Marianne , Sirèn Marja-Kaisa , Ekblad Henrik , Tikanoja Tero , Julkunen Heikki , Paavilainen Terho 
Published: August 2004

Objectives.
Few data are available in the literature regarding the long-term outcome of newborns with congenital complete heart block (CHB). The aims of this retrospective study were to assess neonatal morbidity and mortality, incidences of dilated cardiomyopathy (DCM), and associated heart defects, and to establish prenatal and postnatal factors that might predict adverse outcome in children with CHB.

Design and Setting.
The cohort includes 91 infants with CHB diagnosed in 5 tertiary centers in Finland between 1950 and 1998.

Patients.
Maternal connective tissue disease was evident in 89% of the patients. At birth, the median gestational age was 37.1 weeks, and the median weight was 2969 g. Of the 91 infants, 60 (66%) were girls and 7 (8%) were twins.

Results.
Incidences of perinatal morbidity and mortality were 58% and 7%, respectively. The total mortality of CHB was 16%; 11 of 15 (73%) died during the first 12 months. Cumulative probability of survival at 10 years old was 82%. Pacing as a newborn was indicated in 48 of 90 cases (53%), and 36 received pacemakers at older ages. Cardiac defects not causally related to CHB were found in 38 of 90 patients (42%), of whom 22 were operated on. DCM was found in 21 (23%), of whom 13 died. During the follow-up, among 75 survivors with a median age of 9 years, 54 (72%) are free from symptoms. Poor outcome defined as clinically or pathologically evident congestive DCM was associated with intrauterine hydrops, low fetal and neonatal heart rate, low birth weight, male sex, and neonatal problems attributable to prematurity or neonatal lupus.

Conclusions.
Despite early pacing, CHB carries high mortality during the first 12 months of life. High incidences of DCM and associated heart defects indicate close echocardiographic monitoring of all children with CHB.
Cardiovascular Changes During Mild Therapeutic Hypothermia and Rewarming in Infants With Hypoxic–Ischemic Encephalopathy
Authors: Thoresen Marianne , Whitelaw Andrew 
Published: August 2004

Background.
Clinical trials of mild cooling to 35°C or below in infants with early hypoxic–ischemic encephalopathy are under way. The objective of this study was to systematically document cardiovascular changes associated with mild therapeutic hypothermia and rewarming in such infants.

Patients and Methods.
Nine infants with gestational ages of 36 to 42 weeks, with 10-minute Apgar scores of 5 or less, clinical encephalopathy, and an abnormal electroencephalogram before 6 hours were cooled by surface cooling the trunk (n = 3) or by applying a cap perfused with cooled water (n = 6) for a median of 72 hours. The target core temperature was 34.0°C to 35.0°C for head-cooled infants and 33.0°C to 34.0°C for surface-cooled infants. Maintenance heating and rewarming were provided by an overhead heater.

Results.
Mean arterial blood pressure increased by a median of 10 mm Hg during cooling and fell by a median of 8 mm Hg on rewarming. Heart rate decreased by a median of 34 beats/minute on cooling and increased by a median of 32 beats/minute on rewarming. A large increase in the output of the overhead heater decreased mean arterial blood pressure in 5 infants. Anticonvulsant drugs, sedatives, or intercurrent hypoxemia also produced falls in temperature. The inspired oxygen fraction had to be increased by a median of .14 to maintain oxygenation during cooling with 2 infants requiring 100% oxygen, an effect probably attributable to pulmonary hypertension, which was reversible with rewarming.

Conclusions.
Therapeutic cooling produces changes in heart rate and blood pressure that are not hazardous, but the combination of inadvertent overcooling and inappropriately rapid rewarming, together with sedative drugs that can impair normal thermoregulatory vasoconstriction, can cause hypotension in posthypoxic newborn infants. Infants who already require 50% oxygen should be cooled cautiously because pulmonary hypertension may develop. Knowledge of these cardiovascular changes, careful monitoring, anticipation, and correction should help to avoid potential adverse effects in the upcoming clinical trials.
How Much Antibiotic Suspension Is Enough?
Authors: Dusdieker Lois B. , Murph Jody R. , Milavetz Gary 
Published: August 2004

Objectives.
Pilot data suggest that inadequate antibiotic volumes are often dispensed. Study goals were to determine the frequency of inadequate antibiotic volumes dispensed by local pharmacies, develop prescription-writing guidelines to ensure that adequate antibiotic suspension volumes are dispensed, and document the adequacy of verbal/written counseling pharmacists provide.

