bluuebunny/crossref_metadata_2025_split huggingface dataset:
Asthma Morbidity After the Short-Term Use of Ibuprofen in Children
Authors: Lesko Samuel M. , Louik Carol , Vezina Richard M. , Mitchell Allen A. 
Published: August 2004

Objective. To test the hypothesis that short-term use of ibuprofen increases asthma morbidity in children.
Methods. A randomized, double-blind, acetaminophen-controlled clinical trial was conducted. Children who had asthma and a febrile illness were randomly assigned to receive either acetaminophen suspension or ibuprofen suspension for fever control. Rates of hospitalization and outpatient visits for asthma during follow-up were compared by randomization group.
Results. A total of 1879 children receiving asthma medications were studied. Rates of hospitalization for asthma did not vary significantly by antipyretic assignment; compared with children who were randomized to acetaminophen, the relative risk for children who were assigned to ibuprofen was 0.63 (95% confidence interval: 0.25–1.6). However, the risk of an outpatient visit for asthma was significantly lower in the ibuprofen group; compared with children who were randomized to acetaminophen, the relative risk for children who were assigned to ibuprofen was 0.56 (95% confidence interval: 0.34–0.95).
Conclusions. Rather than supporting the hypothesis that ibuprofen increases asthma morbidity among children who are not known to be sensitive to aspirin or other nonsteroidal antiinflammatory drugs, these data suggest that compared with acetaminophen, ibuprofen may reduce such risks. Whether the observed difference in morbidity according to treatment group is attributable to increased risk after acetaminophen use or a decrease after ibuprofen cannot be determined. These data provide evidence of the relative safety of ibuprofen use in children with asthma.
Newborn Hepatitis B Vaccination Policy in Hospital Nurseries
Authors: Cabana Michael D. , Aiken Kimberly D. , Clark Sarah J. 
Published: August 2004

Objective. Hepatitis B vaccination (HBV) is unlike any other immunization series because it can be initiated in the hospital nursery. The objective of this study was to describe how hospital nurseries develop HBV policies and to describe the sources of information used for learning about national HBV recommendations.
Methods. A cross-sectional telephone survey was conducted on a national random sample of nursery medical directors of 290 hospital nurseries representing all 50 states. The outcomes measured were methods used by hospital nurseries to develop HBV policy and sources of information used by nursery directors to learn about national HBV recommendations.
Results. Directors at 207 (71%) of 290 eligible nurseries responded. Of the 184 nurseries that have considered developing an HBV policy, the most common method was through a formal committee (43%). In 104 (57%) of these nurseries a nurse was involved in policy development, and in 15 (8%) the nurse manager initiated the process. The most common source of initial information about the July 1999 announcement to suspend the nursery dose of HBV was the American Academy of Pediatrics. The most common initial source of information about the availability of thimerosal-free HBV was pharmaceutical companies. Physician, nurse, and pharmacist colleagues were cited as sources of information with similar frequency (12, 11, and 20 cases, respectively).
Conclusions. Physicians are not the sole initiators and developers of HBV policy in the newborn nursery. Although almost all nurseries designate a physician as a nursery director, in many cases (55% of cases) the position is “rotating” or as part of another administrative position (63% of cases). Many hospital nurseries involve nurses and pharmacists in key roles to stay current with HBV recommendations and to develop subsequent policy. Using nonphysician national organizations as additional channels of information might expedite dissemination about changes in HBV recommendations and, as a result, improve nursery awareness and adoption of national HBV guidelines.
Evaluating Acceptability and Completeness of Overseas Immunization Records of Internationally Adopted Children
Authors: Schulte Joann M. , Maloney Susan , Aronson Jane , Gabriel Pablo San , Zhou Juyan , Saiman Lisa 
Published: August 2004

