bluuebunny/crossref_metadata_2025_split huggingface dataset:
Desensitization to Pancreatic Enzyme Intolerance in a Child With Cystic Fibrosis
Authors: Chamarthy Latha M. , Reinstein L. Julio , Schnapf Bruce , Good Robert A. , Bahna Sami L. 
Published: August 2004

Objective. Pancreatic enzyme is essential in the treatment of cystic fibrosis (CF), but intolerance to it occasionally occurs. We encountered a child who was intolerant to multiple commercially available preparations of pancreatic enzymes and, hence, desensitization was attempted, with success.Case Presentation. A 33-month-old girl was diagnosed with CF at 6 months of age. Initially, she was started on Pancrease MT 16, which was subsequently discontinued because fecal fat studies were normal and she seemed to do well on Nutramigen and vitamin supplements. At 29 months of age, she developed diarrhea with bulky stools and weight loss. A fecal fat 72-hour study revealed a coefficient of absorption of 50%. She was treated with Pancrease MT 16, but had consistent vomiting 1 to 2 hours after administration of enzymes. The vomiting occurred on switching to different pancreatic enzymes preparations, ie, Creon 10, Viokase, and Pancrease MT 16. Vomiting occurred even with small doses of enzymes disguised in food. She had no history suggestive of gastroesophageal reflux, peptic ulcer, or pork allergy, and no vomiting on days when enzymes were not given. This was suggestive of type I hypersensitivity reaction. Pancreatic enzymes were discontinued, and she was given a low-fat, high-carbohydrate diet with satisfactory weight gain.Methods. Double-blind, placebo-controlled titrated oral challenges with pancreatic enzymes resulted in definite vomiting within 1 to 1.5 hours after challenges with Viokase and Pancrease MT 16, but not with placebo. Rush oral desensitization with Viokase solution was attempted, starting with 5 mg, and the dose was doubled every 20 minutes, aiming to reach a cumulative dose of 700 mg. However, the child vomited when a cumulative dose of 315 mg was reached. Another trial of slower desensitization was done using Pancrease MT 16 (1 capsule: 16 000 U of lipase, 48 000 U of amylase, and 48 000 U of protease), starting with ¼ capsule per day, with increments of ¼ capsule every 3 days, until an entire capsule was reached by day 10, then increased by ∼½ capsule every 4 days until reaching the therapeutic dose of 1 capsule with each meal by day 25.Results. The patient tolerated this fairly well and has been on this treatment and regular diet for &gt;1 year, without any adverse reaction. This illustrates a rare case of gastrointestinal adverse reaction to pancreatic enzymes that was treated successfully with desensitization.Conclusion. Pancreatic enzyme intolerance, although rare, would be a major problem in the management of patients with CF. Hence, desensitization would be essential and may be accomplished successfully using the protocol described in this report.
Incidence of Passive Exposure to Crack/Cocaine and Clinical Findings in Infants Seen in an Outpatient Service
Authors: Lustbader Andrew S. , Mayes Linda C. , McGee Barbara A. , Jatlow Peter , Roberts William L. 
Published: August 2004

Objectives. Passive exposure to crack/cocaine and the associated clinical symptoms may present a significant health risk to very young infants and children. This study was designed to determine the incidence of cocaine exposure, presumed to be passive, in ill infants younger than 1 year of age, using a threshold of detection for cocaine and/or its major metabolite, benzoylecognine (BE), that is lower than the current National Institute on Drug Abuse standard. The study also investigates the morbidity associated with passive cocaine exposure in this population.Methods. We prospectively obtained 124 samples of urine from 122 children younger than 1 year of age for routine clinical indications from the emergency department at Yale–New Haven Hospital. Samples were analyzed by radioimmunoassay (RIA) for cocaine, with cross-reactivity for BE. The presence of BE in a portion of the RIA-positive samples also was detected in additional analyses by enzyme-multiplied immunoassay technique or by gas chromatography-mass spectrometry. A chart review was conducted on all 122 patients by reviewers blind to the urine toxicology results. Presenting complaints, symptoms, vital signs, and diagnosis were obtained for all visits before the first birthday. Birth history, including maternal drug history and birth weight, demographics, and number of medical visits in the first year, were recorded as well.Results. Of the 124 samples, 45 (36.3%) were positive (≥50 ng/mL of BE equivalents) for cocaine and/or cocaine metabolite by RIA testing. The positive results, determined by RIA, were highly correlated with patients who had lower and upper respiratory symptoms and sought medical care more often.Conclusions. The incidence of unsuspected, passive cocaine exposure in ill infants seeking medical care primarily through an emergency service may be as high as 1 in 3 to 6 infants from our predominantly inner city population. Current immunoassay methods, specific for BE, and their routine threshold of detection (200 to 300 ng/mL) may not be sensitive enough to detect cocaine and BE in the urine samples of children younger than 1 year of age who are exposed passively. The development of upper and lower respiratory symptoms is correlated significantly with positive urine results in this study. The increased use of health care resources correlated with passive cocaine exposure in this sample may serve as an indirect marker for the increased medical needs of these infants.
Neuroimaging, Physical, and Developmental Findings After Inflicted and Noninflicted Traumatic Brain Injury in Young Children
Authors: Ewing-Cobbs Linda , Kramer Larry , Prasad Mary , Canales Denise Niles , Louis Penelope T. , Fletcher Jack M. , Vollero Hilda , Landry Susan H. , Cheung Kim 
Published: August 2004

