bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of Long-Term Outcome in Very Preterm Infants: Gestational Age Versus Neonatal Cranial Ultrasound
Authors: Vollmer Brigitte , Roth Simon , Baudin Jenny , Stewart Ann L. , Neville Brian G. R. , Wyatt John S. 
Published: August 2004

Objectives. To investigate the effect of gestational age at birth on the frequency of ultrasound-detected brain lesions in infants born at &lt;33 weeks of gestation and to investigate whether the relationship between neonatal cranial ultrasound diagnosis and neurodevelopmental outcome at 8 years of age was independent of gestational age.Methods. Eight hundred forty-seven infants born at &lt;33 weeks of gestation, admitted to a single tertiary referral center between 1983 and 1988, underwent serial neonatal cranial ultrasound. At 8 years of age neurodevelopmental outcome was assessed by structured neurologic examination, psychometric tests (Wechsler Intelligence Scale for Children), tests of visuomotor integration (Beery) and motor impairment (Henderson-Stott). Infants were subdivided into a group born at &lt;28 weeks and a group born at between 28 and 32 weeks. Neurodevelopmental outcome was analyzed for each ultrasound diagnosis.Results. Hemorrhagic lesions such as germinal matrix/intraventricular hemorrhage and hemorrhagic parenchymal infarction were more frequent in infants born at &lt;28 weeks. There was no difference in the frequency of cystic periventricular leucomalacia between the 2 groups. When neurodevelopmental outcome for each ultrasound diagnosis was compared, no significant difference was found between the 2 gestational age groups.Conclusion. In the gestational age range studied, adverse neurodevelopmental outcome depends primarily on the type of the intracranial lesion rather than on gestational age.
Dysfunctional Elimination Syndrome: Is It Related to Urinary Tract Infection or Vesicoureteral Reflux Diagnosed Early in Life?
Authors: Shaikh Nader , Hoberman Alejandro , Wise Barbara , Kurs-Lasky Marcia , Kearney Diana , Naylor Stephanie , Haralam Mary Ann , Colborn D. K. , Docimo Steven G. 
Published: August 2004

Objective. It has been suggested that urinary tract infections (UTIs) early in life predispose to dysfunctional elimination syndrome (DES). This study evaluated the relationship between early UTI, vesicoureteral reflux (VUR), and DES by comparing two cohorts of school-aged children.
Methods. The UTI cohort (n = 123) included children previously enrolled in a prospective treatment trial conducted between 1992 and 1997. All were diagnosed with a febrile UTI before 2 years of age. The comparison cohort (n = 125) included children who were evaluated for fever in the emergency department between 1992 and 1997, whose urine culture was negative. Dysfunctional elimination symptoms were compared in the two cohorts by having families complete a revised version of the Dysfunctional Voiding Scoring System.
Results. Completed questionnaires were received from 248 children. There were no significant differences in selected demographic or clinical characteristics between the two cohorts. DES was present in 22% and 21% of children with and without a history of early UTI, respectively. Among children with UTIs, 18% of those with VUR and 25% of those without VUR had DES.
Conclusions. Dysfunctional elimination is common in a general pediatric population. Neither UTI nor VUR diagnosed before 2 years of age was associated with DES in school-aged children.
Association Between Clinically Meaningful Behavior Problems and Overweight in Children
Authors: Lumeng Julie C. , Gannon Kate , Cabral Howard J. , Frank Deborah A. , Zuckerman Barry 
Published: August 2004