Background. Increasing numbers of families in the United States are adopting children who were born in other countries. Appropriate immunization of internationally adopted children provides a challenge to pediatricians who must evaluate documentation of vaccines administered overseas and fulfill the recommended US childhood immunization schedule. The acceptability of vaccinations received outside the United States was addressed by the Advisory Committee on Immunization Practices in 1994, but few population-based studies assessing these vaccinations have been reported.Methods. We performed a retrospective cohort study of 504 children who were adopted from other countries and evaluated in 1997 and 1998. Our goal was to determine the acceptability of overseas vaccinations for meeting US immunization requirements. We assessed immunization records for both valid documentation of receipt of vaccine and comparability with the recommended US schedule. We also determined the number of children who were up to date (UTD) for diphtheria-tetanus-pertussis, polio, hepatitis B, and measles-mumps-rubella vaccines under the US schedule.Results. The children’s mean age at initial US evaluation was 19 months; 71% were girls, and most (88%) had resided in orphanages. They were adopted from 16 countries, most frequently from China (48%) and Russia (31%). Thirty-five percent (178) of children had overseas immunization records, 167 (94%) of which were considered valid. Most children with valid records (112 [67%] of 167) were UTD for 1 or more vaccine series under the US schedule.Conclusion. The majority (65%) of internationally adopted children had no written records of overseas immunizations. Among the 178 children with documented overseas immunizations, 167 (94%) had valid records and some vaccine doses that were acceptable and UTD under the US schedule. Additional research and more specific guidance in the most cost-effective approaches to evaluation of overseas vaccinations are needed to ensure appropriate state-side vaccination and to improve the health of these children and their communities.
Relation of Childhood Height to Obesity Among Adults: The Bogalusa Heart Study
Authors: Freedman David S. , Khan Laura Kettel , Mei Zuguo , Dietz William H. , Srinivasan Sathanur R. , Berenson Gerald S. 
Published: August 2004

Objective. In a previous study of the role of various predictors of adult obesity, we found that relatively tall children had a higher body mass index (BMI; kg/m2) in early adulthood. In this study, the objective was to determine whether childhood height is related to adult adiposity and whether the association is independent of childhood levels of BMI and triceps skinfold thickness.Methods. The longitudinal relations of childhood height to relative weight and skinfold (sum of subscapular and triceps) thicknesses in adulthood were examined in a larger sample (N = 1055) of 2- to 8-year-olds who were followed for an average of 18 years.Results. Compared with children whose heights were below the gender- and age-specific median, a child with a height-for-age above the 95th percentile (P) was approximately 2.5 times as likely to have a BMI ≥30 kg/m2 and approximately 5 times as likely to have a skinfold sum &gt;90th P in adulthood. Although height and adiposity were associated (r = 0.29) among children, the observed longitudinal relations persisted after controlling for BMI and the triceps skinfold thickness in childhood. For example, among children with the same BMI, each 10-cm difference in height was associated with differences in adulthood of 0.9 kg/m2 for BMI and 4 mm for the skinfold sum.Conclusions. Although these results need to be confirmed in other studies, it is possible that information on childhood height could be used to identify more accurately children who are likely to be obese in later life.
Cardiopulmonary Manifestations of Fulminant Enterovirus 71 Infection
Authors: Wu Jing-Ming , Wang Jieh-Neng , Tsai Yu-Chien , Liu Ching-Chuan , Huang Chao-Ching , Chen Yung-Jung , Yeh Tsu-Fuh 
Published: August 2004