Objective. To characterize neuroimaging, physical, neurobehavioral, and developmental findings in children with inflicted and noninflicted traumatic brain injury (TBI) and to identify characteristic features of inflicted TBI.Methods and Patients. Forty children, 0 to 6 years of age, hospitalized for TBI who had no documented history of previous brain injury were enrolled in a prospective longitudinal study. TBI was categorized as either inflicted (n = 20) or noninflicted (n = 20) based on the assessment of hospital and county protective services. Glasgow Coma Scale scores and neonatal history were comparable in both groups.Outcome Measures. Acute computed tomography/magnetic resonance imaging studies and physical findings were evaluated. Glasgow Outcome Scale scores, cognitive development, and motor functioning were assessed an average of 1.3 months after TBI. χ2 analyses assessed differences in the distribution of findings in the inflicted and noninflicted TBI groups.Results. Signs of preexisting brain injury, including cerebral atrophy, subdural hygroma, and ex vacuo ventriculomegaly, were present in 45% of children with inflicted TBI and in none of the children with noninflicted TBI. Subdural hematomas and seizures occurred significantly more often in children with inflicted TBI. Intraparenchymal hemorrhage, edema, skull fractures, and cephalohematomas were similar in both groups. Retinal hemorrhage was only identified in the inflicted TBI group. Glasgow Outcome Scale scores indicated a significantly less favorable outcome after inflicted than noninflicted TBI. Mental deficiency was present in 45% of the inflicted and 5% of the noninflicted TBI groups.Conclusions. Characteristic features of inflicted TBI included acute computed tomography/magnetic resonance imaging findings of preexisting brain injury, extraaxial hemorrhages, seizures, retinal hemorrhages, and significantly impaired cognitive function without prolonged impairment of consciousness.
Psychological Findings in Preterm Children Related to Neurologic Status and Magnetic Resonance Imaging
Authors: Olsén Paivi , Vainionpää Leena , Pääkkö Eija , Korkman Marit , Pyhtinen Juhani , Järvelin Marjo-Riitta 
Published: August 2004

Objective. Preterm children experience learning disabilities more often than full-term children, but detailed information on their neuropsychological and neurologic determinants is lacking. We therefore examined these problems more closely and also studied if clinical neurologic examination and/or magnetic resonance imaging (MRI) can be used as tools to screen the preterm children at risk for these problems.Methods. In a population-based study, the psychological performance of 42 preterm children with a birth weight &lt;1750 g and of their matched controls was assessed at 8 years of age and the findings were then related to clinical neurologic examination and MRI. Learning disabilities of these children, reported by the teachers, were also studied.Results. The cognitive ability of the preterm children, although in the normal range, was significantly lower than that of the control children. They performed particularly poorly in tasks requiring spatial and visuoperceptual abilities, which were associated with the finding of periventricular leukomalacia in MRI, especially with posterior ventricular enlargement. The preterm children with minor neurodevelopmental dysfunction (MND) had the most problems in neuropsychological tests, whereas the clinically healthy preterm children and those with cerebral palsy had fewer problems. The problems of MND children emerged in the domain of attention. They also experienced the most problems at school.Conclusions. Visuospatial problems were associated with periventricular leukomalacia in MRI, but learning disabilities were most frequent among the preterm children with minor neurologic abnormalities. We recommend closer follow-up of preterm children with MND.
Hepatitis C Virus Infection in the Mothers and Infants Cohort Study
Authors: Granovsky Monica O. , Minkoff Howard L. , Tess Beatriz H. , Waters David , Hatzakis Angelos , Devoid David E. , Landesman Sheldon H. , Rubinstein Arye , Di Bisceglie Adrian M. , Goedert James J. 
Published: August 2004