Methods.
Sixty-one local pharmacies filled prescriptions for penicillin potassium (PCN; 250 mg/5 mL [5 mL orally 3 times daily for 10 days]) and Bactrim (trimethoprim-sulfamethoxazole [TMP-SMX] 5 mL orally twice daily for 10 days). The prescriptions noted only to “dispense a 10-day supply.” Volumes were measured first as total amount dispensed and then into total doses dispensed. Written/verbal instructions were documented.

Results.
The volume of PCN dispensed was 195 ± 25 mL (range: 105–222 mL) for an average of 29.4 doses, where 30 doses were needed. TMP-SMX dispensed had a volume of 107 ± 5 mL (range: 98–120 mL) resulting in an average of 16.5 doses, where 20 doses were needed. Twenty pharmacies (33%) did not dispense a measuring device. Verbal counseling by the pharmacist and written instructions were not uniformly given.

Conclusions.
We suggest calculating the actual volume needed plus an additional 10% to 30% of volume (depending on the viscosity). The prescription should also request a medication-measuring/administering device. Patient counseling and instruction should be expanded.
Childhood Weight, Stature, and Body Mass Index Among Never Overweight, Early-Onset Overweight, and Late-Onset Overweight Groups
Authors: Wisemandle Wayne , Maynard L. Michele , Guo Shumei S. , Siervogel Roger M. 
Published: August 2004

Objective.
To determine the effects of timing of onset of overweight (OW) on childhood anthropometric adiposity levels using long-term serial data from the Fels Longitudinal Study.

Classification.
OW was defined as body mass index (BMI; kg/m2) &gt;25, and the age at first measurement of BMI &gt;25 was the age of onset of OW. Early onset of OW (early-OW) and late onset of OW (late-OW) were defined as having onset of OW before and after 25 years of age, respectively, whereas never OW (never-OW) was defined as never having a BMI &gt;25.

Subjects.
Subjects consisted of 67 males and 47 females in early-OW groups, 62 males and 48 females in late-OW groups, and 80 males and 114 females in never-OW groups.

Results.
Levels of weight and BMI in early-OW males and females were significantly greater than those in never-OW and late-OW males and females beginning at the time of adiposity rebound, which generally occurs between 4 and 8 years of age. Median BMI and weight patterns between never-OW and late-OW males were similar throughout childhood. However, significant differences in median levels of BMI for never-OW and late-OW females began at 11 years of age, although onset of OW was not until &gt;25 years of age in the latter group.

Conclusions.
For both males and females, adiposity rebound is likely an effective time in a child's development to detect and initiate prevention for childhood and early adulthood onset of OW. Although later-onset OW needs additional study, puberty seems to be a critical phase in the development of later adult onset of OW in females.
Use of C-Reactive Protein in Minimizing Antibiotic Exposure: Experience With Infants Initially Admitted to a Well-Baby Nursery
Authors: Philip Alistair G. S. , Mills Pamela C. 
Published: August 2004

Objective.To evaluate the use of a clinical pathway for neonatal sepsis in decisions about initiating and continuing antibiotic treatment.Setting.A district hospital primarily served by private pediatricians practicing in a managed care environment.Patients and Laboratory Tests.All infants admitted to the well-baby nursery in 1997–1998 were eligible for this study. Infants born with a variety of risk factors (eg, borderline prematurity, membranes ruptured for over 18 hours, mother positive for group B streptococcus [GBS], and maternal fever) or clinical manifestations suggesting possible infection (either clinical signs or persistent hypoglycemia) were evaluated with white blood cell count, differential, and C-reactive protein (CRP) soon after birth and 12 hours later. Decisions to transfer to the neonatal intensive care unit and to treat with antibiotics were based on abnormal laboratory test results, particularly an increased level of CRP (&gt;1 mg/dL), persistent hypoglycemia, or clinical signs. Discontinuation of antibiotic treatment was primarily based on return to normal of the CRP.Results.Of 8299 live births, 7562 initially went to the well-baby nursery. Evaluation occurred in 1894 (25%) and 425 were transferred to the neonatal intensive care unit. In 162, antibiotics were discontinued within 48 hours. The majority were treated for 3 to 5 days, with only 19 (3 with GBS sepsis) treated for 6 days or more. There were 216 infants transferred because of risk factors and 209 because of clinical findings. Peak CRP primarily determined the duration of antibiotic treatment, with the mean peak CRP rising from 2.8 mg/dL in those treated for 3 days, to 3.8, 4.3, 8.4, 8.9, and 13.7 mg/dL in those treated for 4, 5, 6, 7, or &gt;7 days, respectively. The mean duration of treatment was 3.1 days. No infant initially treated with antibiotics and discharged when the CRP returned to normal was readmitted within the next month. No infant with normal values on the sepsis screen was readmitted within 1 month with evidence of bacterial infection, but 1 infant with no risk factors was readmitted at 22 days of age with GBS sepsis and meningitis.Conclusions.Using a clinical pathway for neonatal sepsis, which is based primarily on CRP determinations, can minimize antibiotic exposure and shorten hospital stays.
Outpatient Pediatric Blood Cultures: Time to Positivity
Authors: McGowan Karin L. , Foster Jill A. , Coffin Susan E. 
Published: August 2004

