bluuebunny/crossref_metadata_2025_split huggingface dataset:
Headache and Backache After Lumbar Puncture in Children and Adolescents: A Prospective Study
Authors: Ebinger Friedrich , Kosel Christina , Pietz Joachim , Rating Dietz 
Published: August 2004

Objective. After lumbar puncture, many adults develop headaches or backaches. Postpuncture complaints are believed to be rare in children and adolescents, but their exact incidence is unclear because there is a paucity of data derived from general pediatric patients. In a prospective study of general pediatric and neuropediatric patients, we investigated the frequency of postlumbar puncture headaches or backaches and factors that might influence their occurrence.
Methods. Conducted over 12 months, the prospective study included 112 patients aged 2 to 16 years. We evaluated them for factors that might influence the rate of postpuncture complaints: age, gender, use of local anesthesia, cannula gauge, bevel orientation, number of puncture attempts, volume of cerebrospinal fluid (CSF) aspirated, and cell count in CSF.
Results. Twenty-seven percent of the patients experienced headaches (positional headache in 9%), and 40% developed backache. Frequency of complaints increased in relation to patients' age. In older children, girls reported complaints more frequently than did boys. Patients with higher cell counts in CSF had more frequent headaches than did patients without pleocytosis. Cannula gauge or bevel orientation did not influence outcome.
Conclusion. The frequency of positional and nonpositional headaches after lumbar puncture is lower in children than in adults. Backaches contribute significantly to postpuncture morbidity. With puberty, the incidences of postpuncture complaints increase, and girls start to become more prone to develop postpuncture headaches. Recommendations regarding cannula gauge or bevel orientation that derive from studies in adults are not confirmed for children.
Impact of Early Newborn Discharge Legislation and Early Follow-up Visits on Infant Outcomes in a State Medicaid Population
Authors: Meara Ellen , Kotagal Uma R. , Atherton Harry D. , Lieu Tracy A. 
Published: August 2004

Objective. Scant information exists on the effects of legislation mandating coverage of minimum postnatal hospital stays on infant health outcomes. There are also gaps in knowledge regarding the effectiveness of early follow-up visits for newborns. The objective of this study was to determine the impact of 1) legislation mandating coverage of minimum postnatal hospital stays and 2) early follow-up visits by the age of 4 days on infant outcomes during the first month of life.
Methods. A retrospective analysis was conducted of Ohio Medicaid claims data linked with birth certificate data for the period 1991-1998. The impact of the legislation was evaluated using interrupted time-series analysis of health-related utilization. The effects of early follow-up visits for vaginally delivered newborns with short stays were analyzed using the day of the week on which the birth occurred (eg, Monday, Tuesday) as an instrumental variable to account for potential confounding. A total of 155 352 full-term newborns who were born to mothers who receive Medicaid were studied. The main outcomes measured were rehospitalizations, emergency department (ED) visits, and diagnoses of dehydration and infection within 10 and 21 days of birth.
Results. Few outcomes exhibited significant changes after legislation mandating coverage of minimum postnatal hospital stays. Rates of rehospitalization for jaundice within 10 days of birth fell from 0.78% to 0.47% in the year after legislation was introduced but leveled off after the legislation took effect. Rates of ED visits within 21 days increased from 6.0% to 10.4% during periods of increasing short stay but fell to 8.0% during the year after introduction of the legislation and leveled off when the legislation took effect. Rates of all-cause rehospitalization, dehydration, and infection diagnoses showed no consistent relationship to Ohio's legislation. Using instrumental variable analysis, newborns who received early follow-up visits were significantly less likely to have rehospitalizations within the first 10 days of life than those who did not.
Conclusions. In this state Medicaid population, legislation mandating coverage of minimum postnatal hospital stays was associated with reductions in the rates of rehospitalization for jaundice and ED visits. For newborns with short stays, early follow-up visits may reduce rehospitalizations in the early postpartum period.
Evaluation of a New Transcutaneous Bilirubinometer
Authors: Maisels M. Jeffrey , Ostrea Enrique M. , Touch Suzanne , Clune Sarah E. , Cepeda Eugene , Kring Elizabeth , Gracey Karin , Jackson Cheryl , Talbot Deborah , Huang Raywin 
Published: August 2004

