bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neurocognitive Sequelae of Scaphocephaly
Authors: Virtanen Riitta , Korhonen Tapio , Fagerholm Janita , Viljanto Jouko 
Published: August 2004

Objective.Early cranioplasty for scaphocephaly has become routine in most countries. In addition to normalizing the shape of the skull, it has been found to decrease intracranial hypertension. Whether corrective surgery benefits the child's cognitive outcome has been poorly documented.Design.Eighteen children whose sagittal suture showed premature fusion at birth or soon thereafter were operated on at age 1 week to 7 months. All patients healed without complications and were followed-up at regular intervals. At the age of 7.8 to 16.3 years they were examined to clarify their neurocognitive development and to compare the results with their age- and gender-matched healthy controls.Results.Originally scaphocephalic children, although operated on, had mild deficiencies in auditory short-term memory and language development when examined with the general comprehension, similarities, and digit span subscales of the Wechsler Intelligence Scale for Children–Revised. In all other respects their developmental outcome was equal to that of the controls.Conclusions.Despite relative early correction of the skull shape, originally scaphocephalic children's neurocognitive performances do not reach the same level in all of the neurocognitive domains as their matched controls at school age. Early operation (≤1 month) may decrease this developmental delay. This implies that impairment of brain function has already taken place in utero. For the same reason an early operation seems to be justified not only for correction of the skull shape, but also to allow unrestricted development for the brain. Postponement of the operation would not serve either of these aims.
Nosocomial Infections in Pediatric Intensive Care Units in the United States
Authors: Richards Michael J. , Edwards Jonathan R. , Culver David H. , Gaynes Robert P. ,   the National Nosocomial Infections Surveillance System
Published: August 2004

Objectives.
To describe the epidemiology of nosocomial infections in pediatric intensive care units (ICUs) in the United States.

Background.
Patient and ICU characteristics in pediatric ICUs suggest the pattern of nosocomial infections experienced may differ from that seen in adult ICUs.

Methods.
Data were collected between January 1992 and December 1997 from 61 pediatric ICUs in the United States using the standard surveillance protocols and nosocomial infection site definitions of the National Nosocomial Infections Surveillance System's ICU surveillance component.

Results.
Data on 110 709 patients with 6290 nosocomial infections were analyzed. Primary bloodstream infections (28%), pneumonia (21%), and urinary tract infections (15%) were most frequent and were almost always associated with use of an invasive device. Primary bloodstream infections and surgical site infections were reported more frequently in infants aged 2 months or less as compared with older children. Urinary tract infections were reported more frequently in children &gt;5 years old compared with younger children. Coagulase-negative staphylococci (38%) were the most common bloodstream isolates, and aerobic Gram-negative bacilli were reported in 25% of primary bloodstream infections. Pseudomonas aeruginosa (22%) was the most common species reported from pneumonia and Escherichia coli (19%), from urinary tract infections. Enterobacter spp. were isolated with increasing frequency from pneumonia and were the most common Gram-negative isolates from bloodstream infections. Device-associated infection rates for bloodstream infections, pneumonia, and urinary tract infections did not correlate with length of stay, the number of hospital beds, or season.

Conclusions.
In pediatric ICUs, bloodstream infections were the most common nosocomial infection. The distribution of infection sites and pathogens differed with age and from that reported from adult ICUs. Device-associated infection rates were the best rates currently available for comparisons between units, because they were not associated with length of stay, the number of beds in the hospital, or season.
Zinc Supplementation in Malnourished Children With Persistent Diarrhea in Pakistan
Authors: Bhutta Zulfiqar Ahmed , Nizami Shaikh Qamaruddin , Isani Zeenat 
Published: August 2004