Background. The pathogenesis of acute pulmonary edema and cardiac collapse after enterovirus 71 (EV71) infection are not completely understood.
Objective. To determine the hemodynamic features and the mechanism of pulmonary edema (PE) after EV71 infection by direct intracardiac monitoring.
Design. Prospective clinical and laboratory study at a tertiary medical center.
Participants. Five consecutive infants, ages 2 to 13 months, with EV71 infection—proved by viral isolation in 4 and antibody in 1—with PE were enrolled. The clinical characteristics were systemically assessed. Hemodynamic profiles were determined every 4 hours by simultaneously implanted pulmonary arterial and central venous catheters during the acute stage.
Results. Magnetic resonance imaging revealed that all 5 infants had brainstem lesions. All patients had tachycardia and hyperthermia. Transient systolic hypertension was noted in 1 patient, and 1 presented with hypotension. Pulmonary artery pressure in all 5 infants was normal or mildly elevated (26–31 mm Hg), and central venous pressure ranged from 10 to 22 mm Hg. Pulmonary artery occlusion pressures were normal or slightly elevated (13–16 mm Hg). Systemic and pulmonary vascular resistances were transiently increased in only 1 patient. The stroke volume index decreased to 15.3 to 35.7 mL/M2 (normal: 30–60 mL/M2), but because of the elevated heart rate, the cardiac index did not decrease. All hemodynamics normalized within days.
Conclusion. Fulminant EV71 infection may lead to severe neurologic complications and acute PE. The acute PE and cardiopulmonary decompensation in EV71 infection are not directly caused by viral myocarditis. The mechanism of PE may be related to increased pulmonary vascular permeability caused by brainstem lesions and/or systemic inflammatory response instead of increased pulmonary capillary hydrostatic pressure.
Polymerase Chain Reaction in the Diagnosis and Prognosis of Mediterranean Visceral Leishmaniasis in Immunocompetent Children
Authors: Cascio Antonio , Calattini Sara , Colomba Claudia , Scalamogna Chiara , Galazzi Morena , Pizzuto Massimo , Camilli Romina , Gramiccia Marina , Titone Lucina , Corbellino Mario , Antinori Spinello 
Published: August 2004

Objective. To assess the usefulness of a polymerase chain reaction (PCR) assay amplifying the small subunit rRNA coding region of Leishmania species performed on peripheral blood (PB) and bone marrow (BM) aspirates for the diagnosis and follow-up of visceral leishmaniasis (VL) in children living in the Mediterranean basin.
Design. A prospective study was conducted on children consecutively hospitalized over a 1-year period at our Infectious Diseases Department in Sicily (Italy) presenting with fever, hepatosplenomegaly, and/or pancytopenia and a positive Leishmania serology (≥1:40).
Results. Among the 14 patients hospitalized with signs and symptoms suggestive of the disease and a positive serology, we identified 10 cases of Mediterranean VL. PCR performed on PB and BM aspirates was positive in all cases and concordant with microscopy and/or culture performed on BM. Leishmania DNA was cleared from PB a median of 6 days after the start of treatment; during follow-up (median: 9 months; range: 6–12 months) 1 child relapsed. In this case, BM PCR remained positive with rapid reappearance of a positive signal also in PB.
Conclusions. PB PCR allows a rapid and noninvasive parasitologic diagnosis of Mediterranean VL among immunocompetent children and is at least as sensitive as a diagnosis made on the basis of BM aspirates. The lack of disappearance from BM and the reappearance of positive PCR on PB is predictive of clinical relapse. Qualitative and semiquantitative PCR may be the standard method for monitoring response to therapy in immunocompetent children.
Bilateral Laparoscopic Adrenalectomy as a Treatment for Classic Congenital Adrenal Hyperplasia Attributable to 21-Hydroxylase Deficiency
Authors: Gmyrek Glenn A. , New Maria I. , Sosa R. E. , Poppas Dix P. 
Published: August 2004

Objective. Current medical therapy for congenital adrenal hyperplasia (CAH) attributable to a complete 21-hydroxylase deficiency is not optimal. Difficulties in adequate adrenal androgen suppression are common, causing short adult stature, infertility, and hyperandrogenism. We report the use of laparoscopic bilateral adrenalectomy as a definitive therapy for this condition and argue that it is superior to conventional medical therapy in selected patients.
Methods. Participants were 2 adult females with classic, salt-wasting CAH and a history of poor adrenal control were selected for adrenalectomy: case 1 was a 22-year-old woman with mild hirsutism and primary amenorrhea; case 2 was a 28-year-old woman with severe hirsutism, acne, and amenorrhea. Preoperative and postoperative hormonal profiles were performed. Both underwent laparoscopic bilateral adrenalectomy with a mean follow-up of 37 months.
Results. Bilateral laparoscopic adrenalectomy was performed in both patients with no complications and an uneventful recovery. Maintenance medications of glucocorticoid and mineralocorticoid replacement were reduced compared with preoperative doses. Three years postoperatively, however, rising adrenal steroid precursor levels in case 1, presumably caused by adrenal rests, prompted an increase in replacement therapy dose. Hirsutism and acne improved in both patients, and regular menstruation began 5 months (case 1) and 2 months (case 2) postoperatively. Pregnancy 3 years postoperatively was successful in case 2, who delivered a unaffected infant, full-term via Cesarian section.
Conclusions. Surgical adrenalectomy should be considered in females with classic CAH attributable to 21-hydroxylase deficiency and a history of poor hormonal control. Adrenalectomy may prove to be superior to current medical therapy for these patients.
Early Excess Weight Gain of Children in the Pima Indian Population
Authors: Lindsay Robert S. , Cook Valerie , Hanson Robert L. , Salbe Arline D. , Tataranni Antonio , Knowler William C. 
Published: August 2004