Objective. The objective of this study was to evaluate the Minolta/Hill-Rom Air-Shields Transcutaneous Jaundice Meter model JM-103.
Methods. We studied a convenience sample of 849 newborns ≥35 weeks of gestation in 3 hospitals. These infants had total serum bilirubin (TSB) levels measured on clinical indication, and transcutaneous bilirubin (TcB) levels were obtained within 1 hour of the TSB levels. The population was 59.2% white, 29.8% black, 4.5% East Asian, 3.8% Middle Eastern, 1.6% Indian/Pakistani, and 1.1% Hispanic.
Results. There was a close correlation between TSB and TcB values in all of the population groups: white (n = 503, r = .949); black (n = 253, r = .822); and East Asian, Indian/Pakistani, and Hispanic (n = 93, r = .926). In the black population, the correlation was less close than in the other groups, and differences between the TcB and TSB measurements tended to increase with rising TSB values. JM-103 values differed from TSB values by 3 mg/dL or more in 2% of white, 3.2% of other, and 17.4% of black infants. In these black infants, the JM-103 value was always greater than the TSB value.
Conclusions. We conclude that TcB measurements using the JM-103 jaundice meter correlate very closely with TSB levels over the range of TSB encountered in this study. Because only 3.3% of our infants had TSB values &gt;15 mg/dL (257 μmol/L), more data are needed in this range of TSB concentration. The correlation in black infants is not as close as in other groups, but because the tendency in blacks is for the JM-103 to overestimate serum bilirubin levels, dangerous clinical errors are unlikely to occur. The measurement technique is rapid and simple, and it is easy to perform repeated measurements over time, thus reducing the likelihood of error. TcB measurements with the JM-103 jaundice meter should obviate the need for most serum bilirubin levels in newborn infants ≥35 weeks of gestation, although serum bilirubin measurements are still required when treatment with phototherapy or exchange transfusion is being considered.
Transcutaneous Bilirubin Measurements and Serum Total Bilirubin Levels in Indigenous African Infants
Authors: Slusher Tina M. , Angyo Ishaya A. , Bode-Thomas Fidela , Akor Francis , Pam Sunday D. , Adetunji Adedotun A. , McLaren Donald W. , Wong Ronald J. , Vreman Hendrik J. , Stevenson David K. 
Published: August 2004

Objective. The objective of this study was to determine whether transcutaneous bilirubin (TcB) measurements correlate with serum total bilirubin (STB) levels in indigenous, darkly pigmented African newborns with varying degrees of skin pigmentation, some of which had developed kernicterus.
Methods. Jaundiced infants who were ≤2 weeks of age and admitted to Baptist Medical Center-Eku (Eku; n = 29) and Jos University Teaching Hospital (Jos; n = 98) in Nigeria were studied. TcB measurements using the BiliChek were made simultaneously with blood sampling for STB measurements by spectrophotometry before phototherapy.
Results. Using linear regression analysis, we found that measurements of TcB correlated well with those of STB with r values of .90 and .88 for Eku and Jos, respectively. Mean bias and imprecision of TcB measurements as compared with STB measurements for the total population was 0.5 ± 7.6 mg/dL using the method of Bland and Altman. At STB ≥12 mg/dL, correlation (r = .84) and bias and imprecision (−1.2 ± 8.6 mg/dL) of measurements were only slightly poorer. Furthermore, when infants were grouped by degree of skin pigmentation, correlations of TcB and STB measurements remained strong.
Conclusions. From these results, we can conclude that TcB measurements are a useful and reliable index for estimating STB levels in pigmented neonates, including those with hyperbilirubinemia and kernicterus. In the absence of reliable STB measurements, the relatively simple and noninvasive TcB measurements can be an important adjunct in directing phototherapy and exchange transfusions, thereby preventing bilirubin-induced morbidity and mortality in low-technology clinical environments.
Trends in the Incidence of Severe Retinopathy of Prematurity in a Geographically Defined Population Over a 10-Year Period
Authors: Hameed Biju , Shyamanur Kallinath , Kotecha Sailesh , Manktelow Bradley N. , Woodruff G. , Draper Elizabeth S. , Field David 
Published: August 2004