Objective.To evaluate the potential benefit of dietary supplementation of a rice-lentil (Khitchri) and yogurt diet with 3 mg/kg/d of elemental zinc (as zinc sulfate) in hospitalized malnourished children (age 6–36 months) with persistent diarrhea for 14 days.Methodology.Randomized, double-blind placebo-controlled trial.Setting.Nutrition Research Ward at the National Institute of Child Health, Karachi, Pakistan, where children were admitted for 14 days of inpatient supervised rehabilitation.Main Outcome Measures.Primary outcome: overall weight gain by day 14. Secondary outcomes: overall energy intake, stool output, time to diarrheal recovery and weight gain (≥3 days), plasma zinc, copper, prealbumin, and insulin-like growth factor-1.Results.Of 87 children randomized for supplementation with either zinc or placebo, the two groups were comparable at admission in terms of severity and duration of diarrhea, as well as nutritional and anthropometric parameters. The overall weight gain, stool volume, stool frequency, as well as the time taken for diarrheal recovery or steady weight gain, were comparable for both supplemented children and controls. Supplemented children had a significant improvement in plasma zinc levels and serum alkaline phosphatase by day 14 of therapy in comparison with controls. Plasma copper levels were low in both groups at admission and although an increase was seen in control children, levels decreased further after zinc supplementation. There was no significant difference between the two groups for hemoglobin, serum albumin, prealbumin, and plasma insulin-like growth factor-1 increments during the course of therapy. Evaluation of primary and secondary outcome criteria among the subset of children with plasma zinc levels &lt;60 μg/d at admission did not reveal any significant differences.Conclusions.Although there was satisfactory recovery in malnourished children with persistent diarrhea receiving the Khitchri-yogurt diet, there was no evidence of improved weight gain or acceleration of recovery from diarrhea with zinc supplementation. In contrast, the reduction in plasma copper levels in zinc-supplemented malnourished children suggests that caution should be exercised in supplementing severely malnourished children with zinc alone.
Anaphylactic Reaction to Oral Cefaclor in a Child
Authors: Grouhi Masoud , Hummel David , Roifman Chaim M. 
Published: August 2004

Adverse drug reactions are a common clinical problem. It has been estimated1 that 6% to 15% of hospitalized patients experience some sort of adverse drug reaction. Clinical manifestations of adverse drug reactions include skin rash; a serum sickness-like reaction; drug fever; pulmonary, hepatic, and renal involvement; and systemic anaphylaxis. Many of these adverse events are not immunologically mediated. Actual allergic or immunologic drug reactions probably account for &lt;25% of adverse drug reactions overall.1
Antibiotics are one of the major contributors to drug hypersensitivity. Cefaclor, an oral second-generation cephalosporin with a β-lactam ring, is used against various infectious diseases of the respiratory tract, especially in children. Several cases of cefaclor hypersensitivity have been reported.2,3 The most common presentations are either erythematous or papular eruptions, although serum sickness-like reactions have also been described. Anaphylactic reactions, although rare, have been observed in adults. Here we report a case of anaphylactic reaction to cefaclor in a 2½-year-old patient.
Intravenous Catheter Blood Cultures: Utility and Contamination
Authors: McQuillen Kemedy K. , Santucci Karen A. , Conrad Margaret A. , Nelson David G. , Lewander William , Duffy Susan J. , Anderson Angela C. 
Published: August 2004

Objective.
In pediatrics, blood cultures (BCs) are often drawn as intravenous (IV) catheters are placed. This routine minimizes the number of painful and often difficult punctures a child must undergo but results in the discarding of multiple BC bottles when these cultures are later determined to be unnecessary. If the contamination rate of BCs drawn through an indwelling IV did not exceed the contamination rate of BCs drawn at the time of IV placement, BCs could be drawn from the IV without subjecting the patient to another venipuncture. This study was done to compare the contamination rates of BCs drawn by these two methods. Additionally, we sought to determine if the collection of two BCs enhances pathogen recovery.

Methods.
Prospective comparison of contamination and bacteremia rates of BCs drawn by two different methods: the first BC was drawn at the time of IV line placement and the second BC was drawn from the previously placed IV at a later time.

Setting.
Urban pediatric emergency department with an annual census of 40 000.

