bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhanced Growth of Preterm Infants Fed a New Powdered Human Milk Fortifier: A Randomized, Controlled Trial
Authors: Reis Bridget Barrett , Hall Robert T. , Schanler Richard J. , Berseth Carol L. , Chan Gary , Ernst Judith A. , Lemons James , Adamkin David , Baggs Geraldine , O'Connor Deborah 
Published: August 2004

Objective.
A prospective, double-blind, randomized, controlled trial was conducted to evaluate the growth and nutritional status of preterm infants receiving preterm human milk supplemented with a newly formulated powdered human milk fortifier (HMF), study fortifier (SF), or a powdered commercial HMF (CF).

Methods.
Infants (n = 144) with a birth weight ≤1600 g and gestational age at birth of ≤33 weeks were enrolled and randomized before 21 days of life. Study day (SDAY) 1 was defined as the day full-strength fortification (4 packets/100 mL) began and the infant reached an intake of at least 100 mL/kg/day. Growth, biochemical indices of nutritional status, enteral intake, feeding tolerance, clinical histories, and morbidity were assessed serially. The primary outcome variable was weight gain (g/kg/day) from SDAYs 1 to 29 or hospital discharge, whichever came first.

Results.
Infants fed human milk supplemented with SF consistently grew more rapidly from SDAYs 1 to 29 (or hospital discharge), regardless of whether the statistical analyses were performed on all subjects who were randomized into the study and reached SDAY 1 (intent-to-treat) or were limited to those able to adhere strictly to the feeding protocol of the study (subgroup). Using mean values adjusted for study site (least square [LS] means), the weight gain differences were 2.6 and 3.8 g/kg/day for the intent-to-treat and subgroup analyses, respectively. Likewise, the length-gain differences were .14 and .18 cm/week for the intent-to-treat and subgroup analyses, respectively. Infants in the SF group reached a weight of 1800 g at SDAY 18, and those in the CF group at SDAY 25. Mean alkaline phosphatase values among infants in the SF group were higher than for the CF infants (eg, LS means: 327 U/L vs 272 U/L, intent-to-treat analysis), likely reflecting the more rapid linear growth of the SF infants. Mean serum calcium values tended to be lower in the SF group in the intent-to-treat analysis and were significantly lower in the subgroup analysis (LS means: 10.3 mg/dL vs 11.2 mg/dL). Both fortifiers were generally well-tolerated, although an increased number of infants in the CF group exited the feeding protocol because of gastric residuals and abdominal distention.

Conclusion.
A new powdered HMF was shown to enhance the growth of preterm infants, compared with a commercially available powdered HMF in the United States.
Medical Concerns in the Female Athlete
Authors:   Committee on Sports Medicine and Fitness
Published: August 2004

This Clinical Report was revised. See https://doi.org/10.1542/peds.2016-0922.
Female children and adolescents who participate regularly in sports may develop certain medical conditions, including disordered eating, menstrual dysfunction, and decreased bone mineral density. The pediatrician can play an important role in monitoring the health of young female athletes. This revised policy statement provides updated and expanded information for pediatricians on these health concerns as well as recommendations for evaluation, treatment, and ongoing assessments of female athletes.
International Guidelines for Neonatal Resuscitation: An Excerpt From the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science
Authors:   Contributors and Reviewers for the Neonatal Resuscitation Guidelines
Published: August 2004