Objective. To determine whether there is a relationship between clinically meaningful behavior problems and concurrent and future overweight in 8- to 11-year-old children.Methods. 1998 National Longitudinal Survey of Youth interview data for 8- to 11-year-old children and their mothers were analyzed. A Behavior Problems Index score &gt;90th percentile was considered clinically meaningful. Child overweight was defined as a body mass index (BMI) ≥95th percentile for age and sex. Multiple logistic regression was used to control for potential confounders (selected a priori): child’s sex, race, use of behavior-modifying medication, history of academic retention, and hours of television per day; maternal obesity, smoking status, marital status, education, and depressive symptoms; family poverty status; and Home Observation for Measurement of the Environment-Short Form (HOME-SF) cognitive stimulation score. In an attempt to elucidate temporal sequence, a second analysis was conducted with a subsample of normal-weight children who became overweight between 1996 and 1998 while controlling for BMI z score in 1996.Results. The sample included 755 mother-child pairs. Of the potential confounding variables, race, maternal obesity, academic grade retention, maternal education, poverty status, and HOME-SF cognitive stimulation score acted as joint confounders, altering the relationship between behavior problems and overweight in the multiple logistic regression model. With these covariates in the final model, behavior problems were independently associated with concurrent child overweight (adjusted odds ratio: 2.95; 95% confidence interval: 1.34–6.49). The relationship was strengthened in the subsample of previously normal-weight children, with race, maternal obesity, HOME-SF cognitive stimulation score, and 1996 BMI z score acting as confounders (adjusted odds ratio: 5.23; 95% confidence interval: 1.37–19.9).Conclusions. Clinically meaningful behavior problems in 8- to 11-year-old children were independently associated with an increased risk of concurrent overweight and becoming overweight in previously normal-weight children.
Addressing Parental Smoking in Pediatrics and Family Practice: A National Survey of Parents
Authors: Winickoff Jonathan P. , McMillen Robert C. , Carroll Bronwen C. , Klein Jonathan D. , Rigotti Nancy A. , Tanski Susanne E. , Weitzman Michael 
Published: August 2004

Background. Parental smoking has been associated with increased rates of sudden infant death syndrome, low birth weight, otitis media, asthma, and decreased lung growth. No prior parent surveys have assessed national rates of screening and counseling for parental tobacco use in the context of their child’s visit to primary care.Objective. To assess and compare rates of pediatrician and family practitioner screening and counseling for parental smoking.Design/Methods. Data were collected by telephone survey of households from July to September 2001. The sample is weighted by race and gender based on 1999 US Census estimates to be representative of the US population.Results. Of 3566 eligible respondents contacted, 3002 (84%) completed surveys; 902 of those were parents who had a child seen by a pediatrician (62%) or family practitioner (38%) in the past year. About half of all parents who visited a pediatrician or family practitioner reported that they had been asked about household member smoking status (52% vs 48%). More parents who visited pediatricians had been asked if they had rules prohibiting smoking in the home than those who visited family practitioners (38% vs 29%). Of 190 (21%) parents who were smokers, fewer than half reported being counseled by either specialty about dangers of second-hand smoke (41% vs 33%) or risks of modeling smoking behavior (31% vs 28%). Similarly, fewer than half of parental smokers received advice to quit (36% vs 45%).Conclusion. Overall rates of screening and counseling for parental smoking in pediatric and family practice are low. Despite some differences between specialties, significant opportunities exist to improve tobacco control activities in primary care settings that serve children.
Poison Treatment in the Home
Authors:   Committee on Injury, Violence, and Poison Prevention
Published: August 2004

This Policy Statement was retired June 2010.
The ingestion of a potentially poisonous substance by a young child is a common event, with the American Association of Poison Control Centers reporting approximately 1.2 million such events in the United States in 2001. The American Academy of Pediatrics (AAP) has long concerned itself with this issue and has made poison prevention an integral component of its injury prevention initiatives. A key AAP recommendation has been to keep a 1-oz bottle of syrup of ipecac in the home to be used only on the advice of a physician or poison control center. Recently, there has been interest regarding activated charcoal in the home as a poison treatment strategy. After reviewing the evidence, the AAP believes that ipecac should no longer be used routinely as a home treatment strategy, that existing ipecac in the home should be disposed of safely, and that it is premature to recommend the administration of activated charcoal in the home. The first action for a caregiver of a child who may have ingested a toxic substance is to consult with the local poison control center.
Decrease in Hospital Admissions for Febrile Seizures and Reports of Hypotonic-Hyporesponsive Episodes Presenting to Hospital Emergency Departments Since Switching to Acellular Pertussis Vaccine in Canada: A Report From IMPACT
Authors: Le Saux Nicole , Barrowman Nicholas J. , Moore Dorothy L. , Whiting Sharon , Scheifele David , Halperin Scott ,   for Members of the Canadian Paediatric Society/ Health Canada Immunization Monitoring Program–Active (IMPACT)
Published: August 2004