Participants.
One thousand five hundred sixty-four patients between the ages of 3 days and 22.1 years. The median age was 2.2 years. Sixty-four patients were excluded because we were unable to draw the second BC. Forty-six percent of eligible patients (n = 690) were girls.

Results.
Fifty-seven (1.9%) of 3000 grew contaminants: 27 in the first and 30 in the second BC for contamination rates of 1.8% and 2.0%. Thirty-eight (1.3%) of 3000 BCs grew pathogens: 24 represent 12 patients with growth in two out of two cultures and 14 represent 14 patients with growth in one out of two cultures. Pathogen rates were 1.1% (16/1500) with one BC per patient and 1.7% (22/1500) with two BCs per patient.

Conclusions.
There is no difference in the contamination rates of two BCs drawn from the same site at two different times. The collection of two BCs per patient may enhance pathogen recovery.
Fetal Therapy—Ethical Considerations
Authors:   Committee on Bioethics
Published: August 2004

This Policy Statement was retired October 2006.
Decisions to undertake fetal therapy involve a complex assessment of the best interests of the fetus and a pregnant woman's interest in her own health and freedom from unwanted invasion of her body. Pregnant women almost always accept a recommendation for fetal therapy that is approached collaboratively, especially if the therapy is of proven efficacy and has a low maternal risk. Fetal therapy of unproven efficacy should only be undertaken as part of an approved research protocol. In recommending fetal therapy of proven efficacy, physicians should respect maternal choice and assessment of risk. Under limited circumstances when fetal therapy would be effective in preventing irrevocable and substantial fetal harm with negligible risk to the health and well-being of the pregnant woman, should the pregnant woman be opposed to the intervention, physicians should engage in a process of communication and conflict resolution that may require consultation from an ethics committee and, in rare cases, require judicial review. A physician should never intervene without the woman's explicit consent before judicial review.
Association Between Diabetes Control and Visits to a Multidisciplinary Pediatric Diabetes Clinic
Authors: Kaufman Francine Ratner , Halvorson Mary , Carpenter Sue 
Published: August 2004

Objective.
To determine if there is a relationship between diabetes outcome as measured by HbA1C and the number of multidisciplinary clinic visits per year in children and youth with diabetes.

Research Design and Methods.
The number of clinic visits per year, the mean HbA1C (by DCA 2000, Miles, Tarrytown, NY), type of insurance, parental marital status, parental age, maximal parental grade level achieved, family income, self-identified race, and scores on adherence and knowledge tests were compared for 1995 in 360 patients with a mean age of 11.6 ± 4.8 years (1–2 visits, 85 patients; 3–4 visits, 275 patients), for 1996 in 412 patients with a mean age of 11.6 ± 4.7 years (1–2 visits, 115 patients; 3–4 visits, 297 patients), and for 1997 in 442 patients with a mean age of 11.8 ± 4.9 years (1–2 visits, 126 patients; 3–4 visits, 332 patients).

Results.
There was a significant difference in the mean HbA1C levels between subjects with 1 to 2 visits versus 3 to 4 visits during the 3 years of this study. In 1995, the mean HbA1C was 9.0 ± 2.0% for subjects with 1 to 2 visits and 8.3 ± 1.6% for subjects with 3 to 4 visits. In 1996, the mean HbA1C was 9.3 ± 2.0% for subjects with 1 to 2 visits and 8.4 ± 1.6% in those with 3 to 4 visits, whereas in 1997, the mean HbA1C was 9.1 ± 1.9% with 1 to 2 visits and 8.3 ± 1.5% with 3 to 4 visits. There was a significant difference in the number of visits by the age of the subject. The mean age of patients with 1 to 2 visits was 13.6 ± 4.5 years; it was 10.8 ± 4.6 years with 3 to 4 visits. However, for age groups &lt;13 years versus ≥13 years, there was still a difference between HbA1C levels for subjects with 1 to 2 visits compared with 3 to 4 visits (8.9 ± 1.7% versus 8.1 ± 1.3%, respectively). The only patient/family characteristic that had an association with number of visits was the marital status of the parents. Children from single-parent households had fewer visits. There was no association between health insurance status and number of visits and there was no difference between the number of visits and the mean scores on tests of adherence or knowledge. Multivariate analysis showed that the number of visits was a significant predictor of HbA1C even after controlling for age, duration of diabetes, and scores on adherence and knowledge tests.