The International Guidelines 2000 Conference on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) formulated new evidenced-based recommendations for neonatal resuscitation. These guidelines comprehensively update the last recommendations, published in 1992 after the Fifth National Conference on CPR and ECC.As a result of the evidence evaluation process, significant changes occurred in the recommended management routines for:• Meconium-stained amniotic fluid: If the newly born infant has absent or depressed respirations, heart rate &lt;100 beats per minute (bpm), or poor muscle tone, direct tracheal suctioning should be performed to remove meconium from the airway.• Preventing heat loss: Hyperthermia should be avoided.• Oxygenation and ventilation: 100% oxygen is recommended for assisted ventilation; however, if supplemental oxygen is unavailable, positive-pressure ventilation should be initiated with room air. The laryngeal mask airway may serve as an effective alternative for establishing an airway if bag-mask ventilation is ineffective or attempts at intubation have failed. Exhaled CO2 detection can be useful in the secondary confirmation of endotracheal intubation.• Chest compressions: Compressions should be administered if the heart rate is absent or remains &lt;60 bpm despite adequate assisted ventilation for 30 seconds. The 2-thumb, encircling-hands method of chest compression is preferred, with a depth of compression one third the anterior-posterior diameter of the chest and sufficient to generate a palpable pulse.• Medications, volume expansion, and vascular access: Epinephrine in a dose of 0.01–0.03 mg/kg (0.1–0.3 mL/kg of 1:10,000 solution) should be administered if the heart rate remains &lt;60 bpm after a minimum of 30 seconds of adequate ventilation and chest compressions. Emergency volume expansion may be accomplished with an isotonic crystalloid solution or O-negative red blood cells; albumin-containing solutions are no longer the fluid of choice for initial volume expansion. Intraosseous access can serve as an alternative route for medications/volume expansion if umbilical or other direct venous access is not readily available.• Noninitiation and discontinuation of resuscitation: There are circumstances (relating to gestational age, birth weight, known underlying condition, lack of response to interventions) in which noninitiation or discontinuation of resuscitation in the delivery room may be appropriate.
Targeted Early Rescue Surfactant in Ventilated Preterm Infants Using the Click Test
Authors: Osborn David A. , Jeffery Heather E. , Bredemeyer Sandie L. , Polverino Jan M. , Reid Shelley 
Published: August 2004

Objective.To determine whether use of the click test, a rapid bedside test of surfactant function, results in earlier and more appropriate surfactant administration in ventilated preterm infants than does usual early rescue treatment.Study Design.Ventilated preterm infants (n = 126) with inspired oxygen ≥25% and mean airway pressure ≥7 cm H2O were randomized in gestational strata (&lt;28 weeks and 28–36 weeks) to have surfactant therapy determined by the click test or by usual clinical and chest radiograph criteria. The treatment group had the click test performed on a tracheal aspirate as soon as possible after intubation and, if negative or equivocal (surfactant deficient), surfactant was given. The control group had surfactant given as soon as possible based on clinical and chest radiograph diagnoses of respiratory distress syndrome.Results.In infants of &lt;28 weeks' gestation, use of the click test resulted in significantly earlier surfactant therapy (median time: 50 vs 159 minutes) and a reduction in the number of infants receiving surfactant (48% vs 79%). In infants of 28 to 36 weeks' gestation, there was no difference in time to surfactant (median time: 300 vs 268 minutes) or in the number of infants receiving surfactant. Neonatal morbidity and mortality were similar in click test and control groups.Conclusions.Use of the click test in ventilated, extremely premature infants results in significantly earlier and more appropriately targeted administration of surfactant than does early rescue therapy based on clinical and radiograph criteria. A randomized trial of targeted early rescue surfactant therapy versus prophylactic surfactant therapy in infants of &lt;28 weeks' gestation is warranted. The click test has the potential to improve clinical outcomes and reduce costs.
Morbid Hypocalcemia Associated With Phosphate Enema in a Six-Week-Old Infant
Authors: Walton Dawn M. , Thomas David C. , Aly Hany Z. , Short Billie L. 
Published: August 2004