Objective. To examine trends in the incidence of severe (≥grade 3) retinopathy of prematurity (ROP) in infants with birth weight of ≤1250 g in a geographically defined population over a 10-year period.Methods. An observational study was conducted of all infants who had a birth weight ≤1250 g and were born to mothers who were resident in the county of Leicestershire, United Kingdom, during the period January 1, 1990, to December 30, 1999. Cases were identified by the Trent Neonatal Survey. The incidence of severe ROP (≥grade 3) was compared in 2 successive 5-year periods: 1990–1994 and 1995–1999.Results. Comparing the first 5-year period (1990–1994) with the second (1995–1999), the total number of live births fell (60 789 vs 56 564). However, there was a significant increase in the number of births with birth weight ≤1250 g (including live and dead; 615 vs 734; live births only: 455 vs 556). Survival to 42 weeks of infants who were born at ≤1250 g was significantly better in the latter time period (203 vs 302; odds ratio [OR] for death: 0.54; 95% confidence interval [CI]: 0.39–0.75). The number of cases of severe ROP was 4 times higher during the second time period compared with the first (9 vs 36). A significantly increased risk for the development of severe ROP was seen during the second time period (OR: 2.92; 95% CI: 1.37–6.20). Even after allowing for the change in gestation induced by the improved survival during the second time period, the increased risk remained (OR: 2.81; 95% CI: 1.27–6.21).Conclusions. There is strong evidence that the incidence of severe ROP among infants with birth weight ≤1250 g increased in the latter half of the last decade. The increased risk seems to be independent of the increase in survival.
Does Valsalva Retinopathy Occur in Infants? An Initial Investigation in Infants With Vomiting Caused by Pyloric Stenosis
Authors: Herr Sandra , Pierce Mary C. , Berger Rachel P. , Ford Henri , Pitetti Raymond D. 
Published: August 2004

Objective. Retinal hemorrhages (RHs) are 1 manifestation of child abuse, and although they often are considered to be diagnostic of abuse in a young child, there are other potential causes. RHs have been described in association with valsalva maneuver, such as forceful vomiting or coughing. Our aim was to describe the incidence of RH in infants with vomiting caused by pyloric stenosis.Methods. A prospective, descriptive study was conducted of infants who underwent pyloromyotomy for hypertrophic pyloric stenosis (HPS). Dilated retinal examinations were performed, and the findings were documented.Results. A total of 100 infants with HPS were evaluated. Eighty-four infants were male, 92 were white, and 21 had a family history of pyloric stenosis. Thirty-seven examinations were performed in the operating room. Eighteen examinations were confirmed by a second investigator, and 3 children had dilated eye examinations documented independently by a pediatric ophthalmologist. No RHs were identified (0 of 100; 95% confidence interval: 0%–3%). One patient had facial petechiae, and 2 had subconjunctival hemorrhage. Electrolyte levels were abnormal in 63 patients. In 89 cases, the emesis was described as projectile. Patients varied in the number of episodes of emesis, with 30% of patients having &gt;100 episodes of emesis before diagnosis. One patient had a respiratory arrest associated with vomiting in the emergency department and required bag-valve mask ventilation.Conclusions. No RHs were identified in 100 infants with vomiting caused by HPS. These results suggest that RHs do not result from forceful vomiting in infants.
Serious Bacterial Infections in Febrile Infants 1 to 90 Days Old With and Without Viral Infections
Authors: Byington Carrie L. , Enriquez F. Rene , Hoff Charles , Tuohy Richard , Taggart E. William , Hillyard David R. , Carroll Karen C. , Christenson John C. 
Published: August 2004