Conclusions.
The finding that subjects with more frequent visits to a multidisciplinary diabetes clinic had lower HbA1C levels during the 3 years of this study suggests that strategies should be developed to promote adherence with quarterly visits, particularly targeted to children from single-parent households and to teens.
Characterization of Lyme Meningitis and Comparison With Viral Meningitis in Children
Authors: Eppes Stephen C. , Nelson David K. , Lewis Linda L. , Klein Joel D. 
Published: August 2004

Objectives.The objectives of this study were to characterize Lyme meningitis (LM) in the pediatric population; to compare LM with viral meningitis (VM) with respect to epidemiology, history and physical examination, and laboratory data; and to provide means of early distinction of Lyme neuroborreliosis from other forms of aseptic meningitis.Methods.This retrospective analysis involved children admitted to Alfred I. duPont Hospital for Children between 1990 and 1996 whose discharge diagnoses indicated viral or aseptic meningitis or Lyme disease. LM was defined as the presence of cerebrospinal fluid (CSF) pleocytosis with positive Lyme serology and/or erythema migrans. Patients were considered to have VM if they exhibited CSF pleocytosis and had a positive viral culture. Demographic, clinical, and laboratory data were collected for each patient, and patients with LM were compared with age-matched patients with VM.Results.Of 179 patient records, 12 patients with LM and 10 patients with VM (all, &gt;2 years old) were identified by using the above criteria. In comparing LM patients with VM patients, we noted no differences among demographic variables. Children with LM had significantly lower temperatures at the time of presentation. The presence of headache, neck pain, and malaise was similar for the two groups, but the duration of these symptoms was significantly longer among LM patients. Five children with LM had cranial neuropathies. All but 1 LM patient exhibited either papilledema, erythema migrans, or cranial neuropathy. These three findings were absent in the VM group. On CSF analysis, LM patients had fewer white blood cells (mean, 80/mm3 versus 301/mm3) and a significantly greater percentage of mononuclear cells than the VM patients.Conclusions.In this study, in a Lyme-endemic area, LM was about as common as VM in older children who were hospitalized with aseptic meningitis. Attention to pertinent epidemiologic and historical data, along with physical and CSF findings, allows early differentiation of LM from VM.
Genetic and Environmental Influences on Human Cord Blood Leptin Concentration
Authors: Tarquini Brunetto , Tarquini Roberto , Perfetto Federico , Cornélissen Germaine , Halberg Franz 
Published: August 2004

Objective.
To examine in a population sample of cord blood the time structure (chronome) of leptin, an adipocyte-derived hormone, and to assess any effect of a familial history of noninsulin-dependent diabetes mellitus and obesity, separately, on both the maternal and the paternal side.

Subjects and Methods.
Leptin concentration was determined in cord blood from 93 infants. Effects of gender, gestational age, birth weight, maternal weight, familial antecedents of obesity and noninsulin-dependent diabetes mellitus, and circadian and about-yearly stage were assessed by linear regression and ANOVA.

Results.
Cord blood leptin concentration is elevated in the presence of a family history of obesity on the paternal side, but not on the maternal side. Leptin concentrations are higher in spring and summer than in fall and are higher in infants born before noon. In keeping with earlier work, leptin concentration in cord blood correlates positively with birth weight and height and is higher in infants who are appropriate for or large for gestational age than in infants who are small for gestational age or born prematurely.