Objectives. To estimate the hepatitis C virus (HCV) vertical transmission rate, the effect of potential risk factors, and the pattern of HCV antibody response and viremia in HCV-infected infants.Study Design. The Mothers and Infants Cohort Study enrolled both human immunodeficiency virus (HIV)-seropositive and HIV-seronegative pregnant women at five obstetric clinics in New York City in a prospective cohort study between January 1986 and January 1991. HCV-infected mothers and their 122 offspring were followed-up for a minimum of 12 months for evidence of HCV infection as determined by persistent HCV antibodies or detection of HCV RNA by reverse transcription polymerase chain reaction. Comparisons among groups for categorical variables were performed using the Fisher's exact test.Results. Seven (6%; 95% confidence interval, 2%-11%) of the 122 infants were HCV-infected. There was a tendency for increased risk of transmission with maternal viral and obstetrical factors, such as coinfection with HIV (7% vs 4%), high HIV viral load (13% vs 6%), HCV viremia (8% vs 3%), vaginal delivery (6% vs 0%), and female gender of offspring (8% vs 3%), although none of the associations reached statistical significance. After loss of maternal antibody, HCV antibody seroconversion occurred at a mean age of 26 months in 3 HIV-coinfected infants compared with 7 months of age in 4 HCV-infected HIV-uninfected infants. Serial samples showed that HCV RNA persisted in 6 infants for at least 18 to 54 months.Conclusions. Our study is in accordance with other studies that have shown low overall HCV vertical transmission risk and a trend toward higher risk with maternal risk factors such as HIV-coinfection or HCV viremia. A delay in infant HCV antibody response may be associated with HIV coinfection although larger studies are needed to confirm these findings.
Course and Outcome of Chronic Fatigue in Children and Adolescents
Authors: Krilov Leonard R. , Fisher Martin , Friedman Stanford B. , Reitman David , Mandel Francine S. 
Published: August 2004

Purpose. To describe the epidemiology, symptoms, and psychosocial characteristics of children and adolescents evaluated in a chronic fatigue program and determine the course and outcome of the syndrome in these patients.Methods. During the summer of 1994, chart review was performed for the 58 patients evaluated between 1990 and 1994 and a telephone follow-up was conducted with 42 of the 58 families. Patients were predominantly female (71%) and white (94%), with 50% between the ages of 7 and 14 years and 50% between the ages of 15 and 21 years (mean age 14.6 years).Results. At time of presentation, 50% of patients had been fatigued for 1 to 6 months and 50% had been fatigued for 7 to 36 months. Sixty percent indicated the fatigue had begun with an acute illness and 60% had a history of allergies. Most commonly reported symptoms were fatigue (100%), headache (74%), sore throat (59%), abdominal pain (48%), fever (36%), and difficulties with concentration and/or memory (33%). Most patients had a worsening of school performance and a decrease in social activities. On follow-up, there was significant improvement in many patients during the summer after the first visit, with continued improvement in most patients during the second and third years. At time of the follow-up telephone call, 43% of families considered their child “cured” and 52% considered their child “improved,” whereas only 5% considered their child to be “the same.” Statistical analyses demonstrated no demographic or clinical factors that distinguished between those who did or did not participate in the follow-up study, or between those who did or did not do well on follow-up.Conclusions. These data demonstrate that children and adolescents with chronic fatigue have a syndrome that is similar to that described in adults, but that the syndrome differs in several ways, most specifically, presentation earlier in the course of the illness and a more optimistic outcome.
School-based Interventions Improve Heart Health in Children With Multiple Cardiovascular Disease Risk Factors
Authors: Harrell Joanne S. , Gansky Stuart A. , McMurray Robert G. , Bangdiwala Shrikant I. , Frauman Annette C. , Bradley Chyrise B. 
Published: August 2004