Objective. Acellular pertussis vaccines were introduced with the promise of an improved safety profile compared with whole-cell vaccines. In 1997–1998, Canada adopted 1 combination acellular pertussis vaccine, having previously used 1 particular combination whole-cell pertussis vaccine. We hypothesized that the change would result in a decrease in hospitalization rates for seizures and reports of hypotonic-hyporesponsive episodes (HHEs) temporally related to pertussis vaccination.Methods. Active surveillance was performed between 1995 and 2001 by the Immunization Monitoring Program–Active monitors at 12 hospitals using standard case definitions. Seizures had to occur within 72 hours after immunization with a pertussis-containing vaccine or 5 to 30 days after immunization with measles-mumps-rubella vaccine. HHE episodes had to occur within 48 hours of receipt of a pertussis-containing vaccine. Poisson regression models were used to compare the average number of monthly admissions for seizures and HHEs before and after introduction of the acellular pertussis vaccine.Results. We found a 79% decrease in febrile seizures associated with receipt of pertussis vaccine but no significant decrease in febrile seizures temporally related to measles-mumps-rubella between 1995–1996 and 1998–2001. There was a 60% to 67% reduction in HHEs associated with pertussis-containing vaccines between the same time periods, depending on case definition.Conclusions. The risks of febrile seizures and HHEs after pertussis-containing vaccine declined significantly with the introduction of acellular pertussis vaccine in Canada. Active surveillance systems are important for detecting trends in uncommon adverse events after routine immunizations.
Indoor and Outdoor Environmental Exposures, Parental Atopy, and Physician-Diagnosed Asthma in Taiwanese Schoolchildren
Authors: Lee Yung-Ling , Lin Ying-Chu , Hsiue Tzuen-Ren , Hwang Bing-Fang , Guo Yueliang Leon 
Published: August 2004

Objective. Parental atopy and environmental exposures are recognized risk factors for childhood asthma. However, the relative contributions of specific risk factors and the overall contributions of indoor and outdoor exposures remain unexplored. This study was undertaken to identify risk factors, estimate the population attributable risk of each exposure, and compare the data for boys versus girls for physician-diagnosed asthma in Taiwanese schoolchildren.Methods. During a February to June 2001 cross-sectional national survey, 35 036 6- to 15-year-old schoolchildren were chosen from 22 elementary and 22 middle schools located within 1-km catchment areas of 22 air-monitoring stations in Taiwan. The main outcome measure was physician-diagnosed asthma, as reported by the parents. We investigated hereditary and indoor and outdoor environmental factors for childhood asthma by questionnaire. The adjusted prevalences of questionnaire-determined outdoor indicators were also compared with air-monitoring data.Results. Outdoor air pollutants were associated with parent-reported perceived ambient air pollution. Physician-diagnosed asthma was reported for 8.1% of the boys (1330 of 16 441) and 5.6% of the girls (894 of 16 056). The risk of physician-diagnosed asthma was significantly associated with parental atopy and perceived ambient air pollution in both sexes. The presence of visible cockroaches (odds ratio [OR]: 1.30; 95% confidence interval [CI]: 1.07–1.59), mold on walls at home (OR: 1.20; 95% CI: 1.01–1.41), and water damage (OR: 1.33; 95% CI: 1.02–1.70) were also associated with asthma in girls; however, only visible mold on walls at home was related to asthma in boys. Mutually adjusted analytical models produced statistically significant associations between any indoor factor and asthma in girls (OR: 1.24; 95% CI: 1.00–1.56) but not in boys (OR: 1.04; 95% CI: 0.87–1.25). For all hereditary and environmental factors, the total population attributable risk was 44.31% in boys and 60.61% in girls.Conclusions. Parental atopy contributed more to childhood asthma than indoor or outdoor environmental factors. Girls may be more susceptible to indoor factors than boys.
Evaluation of a Rapid Urine Antigen Assay for the Detection of Invasive Pneumococcal Disease in Children
Authors: Neuman Mark I. , Harper Marvin B. 
Published: August 2004