Discussion.
Changes along the scales of the day and the seasons point to synchronizing environmental as well as genetic influence. An association of cord blood leptin concentration with obesity on the paternal side may help clarify the role of leptin in parental contributions to human obesity and may prompt focus on cholesterol metabolism.
Spread of Varicella-Zoster Virus DNA to Family Members and Environments From Siblings With Varicella in a Household
Authors: Asano Yoshizo , Yoshikawa Tetsushi , Ihira Masaru , Furukawa Hiroshi , Suzuki Kyoko , Suga Sadao 
Published: August 2004

Objective.
To elucidate virus spread from siblings with varicella to other family members and environmental objects in a family setting before and after onset of the disease.

Materials and Methods.
Among a family consisting of five members, a boy developed varicella and the remaining two siblings developed the disease 17 and 18 days after onset of the index case. Swab samples from throats and hands of parents and three siblings and samples from several sources in the environment of the house were collected frequently before and/or after onset of the disease. Varicella-zoster virus (VZV) DNA in the samples was examined by a sensitive polymerase chain reaction amplification assay.

Results.
In total, 108 samples from the throats and hands of the three children with varicella, 72 such samples from parents, and 72 samples from the surfaces of several sources in the house were collected. Eight days after onset of the index case (the older boy), VZV DNA was detected in both samples from the index case and on the surfaces of four sources (air conditioner filter, table, television channel push-buttons, and door handle), but not from the two other siblings or parents. Then, it was detected once on the mother's hand and the air conditioner filter and three times on the television channel push-buttons by January 30, 1998, when the girl developed varicella, 17 days after onset of the index case. The younger brother developed the disease on January 31. Viral DNA could not be detected in any samples obtained on January 30; however, it was detected on the hands of the older boy and the father and in samples from the hand and throat of the girl on January 31. Thereafter, virus DNA was detected three times intermittently by February 13 on the hand and three times persistently in the throat of the girl. The virus DNA was detected three times between February 1 and 3 on the hand and three times between February 1 and 4 in the throat of the younger boy. It was detected occasionally on the hands of the older boy and the parents, and occasionally or intermittently on surfaces of four environmental sources between February 2 and 13.

Conclusions.
The present study showed the rapid and broad contamination of the environment with the VZV DNA when the varicella patient appeared in a family, although it does not directly mean infectivity.
The Perceptions and Practices of Pediatricians: Tobacco Intervention
Authors: Zapka Jane G. , Fletcher Kenneth , Pbert Lori , Druker Susan K. , Ockene Judith K. , Chen Liping 
Published: August 2004

Objectives.To investigate pediatrician self-reported intervention practices related to tobacco use and cessation. We queried about practices with three groups 1) children/adolescents who do not smoke; 2) children/adolescents who smoke; and 3) parents, and the relationship of counseling practices with the personal and professional practice-related factors of pediatricians.Design.Mailed anonymous survey regarding their self-reported tobacco use prevention and cessation intervention practices.Population.Random sample of 350 pediatricians in one state.Results.A response rate of 75% was achieved. Pediatricians reported the greatest counseling practice in encouraging children/adolescents to not start smoking, followed by counseling adolescents who smoke. The lowest practice score was for intervening with parents who smoke. The age, gender, site of practice (eg, HMO, solo practice), and subspecialty status of the pediatricians were not related to practice. Pediatricians who reported at least some community involvement in local tobacco control efforts reported significantly higher levels of smoking cessation counseling with both children and adolescents and with parents who smoke. Pediatricians who reported previous training in counseling about tobacco issues also reported significantly higher levels of counseling of both adolescent smokers and parents who smoke but not of children and adolescents who do not smoke. Higher role perception, believing that smoking cessation counseling provided by pediatricians can be effective, and self-efficacy, were predictive of intervention with all three groups. The perceived barriers scale was not related to intervention with any group.Conclusions.Pediatricians are missing opportunities to help their patients to stop smoking and to prevent smoking initiation. Pediatricians are intervening least frequently with parents who smoke. Practices should be tailored to the specific target group.