Objective. The risk of serious bacterial infection (SBI) in febrile infants who are classified as low risk (LR) or high risk (HR) by the Rochester criteria has been established. LR infants average a 1.4% occurrence of SBI, whereas HR infants have an occurrence of 21%. The occurrence of SBI in Rochester LR or HR infants with confirmed viral infections is unknown. The objective of this study was to determine the occurrence of SBI in Rochester LR and HR infants with and without viral infections.
Methods. All febrile infants who were 90 days or younger and evaluated at Primary Children’s Medical Center between December 1996 and June 2002 were eligible. Infants were classified as Rochester LR or HR, and discharge diagnoses were collected. Viral testing for enteroviruses, respiratory viruses, rotavirus, and herpesvirus was performed as indicated by study protocol, clinical presentation, and season of the year. Results of all bacterial cultures were reviewed.
Results. Of 1779 infants enrolled, 1385 (78%) had some form of viral diagnostic testing and 491 (35%) had 1 or more viruses identified. By the Rochester criteria, 456 (33%) infants were classified as LR and 922 (67%) infants as HR. For infants with viral infections, the occurrence of SBI was significantly lower than in infants without a viral infection (4.2% vs 12.3%). Rochester HR virus-positive (HR+) infants had significantly fewer bacterial infections than HR virus-negative (HR−) infants (5.5% vs 16.7%). When compared with HR− infants, HR+ infants were less likely to have bacteremia, urinary tract infection, or soft tissue infections, and HR+ infants had a similar occurrence of bacteremia as LR infants (0.92% vs 1.97%).
Conclusions. Febrile infants with confirmed viral infections are at lower risk for SBI than those in whom a viral infection is not identified. Viral diagnostic data can positively contribute to the management of febrile infants, especially those who are classified as HR.
How Informative Are Parent Reports of Attention-Deficit/Hyperactivity Disorder Symptoms for Assessing Outcome in Clinical Trials of Long-Acting Treatments? A Pooled Analysis of Parents’ and Teachers’ Reports
Authors: Biederman Joseph , Faraone Stephen V. , Monuteaux Michael C. , Grossbard Joel R. 
Published: August 2004

Objective. The validity of parent reports of children’s attention-deficit/hyperactivity disorder (ADHD) symptoms has been questioned, especially in clinical trials. Some advocate the exclusive use of teacher reports, maintaining that parent reports are not sensitive to changes in ADHD symptoms. This study compares the ability of parent and teacher reports to document change during clinical trials of long-acting treatments.Methods. We conducted a literature search of Medline to identify any published clinical trials in pediatric ADHD that met the following criteria: 1) used a randomized design, 2) examined the efficacy of long-acting agents or standard formulations using 3-times-a-day dosing, and 3) used both parent and teacher reports of the same measure of ADHD symptoms as a study outcome. For each measurement of ADHD symptoms, we calculated effect sizes for parent and teacher reports.Results. Three large, randomized, controlled clinical trials were identified (N = 1445 subjects). For every outcome for which teacher reports documented significant improvement, parent reports did also. Pooled analysis revealed a larger effect captured by the parent report relative to the teacher report.Conclusion. Results suggest that parent reports are at least as sensitive to detecting change in ADHD symptoms as teacher reports in clinical trials that assess the efficacy of long-acting agents. These results suggest that parent reports are informative for detecting change during treatment of children with ADHD.
Range of Neurologic Disorders in Patients With Celiac Disease
Authors: Zelnik Nathanel , Pacht Avi , Obeid Raid , Lerner Aaron 
Published: August 2004

Objective. During the past 2 decades, celiac disease (CD) has been recognized as a multisystem autoimmune disorder. A growing body of distinct neurologic conditions such as cerebellar ataxia, epilepsy, myoclonic ataxia, chronic neuropathies, and dementia have been reported, mainly in middle-aged adults. There still are insufficient data on the association of CD with various neurologic disorders in children, adolescents, and young adults, including more common and “soft” neurologic conditions, such as headache, learning disorders, attention-deficit/hyperactivity disorder (ADHD), and tic disorders. The aim of the present study is to look for a broader spectrum of neurologic disorders in CD patients, most of them children or young adults.
Methods. Patients with CD were asked to fill in a questionnaire regarding the presence of neurologic disorders or symptoms. Their medical charts were reviewed, and those who were reported as having neurologic manifestations underwent neurologic examination and brain imaging or electroencephalogram if required. Their neurologic data were compared with that of a control group matched for age and gender.
Results. Patients with CD were more prone to develop neurologic disorders (51.4%) in comparison with control subjects (19.9%). These disorders include hypotonia, developmental delay, learning disorders and ADHD, headache, and cerebellar ataxia. Epileptic disorders were only marginally more common in CD. In contrast, no difference was found in the prevalence of tic disorders in both groups. Therapeutic benefit, with gluten-free diet, was demonstrated only in patients with transient infantile hypotonia and migraine headache.
Conclusion. This study suggests that the variability of neurologic disorders that occur in CD is broader than previously reported and includes “softer” and more common neurologic disorders, such as chronic headache, developmental delay, hypotonia, and learning disorders or ADHD. Future longitudinal prospective studies might better define the full range of these neurologic disorders and their clinical response to a gluten-free diet.
The Maternal Lifestyle Study: Cognitive, Motor, and Behavioral Outcomes of Cocaine-Exposed and Opiate-Exposed Infants Through Three Years of Age
Authors: Messinger Daniel S. , Bauer Charles R. , Das Abhik , Seifer Ron , Lester Barry M. , Lagasse Linda L. , Wright Linda L. , Shankaran Seetha , Bada Henrietta S. , Smeriglio Vincent L. , Langer John C. , Beeghly Marjorie , Poole W. Kenneth 
Published: August 2004