Objective. To determine the immediate effects of two types of elementary school-based interventions on children with multiple cardiovascular disease (CVD) risk factors.Design. Randomized, controlled field trial.Setting. Conducted in 18 randomly selected elementary schools across North Carolina.Study Participants. Four hundred twenty-two children age 9 ± 0.8 years with at least two risk factors at baseline: low aerobic power and either high serum cholesterol or obesity.Intervention. Both 8-week interventions consisted of a knowledge and attitude program and an adaptation of physical education. The classroom-based intervention was given by regular teachers to all children in the 3rd and 4th grades. The risk-based intervention was given in small groups only to children with identified risk factors. Children in the control group received usual teaching and physical education.Outcome Measures. The primary outcome measure was cholesterol; additional measures were blood pressure, body mass index, body fat, eating and activity habits, and health knowledge.Results. Both interventions produced large reductions in cholesterol (−10.1 mg/dL and −11.7 mg/dL) compared with a small drop (−2.3 mg/dL) in the controls. There was a trend for systolic blood pressure to increase less in both intervention groups than in the controls. Both intervention groups had a small reduction in body fat and higher health knowledge than the control group.Conclusions. Both brief interventions can improve the CVD risk profile of children with multiple risk factors. The classroom-based approach was easier to implement and used fewer resources. This population approach should be considered as one means of early primary prevention of CVD.
Colonoscopy Under General Anesthesia in Children
Authors: Dillon Michelle , Brown Siobhan , Casey William , Walsh Deirdre , Durnin Marie , Abubaker Kabir , Drumm Brendan 
Published: August 2004

Objective. In children, colonoscopy is usually performed using deep sedation that may be associated with significant risks. The purpose of this study was to evaluate the safety of colonoscopy performed under general anesthesia.
Methods. All patients undergoing colonoscopy during a 3-year period were reviewed for the study. One hundred and thirty-six procedures were performed. Colonoscopies were performed by a pediatric gastroenterologist. Anesthesia was administered by a pediatric anesthetist in a gastroenterology procedure room, adjacent to the operating recovery area.
Results. Three patients had significant abdominal pain and tenderness after the procedure, 1 of whom suffered a perforation of the sigmoid colon. This patient had severe ulcerative colitis. The gastrointestinal complication rate was no higher than reported in adult patients undergoing colonoscopy under sedation. No significant complications relating to the administration of anesthesia were encountered.
Conclusion. We conclude that colonoscopy performed under general anesthesia in children is a very safe procedure. It is superior to the use of sedation because the child is not placed at risk of respiratory compromise. Furthermore, the procedure is less worrisome for children when performed under a general anesthetic.
Prevalence of Urinary Tract Infection in Febrile Young Children in the Emergency Department
Authors: Shaw Kathy N. , Gorelick Marc , McGowan Karin L. , Yakscoe Noreen McDaniel , Schwartz J. Sanford 
Published: August 2004

Objective. Establish prevalence rates of urinary tract infection (UTI) in febrile infants and young girls in an emergency department (ED) by demographics and clinical parameters.Methods. Cross-sectional prevalence survey of 2411 (83%) of all infants younger than 12 months and girls younger than 2 years of age presenting to the ED with a fever (≥38.5°C) who did not have a definite source for their fever and who were not on antibiotics or immunosuppressed. Otitis media, gastroenteritis, and upper respiratory infection were considered potential but not definite sources of fever.Results. Overall prevalence of UTI (growth of ≥104 CFU/mL of a urinary tract pathogen) was 3.3% (95% confidence interval [CI]: 2.6,4.0). Higher prevalences occurred in whites (10.7%; 95% CI: 7.1,14.3), girls (4.3%; 95% CI: 3.3,5.3), uncircumcised boys (8.0%; 95% CI: 1.9,14.1), and those who did not have another potential source for their fever (5.9%; 95% CI: 3.8,8.0), had a history of UTI (9.3%; 95% CI: 3.0,20.3), malodorous urine or hematuria (8.6%; 95% CI: 2.8,19.0), appeared “ill” (5.7%; 95% CI: 4.0,7.4), had abdominal or suprapubic tenderness on examination (13.2%; 95% CI: 3.7,30.7), or had fever ≥39°C (3.9%; 95% CI: 3.0,4.8). White girls had a 16.1% (95% CI: 10.6,21.6) prevalence of UTI.Conclusions. UTI is prevalent in young children, particularly white girls, without a definite source of fever. Specific clinical signs and symptoms of UTI are uncommon, and the presence of another potential source of fever such as upper respiratory infection or otitis media is not reliable in excluding UTI.
Hemodynamic Support in Fluid-refractory Pediatric Septic Shock
Authors: Ceneviva Gary , Paschall J. Alan , Maffei Frank , Carcillo Joseph A. 
Published: August 2004