Objective. To determine the period of childhood in which weight relative to height increases in Pima Indian children and young adults in comparison with the general US population.
Methods. Heights and weights of children in the Pima Indian population were derived from either clinical examinations conducted by the Department of Public Health Nursing (from 1–48 months of age), or from examinations in the National Institutes of Health longitudinal survey of health in the Pima population (for birth and ages 5–20 years), and compared with standards for the US population recently published by the National Center for Health Statistics.
Results. Weight relative to height (weight-for-length in children aged &lt;24 months, body mass index at ages ≥2 years) was significantly higher in Pima children at all ages examined after the first month of life. Compared with reference values, the most dramatic increases in weight relative to height occurred in 2 stages of childhood: mean z scores of weight-for-length increased between 1 month (mean ± SEM: males: −0.2 ± 0.19; females: −0.02 ± 0.14) and 6 months (males: 0.8 ± 0.04; females: 0.7 ± 0.04) of age; mean z scores for body mass index increased gradually between 2 years (males: 0.4 ± 0.06; females: 0.4 ± 0.08) and 11 years (males: 1.4 ± 0.08; females: 1.4 ± 0.08) and remained stable thereafter.
Conclusion. Excessive weight gain occurs early in the Pima population with changes relative to reference values most marked in the first 6 months of life and between 2 and 11 years. Interventions toward primary prevention of obesity may need to be targeted at children rather than adults in this population.
Health-Related Quality of Life of Children and Adolescents After Traumatic Brain Injury
Authors: Stancin Terry , Drotar Dennis , Taylor H. Gerry , Yeates Keith Owen , Wade Shari L. , Minich Nori Mercuri 
Published: August 2004

Objective. Relatively little is known about the longer-term impact of traumatic brain injury (TBI) on children’s daily functioning, especially the broader outcome domain referred to as health-related quality of life (HRQL). The objective of the present study was to examine the nature and predictors of HRQL outcomes in children with moderate to severe TBI an average of 4 years postinjury.Methods. The study used a concurrent cohort-prospective design involving postinjury assessments of 3 groups of traumatically injured children and their families including 42 with severe TBI, 42 with moderate TBI, and 50 with orthopedic injuries only. Parent and child perceptions of HRQL and child adaptive behavior measures were obtained along with parent descriptions of the child’s health problems and use of medical and mental health services. Predictors included indices of injury severity, social factors, and ratings of preinjury child behavior problems and school performance.Results. Based on parent report, adolescents who sustained severe TBI had lower HRQL related to overall psychosocial functioning and in the domains of behavior, mental health, general health, and family impact than adolescents who sustained orthopedic injuries only. Communication skills, daily living skills, and general adaptive functioning also were rated lower in the severe TBI group. In contrast to parent reports, adolescents with severe TBI did not rate their HRQL in most domains differently than did adolescents with orthopedic injuries. There were no group differences in frequency of persistent physical limitations. Sixty-seven percent of families of children with severe TBI used mental health counseling at some point after the injury. Risks for poorer HRQL outcomes were related to family social disadvantage and poorer preinjury child behavioral and academic functioning.Conclusions. Findings underscore the importance of using comprehensive measures of HRQL, along with traditional indicators of functional outcomes, when evaluating the longer-term impact of injuries in children. Identification of predictors suggests the need for close monitoring and intervention of high-risk children.
Use of an Internet-Based Community Surveillance Network to Predict Seasonal Communicable Disease Morbidity
Authors: Hammond Lucinda , Papadopoulos Spyridon , Johnson Candice F. , MaWhinney Samantha , Nelson Bernard , Todd James K. 
Published: August 2004