Objective.Using a continuously monitoring blood culture system, we determined the time to positivity of blood cultures performed on immunocompetent infants and children who were not receiving antibiotics at the time of culture.Study Design.This study was conducted prospectively using blood cultures taken in the emergency department and outpatient clinics of an urban pediatric teaching hospital from February 1, 1993, through December 31, 1996. Cultures were excluded if obtained from patients receiving antibiotics, patients with a central line, patients with prosthetic devices, or those being followed by the oncology division. Our measures included: 1) recording the time to positive culture obtained by using a continuously monitoring blood culture instrument, 2) patient information derived from the hospital computer system concerning antibiotic use and the presence of indwelling central venous catheters and prosthetic devices, and 3) a chart review of 10% of patients from whom positive cultures were obtained.Results.During the 47-month study period, 10 200 single bottle blood cultures were obtained, 711 (6.97%) of which became positive. Patients ranged in age from &lt;1 week to 24 years (mean: 2.00 years). Two hundred fifty-eight cultures (36.3%) contained only pathogens, 370 (52%) contained only skin contaminants, and 83 (11.7%) contained a mixture of contaminant and pathogen. Of the 258 cultures containing only pathogens, 14% were positive by 12 hours, 87% by 24 hours, 92% by 36 hours, 95% by 48 hours, 98% by 60 hours, and 99.7% by 72 hours. Ninety-five percent of critical pediatric pathogens including Streptococcus pneumoniae,Salmonella and other Enterobacteriaceae,Neisseria meningitidis, and groups A and B streptococci were detected in &lt;24 hours.Conclusion.Because 87% of all cultures containing pathogens were detected within the first 24 hours of incubation, this study can assist emergency department, clinic, and primary care clinicians when making critical decisions concerning patients on whom blood cultures were obtained. Data on time to positivity of blood cultures can be used in conjunction with clinical status to support clinicians in making patient management decisions. Use of short stay (≤24 hours) or extended care units requiring less patient supervision may be easier to justify when a continuously monitoring blood culture instrument is used in the microbiology laboratory.bacteremia, sepsis.
Neonatal Sepsis Workups in Infants ≥2000 Grams at Birth: A Population-Based Study
Authors: Escobar Gabriel J. , Li De-kun , Armstrong Mary Anne , Gardner Marla N. , Folck Bruce F. , Verdi Joan E. , Xiong Blong , Bergen Randy ,   for the Neonatal Infection Study Group
Published: August 2004

Background.Few data are available on the outcome of neonatal sepsis evaluations in an era when intrapartum antibiotic therapy is common.Methods.We identified all newborns weighing ≥2000 g at birth who were ever evaluated for suspected bacterial infection at 6 Kaiser Permanente hospitals between October 1995 and November 1996, reviewed their records and laboratory data, and tracked them to 1 week after discharge. We analyzed the relationship between key predictors and the presence of neonatal bacterial infection.Results.Among 18 299 newborns ≥2000 g without major congenital anomalies, 2785 (15.2%) were evaluated for sepsis with a complete blood count and/or blood culture. A total of 62 (2.2%) met criteria for proven, probable, or possible bacterial infection: 22 (.8%) had positive cultures and 40 (1.4%) had clinical evidence of bacterial infection. We tracked all but 10 infants (.4%) to 7 days postdischarge. There were 67 rehospitalizations (2.4%; 2 for group B streptococcus bacteremia). Among 1568 infants who did not receive intrapartum antibiotics, initial asymptomatic status was associated with decreased risk of infection (adjusted odds ratio [AOR]: .26; 95% confidence interval [CI]: .11–.63), while chorioamnionitis (AOR: 2.40; 95% CI: 1.15–5.00), low absolute neutrophil count (AOR: 2.84; 95% CI: 1.50–5.38), and meconium-stained amniotic fluid (AOR: 2.23; 95% CI: 1.18–4.21) were associated with increased risk. Results were similar among 1217 infants who were treated, except that maternal chorioamnionitis was not significantly associated with neonatal infection.Conclusions.The risk of bacterial infection in asymptomatic newborns is low. Evidence-based observation and treatment protocols could be defined based on a limited set of predictors: maternal fever, chorioamnionitis, initial neonatal examination, and absolute neutrophil count. Many missed opportunities for treating mothers and infants exist.