A 6-week-old premature infant who was born at 29 weeks of gestation presented to the emergency department with a several-hour history of stiffness and increased alarms on his apnea monitor at home. On arrival he was noted to have generalized seizures, apnea, and bradycardia. He was intubated and required cardiopulmonary resuscitation including chest compressions and medications. After stabilization he was transferred to the neonatal intensive care unit for further management. His initial laboratory tests revealed a serum calcium level of 2.4 mg/dL (normal range: 8.4–10.2 mg/dL) and a serum phosphorus level of 28.5 mg/dL (normal range: 2.4–4.5 mg/dL). During the first week of admission, the infant's mother reported that she had administered a full pediatric Fleets enema (CB Fleet Company Inc, Lynchburg, VA) to him. The infant was discharged after 12 days of hospitalization.
Anticipatory guidance on the stool patterns and behavior of infants can prevent misconceptions about constipation that are especially prevalent in new parents. Proper management of constipation, should it arise, should be addressed with all parents at early well-child visits to avoid hazardous complications of treatments. hypocalcemia, seizures, premature infants, enema.
Early Respiratory Infections and Childhood Asthma
Authors: Nafstad Per , Magnus Per , Jaakkola Jouni J. K. 
Published: August 2004

Objective.
To assess the role of early respiratory infections in the development of bronchial obstruction in the first 2 years of life, and asthma by the age of 4 years in the Oslo Birth Cohort, established in 1992–1993. Having older siblings and attendance to a day care center were also considered as proxy measures of early infections.

Methods.
A total of 2531 children were followed from birth to 4 years of age. Experiences of respiratory infections were recorded in the follow-up surveys at 6 and 12 months of age, and children with symptoms and signs of bronchial obstruction during the first 2 years of life were identified and examined. The presence of current asthma was recorded when the children were 4 years old.

Results.
Children with respiratory infections during infancy had a higher risk of having bronchial obstruction during the first 2 years of life and of having asthma at 4 years of age. In logistic regression adjusting for confounders including other infections, the risk of asthma at 4 years of age was related to lower respiratory tract infection (odds ratio [OR]: 3.4; 95% confidence interval [CI]: 2.3–7.0), otitis media (OR: 1.8; 95% CI: 1.2–2.6), croup (OR: 2.1; 95% CI: 1.2–3.7) in the first year and related to the common cold (OR: 2.0; 95% CI: 1.3–3.1) in the first 6 months of life. The risk of current asthma was inversely related to older siblings after controlling for early respiratory infections.

Conclusion.
Early respiratory infections indicate increased, rather than decreased, risk of developing bronchial obstruction during the first 2 years of life and of having asthma at 4 years of age.
The EPICure Study: Outcomes to Discharge From Hospital for Infants Born at the Threshold of Viability
Authors: Costeloe Kate , Hennessy Enid , Gibson Alan T. , Marlow Neil , Wilkinson Andrew R. ,   for the EPICure Study Group
Published: August 2004

Objective.
To evaluate the outcome for all infants born before 26 weeks of gestation in the United Kingdom and the Republic of Ireland. This report is of survival and complications up until discharge from hospital.

Methodology.
A prospective observational study of all births between March 1, 1995 and December 31, 1995 from 20 to 25 weeks of gestation.

Results.
A total of 4004 births were recorded, and 811 infants were admitted for intensive care. Overall survival was 39% (n = 314). Male sex, no reported chorioamnionitis, no antenatal steroids, persistent bradycardia at 5 minutes, hypothermia, and high Clinical Risk Index for Babies (CRIB) score were all independently associated with death. Of the survivors, 17% had parenchymal cysts and/or hydrocephalus, 14% received treatment for retinopathy of prematurity (ROP), and 51% needed supplementary oxygen at the expected date of delivery. Failure to administer antenatal steroids and postnatal transfer for intensive care within 24 hours of birth were predictive of major scan abnormality; lower gestation was predictive of severe ROP, while being born to a black mother was protective. Being of lower gestation, male sex, tocolysis, low maternal age, neonatal hypothermia, a high CRIB score, and surfactant therapy were all predictive of oxygen dependency. Intensive care was provided in 137 units, only 8 of which had &gt;5 survivors. There was no difference in survival between institutions when divided into quintiles based on their numbers of extremely preterm births or admissions.