Objectives. We designed an Internet-based surveillance network that linked community clinic diagnoses with viral isolation rates and admission patterns at a related children’s hospital. We hypothesized that community surveillance would successfully predict subsequent hospital admissions and laboratory viral isolations. Secondarily, we expected the network to monitor trends in disease and that posting this information on a Web site would be useful to physicians in daily practice.
Study Design. Data were collected from December 1999 through August 2000. Information was summarized and posted weekly on a Web site. Active public piloting of the site took place during August 2000, after which the project was evaluated through an electronic mail survey. The predictive ability of the community surveillance data was evaluated by multivariate linear regression.
Results. Increases in the community diagnosis of most syndromes under surveillance, including lower respiratory infections (adjusted R2 = 0.7086) and gastroenteritis (adjusted R2 = 0.6532) successfully predicted an increase in subsequent hospital admissions. Community surveillance also successfully predicted laboratory isolation of associated viral organisms. Physicians completing the evaluation (N = 11) indicated that the site provided information useful in daily practice for both physician and parent education.
Conclusions. An Internet-based surveillance network linking a hospital with community physicians is beneficial to the hospital in predicting waves of severe cases requiring admission and reciprocally provides useful information to physicians in daily practice regarding the incidence and cause of seasonal disease in the community.
Internet Use in Families With Children Requiring Cardiac Surgery for Congenital Heart Disease
Authors: Ikemba Catherine M. , Kozinetz Claudia A. , Feltes Timothy F. , Fraser Charles D. , McKenzie E. Dean , Shah Naeema , Mott Antonio R. 
Published: August 2004

Objective. We sought to document the prevalence of Internet access and usage patterns among families who have children with congenital heart disease presenting for cardiac surgery.
Design. A cross-sectional study was performed utilizing a questionnaire (10 questions) as the study tool. Statistical analysis was performed on all completed questionnaires. The χ2 test was used to evaluate categorical variables and the t test to evaluate continuous variables.
Results. Two hundred seventy-five questionnaires were completed and analyzed. Thirty-seven percent (102/275) of the children had a cyanotic congenital heart defect. There were 21 children with Trisomy 21. Fifty-eight percent (160/275) of families had access to the Internet. The most common locations for accessing the Internet were home (80%; 129/160) and work (51%; 82/160). There were no significant differences in Internet access with regards to underlying individual congenital heart defect, cyanotic versus acyanotic heart defects, or congenital heart defects with functional univentricular hearts versus biventriuclar hearts. Families with older children (12–24 years) were more likely to have Internet access. Families of children undergoing placement of a right ventricle to pulmonary artery conduit were more likely to have Internet access.
Of the 160 families with Internet access, 58% (93/160) used the Internet to obtain information related to their child’s cardiac diagnosis. Eighty-two percent (76/93) characterized locating cardiology-related information as easy. Six parents created interactive personal Web sites specifically related to their child’s congenital heart defect. Although families with older patients (12–24 years) were more likely to have access to the Internet, this did not translate into greater use of the Internet to obtain cardiology-related information. Among families who accessed the Internet for cardiology-related information, 95% (88/93) of families characterized the information as helpful or very helpful in furthering the understanding of their child’s heart defect.
Conclusion. Families are utilizing the Internet to educate themselves about congenital heart disease. Most parents consider the process easy and the information obtained helpful to the understanding of their child’s congenital heart defect and surgery. Internet use in this patient population is expected to increase. Our vigilance in providing accurate Internet references, as well as in identifying inaccurate Internet information available to our patients and their parents, is of paramount importance.