Objective. Assess outcome in children treated with inotrope, vasopressor, and/or vasodilator therapy for reversal of fluid-refractory and persistent septic shock.Design. Survey; case series.Setting. Three pediatric hospitals.Patients. Fifty consecutive patients with fluid-refractory septic shock with a pulmonary artery catheter within 6 hours of resuscitation.Interventions. Patients were categorized according to hemodynamic state and use of inotrope, vasopressor, and/or vasodilator therapy to maintain cardiac index (CI) &gt;3.3 L/min/m2 and systemic vascular resistance &gt;800 dyne-sec/cm5/m2 to reverse shock.Outcome Measures. Hemodynamic state, response to class of cardiovascular therapy, and mortality.Results. After fluid resuscitation, 58% of the children had a low CI and responded to inotropic therapy with or without a vasodilator (group I), 20% had a high CI and low systemic vascular resistance and responded to vasopressor therapy alone (group II), and 22% had both vascular and cardiac dysfunction and responded to combined vasopressor and inotropic therapy (group III). Shock persisted in 36% of the children. Of the children in group I, 50% needed the addition of a vasodilator, and in group II, 50% of children needed the addition of an inotrope for evolving myocardial dysfunction. Four children showed a complete change in hemodynamic state and responded to a switch from inotrope to vasopressor therapy or vice versa. The overall 28-day survival rate was 80% (group I, 72%; group II, 90%; group III, 91%).Conclusions. Unlike adults, children with fluid-refractory shock are frequently hypodynamic and respond to inotrope and vasodilator therapy. Because hemodynamic states are heterogeneous and change with time, an incorrect cardiovascular therapeutic regimen should be suspected in any child with persistent shock. Outcome can be improved compared with historical literature.
Perinatal Human Immunodeficiency Virus-1 Transmission and Intrauterine Growth: A Cohort Study in Butare, Rwanda
Authors: Weng Ssu , Bulterys Marc , Chao Ann , Stidley Christine A. , Dushimimana Abel , Mbarutso Etienne , Saah Alfred 
Published: August 2004

Objective. To study the association of perinatal human immunodeficiency virus (HIV)-1 transmission with birth outcomes, including birth weight, gestational age, ponderal index, head circumference, and weight/head ratio.Methods. Data from a prospective cohort study of 627 pregnant women and their infants in Butare, Rwanda, from October 1989 until April 1994 were analyzed. A total of 318 HIV-1-infected and 309 seronegative women were enrolled during pregnancy and gave birth to 590 live singletons. Multiple linear regression modeling was used to assess the association of mother–child HIV status with several birth outcome measures.Results. Unadjusted mean birth weight of HIV- infected infants was 235 g (95% confidence interval [CI] = 94 to 376 g) less than that of HIV-uninfected infants born to HIV-positive mothers (the reference group). After adjustment for gestational age, socioeconomic factors, maternal age, parity, hematocrit, and anthropomorphic measures, mean birth weight of HIV-infected infants was 154 g (95% CI = 38 to 271 g) lower than that of the reference group. When infants born to HIV-seronegative mothers were compared with the reference group, mean birth weights did not differ. Adjusted models resulted in estimates of mean head circumference 0.6 cm smaller (95% CI = 0.2 to 1.1 cm), ponderal index 0.14 lower (95% CI = 0.05 to 0.23), weight/head ratio 3.5 lower (95% CI = 0.5 to 6.4), and gestational age 0.5 weeks shorter (95% CI = 0.1 to 0.9 weeks) for HIV-infected infants than for the reference group.Conclusions. After adjustment for potential confounding variables, this study showed statistically significant differences in birth weight, gestational age, ponderal index, and weight/head ratio when HIV-infected infants were compared with noninfected infants born to HIV-positive mothers. HIV-1, mother-to-child transmission, Africa, intrauterine growth, birth weight, gestational age, ponderal index.