Conclusions.
This study provides outcome data for this geographically defined cohort; survival and neonatal morbidity are consistent with previous data from the United Kingdom and facilitate comparison with other geographically based data.
Decline in Prevalence of Neural Tube Defects in a High-Risk Region of the United States
Authors: Stevenson Roger E. , Allen William P. , Pai G. Shashidhar , Best Robert , Seaver Laurie H. , Dean Jane , Thompson Shirley 
Published: August 2004

Objectives.
To conduct surveillance for neural tube defects (NTDs) in a high-risk region of the United States and to prevent occurrence and recurrence of NTDs through the periconceptional use of folic acid supplements.

Design.
Active and passive methods were used for surveillance of NTD-affected pregnancies and births during a 6-year period (October 1992–September 1998). Individual genetic counseling was used to prevent NTD recurrences and a public awareness campaign was used to reduce NTD occurrences.

Setting.
State of South Carolina.

Patients.
All cases of spina bifida, anencephaly, and encephalocele identified among 278 122 live births and fetal deaths to South Carolina residents during 1992–1998 were included.

Main Outcome Measure.
Changes in occurrence and recurrence rates during a 6-year period.

Results.
Over the 6 years of surveillance, the prevalence rates for NTDs decreased from 1.89 to .95 cases per 1000 live births and fetal deaths. The prevalence decrease is explained primarily by a decrease in cases of spina bifida. Isolated NTDs accounted for 297/360 (82%) NTDs and 63/360 (18%) had at least 1 other structural anomaly. Females predominated among isolated NTDs but the sex distribution was equal among NTD cases with other anomalies. Prevalence rates for whites (1.48 cases per 1000 live births and fetal deaths) were higher than rates for blacks (.87 cases per 1000 live births and fetal deaths). There were no NTD recurrences in 113 subsequent pregnancies to mothers of infants with isolated NTDs who took periconceptional folic acid. The rate of periconceptional folic acid use among women of childbearing years increased from 8% to 35% during the 6-year project period.

Conclusion.
The prevalence of NTDs in a high-risk region has declined coincident with the increased periconceptional use of folic acid supplements among women of childbearing age.neural tube defects, high-risk region, birth defects, folic acid, spina bifida, anencephaly, encephalocele.
Prospective Randomized Trial of Early Versus Late Enteral Iron Supplementation in Infants With a Birth Weight of Less Than 1301 Grams
Authors: Franz Axel R. , Mihatsch Walter A. , Sander Silvia , Kron Martina , Pohlandt Frank 
Published: August 2004

Objectives.To examine whether early enteral iron supplementation (EI) would improve serum ferritin as a measure of nutritional iron status at 2 months of age and would prevent definite iron deficiency (ID) in infants with a birth weight of &lt;1301 g.Methods.Infants were randomly assigned to receive enteral iron supplementation of 2 to 6 mg/kg/day as soon as enteral feedings of &gt;100 mL/kg/day were tolerated (EI) or at 61 days of life (late enteral iron supplementation [LI]). Nutritional iron status was assessed: 1) at birth, 2) at 61 days of life, 3) when the infants reached a weight of 1.6 times birth weight, and 4) before blood was transfused at a hematocrit of &lt;.25. ID was defined by any one of the following criteria: ferritin, &lt;12 μg/L; transferrin saturation, &lt;17%; or increase of absolute reticulocyte counts by &gt;50% one week after the onset of enteral iron supplementation. Restrictive red cell transfusion guidelines were followed and all transfusions were documented. Erythropoietin was not administered. The primary outcome variables were: 1) ferritin at 61 days and 2) the number of infants with ID.Results.Ferritin at 61 days was not different between the groups. Infants in the LI group were more often iron-deficient (26/65 vs 10/68) and received more blood transfusions after day 14 of life. No adverse effects of EI were noted.Conclusions.EI is feasible and probably safe in infants with birth weight &lt;1301 g. EI may reduce the incidence of ID and the number of late blood transfusions. ID may occur in very low birth weight infants despite early supplementation with iron and should be considered in the case of progressive anemia. preterm infant, iron supplementation, iron deficiency, blood transfusion.
Large Congenital Melanocytic Nevi and the Risk for Development of Malignant Melanoma and Neurocutaneous Melanocytosis
Authors: Bittencourt Flavia V. , Marghoob Ashfaq A. , Kopf Alfred W. , Koenig Karen L. , Bart Robert S. 
Published: August 2004