Objective. To evaluate the direct effects of prenatal cocaine exposure and prenatal opiate exposure on infant mental, motor, and behavioral outcomes longitudinally between 1 and 3 years old.Methods. As part of a prospective, longitudinal, multisite study, the Bayley Scales of Infant Development II were administered to 1227 infants who were exposed to cocaine (n = 474), opiates (n = 50), cocaine and opiates (n = 48), and neither substance (n = 655) at 1, 2, and 3 years of corrected age by certified, masked examiners. Hierarchic linear modeling of the 1-, 2-, and 3-year scores was conducted using cocaine and opiate exposure as predictors with and without controlling for covariates.Results. Overall retention was 88.4% and did not differ by cocaine or opiate exposure. Overall (at 1, 2, and 3 years), cocaine-exposed infants scored 1.6 Mental Development Index points below infants who were not exposed to cocaine. Opiate-exposed infants scored 3.8 Psychomotor Development Index points below infants who were not exposed to opiates. Neither the cocaine nor the opiate effect remained significant after controlling for covariates. Neither cocaine nor opiate exposure was associated with the Behavioral Record Score during the examination. Low birth weight and indices of nonoptimal caregiving were associated with lower Mental Development Index, Psychomotor Development Index, and Behavioral Record Score scores for all groups of infants.Conclusions. In the largest at-risk sample observed longitudinally to date, infant prenatal exposure to cocaine and to opiates was not associated with mental, motor, or behavioral deficits after controlling for birth weight and environmental risks.
Nonfatal and Fatal Firearm-Related Injuries Among Children Aged 14 Years and Younger: United States, 1993–2000
Authors: Eber Gabriel B. , Annest Joseph L. , Mercy James A. , Ryan George W. 
Published: August 2004

Objective. To provide national estimates of fatal and nonfatal firearm-related (FA) injuries among children ≤14 years old and to examine the circumstances under which these injuries occurred.
Methods. For nonfatal FA injuries among children, we analyzed data on emergency department (ED) visits from the National Electronic Injury Surveillance System for 1993 through 2000. National estimates of injured children who were treated in hospital EDs were examined by selected characteristics, such as age, gender, race/ethnicity of the patient, primary body part affected, intent of the injury, the relationship of the shooter to the patient, where the injury occurred, and activity at the time of injury. For fatal FA injuries among children, we analyzed mortality data from the National Vital Statistics System for 1993 through 2000. Data from both sources were used to calculate case-fatality rates.
Results. From 1993 through 2000, an estimated 22 661 (95% confidence interval [CI]: 16 668–28 654) or 4.9 per 100 000 (95% CI: 3.6–6.2) children ≤ 14 years old with nonfatal FA injuries were treated in US hospital EDs. Assaults accounted for 41.5% of nonfatal FA injuries, and unintentional injuries accounted for 43.1%. Approximately 4 of 5 children who sustained a nonfatal, unintentional FA injury were reportedly shot by themselves or by a friend, a relative, or another person known to them. During this period, 5542, or 1.20 per 100 000 (95% CI: 1.17, 1.23), children ≤14 years old died from FA injuries; 1 of every 5 children who were wounded by a firearm gunshot died from that injury. Most FA deaths were violence related, with homicides and suicides constituting 54.7% and 21.9% of these deaths, respectively. For individuals ≤14 years old, the burden of morbidity and mortality associated with FA injuries falls disproportionately on boys, blacks, and children 10 to 14 years old. Both fatal and nonfatal injury rates declined &gt;50% during the study period.
Conclusions. Although rates of nonfatal and fatal FA injuries declined during the period of study, FA injuries remain an important public health concern for children. Well-designed evaluation studies are needed to examine the effectiveness of potential interventions aimed at reducing FA injuries among children.