Objective.To determine the risk for developing malignant melanoma and neurocutaneous melanocytosis (NCM) in patients with large congenital melanocytic nevi.Design.Follow-up data suitable for calculations were available on 160 patients in the New York University Registry of Large Congenital Melanocytic Nevi who had been free of known melanomas or NCM when entered into the Registry. The cumulative 5-year life-table risks for developing melanoma and NCM were calculated. The relative risk for developing melanoma, using a control general population reference group, was determined.Results.The 160 patients (median age at entry: 14 months) were followed prospectively for an average of 5.5 years. Three extracutaneous melanomas developed: 2 were in the central nervous system (CNS) and 1 was retroperitoneal. The 5-year cumulative life-table risk for developing melanoma was 2.3% (95% confidence interval [CI]: .8–6.6) and the relative risk was 101 (95% CI: 21–296). No melanoma occurred within a large congenital melanocytic nevus. Four patients developed manifest NCM, 2 with CNS melanomas. The 5-year cumulative life-table risk for developing NCM was 2.5% (95% CI: .8–7.2). Ten patients were excluded from the calculations because of preexisting disease on entry into the Registry: 5 with manifest NCM and 5 with melanomas (3 in large congenital melanocytic nevi, 1 in nonnevus skin, and 1 unknown primary).Conclusions.Patients with large congenital melanocytic nevi are at increased risk for developing melanomas. There is also a significant increased risk for developing NCM. The high incidence of CNS involvement may influence decisions concerning treatment of the large congenital melanocytic nevi.
Depressive Symptoms and Cigarette Smoking Among Teens
Authors: Goodman Elizabeth , Capitman John 
Published: August 2004

Context.
Although several risk factors for tobacco use have been implicated in the development of depression, smoking progression has typically been viewed as a consequence of depression. The results of limited longitudinal studies are controversial.

Objective.
To assess the nature and direction of the relationship between cigarette smoking and depression among teens.

Design.
Prospective analysis of baseline and 1-year follow-up data from the National Longitudinal Study of Adolescent Health.

Setting.
In-home teen and parent interviews.

Participants.
Two samples were identified. For the first sample, 8704 adolescents who were not depressed at baseline based on CES-D scores were identified for analyses of the effects of cigarette smoking on development of high depressive symptomatology. Baseline smoking status, which could vary in this group, was the predictor of interest in these analyses. For the second sample, 6947 teens who had not smoked cigarettes in the 30 days before the baseline survey (noncurrent smokers) were identified for analyses on the effect of high depressive symptoms on subsequent moderate to heavy cigarette use at 1 year of follow-up. Baseline high depressive symptomatology based on CES-D score was the predictor of interest in this sample.

Main Outcome Measures.
Among the nondepressed, developing high depressive symptoms at 1 year of follow-up. Among noncurrent smokers, smoking at least 1 pack per week at 1 year of follow-up.

Results.
For the nondepressed, multivariate modeling revealed that current cigarette smoking was the strongest predictor of developing high depressive symptoms in all models (final model odds ratio [OR]: 3.90; 95% confidence interval [CI]: 1.85,8.20). For noncurrent smokers, although in bivariate analyses, baseline high depressive symptoms increased the risk of heavy smoking nearly threefold, multivariate modeling revealed that baseline high depressive symptoms were not predictive of heavy smoking when controlling for other determinants of smoking in teens. Previous experimentation with smoking was the strongest predictor of becoming a heavy smoker (OR: 3.04; 95% CI: 1.93,4.88).

Conclusions.
In contrast to common dictum, depression does not seem to be an antecedent to heavy cigarette use among teens. However, current cigarette use is a powerful determinant of developing high depressive symptoms.