Objective. Streptococcus pneumoniae remains the most common cause of occult bacteremia, bacterial pneumonia, and meningitis in young febrile children. We sought to determine the utility of a pneumococcal urine antigen assay among young febrile children at varying risk of invasive pneumococcal disease.
Methods. We prospectively enrolled 5 groups of children, 3 months to 5 years of age, who presented to an urban pediatric emergency department or hospital-based clinic between January 1, 2000, and April 1, 2001. The groups enrolled included 1) children with pneumococcal bacteremia, 2) febrile children with pneumonia, 3) febrile nonbacteremic children with leukocytosis, 4) febrile nonbacteremic children with normal white blood cell (WBC) counts, and 5) afebrile children with no evidence of current or recent bacterial infection.
Results. Of 346 children enrolled, positive assay results were found in 23 (95%) of 24 with pneumococcal bacteremia (95% confidence interval [CI]: 77%–100%), 47 (76%) of 62 with lobar pneumonia (95% CI: 63%–85%), 28 (15%) of 181 nonbacteremic children with fever (95% CI: 11%–22%) with no difference among patients with elevated WBC counts (18%; 95% CI: 11%–27%) compared with those with normal WBC counts (11%; 95% CI: 5%–21%), and 6 of 79 patients without fever (8%; 95% CI: 3%–16%).
Conclusions. This S pneumoniae antigen detection assay demonstrated high sensitivity for proven (bacteremic) and suspected (focal pneumonia) invasive pneumococcal infections. The rate of false-positive test results among febrile children without identified pneumococcal infection is approximately 15%. Although not ideal, this combination of sensitivity and specificity compares favorably with other available tests, such as the WBC or absolute neutrophil count used to screen children for clinically unsuspected pneumococcal infections.
Importance of Parental Conceptual Model of Illness in Severe Recurrent Abdominal Pain
Authors: Crushell Ellen , Rowland Marion , Doherty Mairin , Gormally Siobhan , Harty Sinead , Bourke Billy , Drumm Brendan 
Published: August 2004

Objectives. Recurrent abdominal pain (RAP) affects up to 15% of children. A biopsychosocial approach to the treatment of children with RAP has been proposed as an alternative to the traditional medical model. The aim of this study was to examine whether the parental conceptual model of illness is a factor in the long-term outcome of children with severe RAP.Methods. The study was undertaken in 2 parts: 1) a review of the medical and psychiatric records (including Child Behavior Checklist [CBCL]) of all children with RAP of sufficient severity to necessitate hospitalization during a 5-year period and 2) a structured telephone interview to collect information on ongoing abdominal pain, other somatic symptoms, school attendance, and the parents’ opinion as to the cause of the child’s pain.Results. Twenty-eight of 30 children who were identified were available for follow-up. Twenty-three (82%) were tertiary referrals from other pediatric services, and 20 had pain for &gt;6 months. On admission 7 (25%) of 28 had a depressive disorder, and 8 (29%) had an anxiety/depressive disorder. Twenty-one of 28 parents completed the CBCL, and on analysis of the CBCL, 11 (52%) children had scores in the clinical range (&gt;65). At follow-up (mean: 3.56 years; standard deviation: 1.59), 14 (50%) of 28 continued to complain of pain. These children also complained of multiple other somatic complaints and had repeated school absences. Only 1 (7%) of 14 parents of children with ongoing pain believed that there was a psychological cause for their child’s pain, whereas 11 (78%) of 14 parents of the children who had recovered believed that the cause was attributable to psychological factors (odds ratio: 47.67; 95% confidence interval: 3.56–1511.6).Conclusions. The acceptance by parents of a biopsychosocial model of illness is important for the resolution of recurrent abdominal pain in children.
A School-Based Exercise Intervention Elicits Substantial Bone Health Benefits: A 2-Year Randomized Controlled Trial in Girls
Authors: MacKelvie Kerry J. , Khan Karim M. , Petit Moira A. , Janssen Patricia A. , McKay Heather A. 
Published: August 2004

Objective. Childhood weight-bearing physical activity is recognized as an important determinant of peak bone mass, and physical activity intervention may represent a feasible strategy for primary prevention of osteoporosis. Previous school-based exercise interventions have all been of &lt;10 months in duration. We implemented a high-impact, circuit-based, jumping intervention (10 minutes, 3 times a week) over 2 school years and compared changes in bone mineral content (BMC) over 20 months (2 school years) in 9.9 ± 0.6-year-old intervention girls (N = 32) and controls (10.3 ± 0.4 years, N = 43).Methods. We measured BMC for the total body, lumbar spine, proximal femur (and femoral neck and trochanteric subregions), and lean and fat mass by dual-energy radiograph absorptiometry (Hologic QDR 4500), and height, sitting height, leg length, and weight at baseline and 20 months. We assessed Tanner stage, general physical activity, and calcium intake by questionnaire.Results. Girls were Tanner breast stage 1 to 3 at baseline. There were no significant differences in baseline or 20-month change in body size or composition, average physical activity, or calcium intake between groups. There were substantially greater gains in lumbar spine (41.7% vs 38.0%) and femoral neck (24.8% vs 20.2%) BMC in intervention than in control girls (P &lt; .05, analysis of covariance; covariates were baseline BMC and height, change in height, physical activity, and final Tanner stage).Conclusion. Three brief sessions of high-impact exercise per week implemented over 2 consecutive years within the elementary school curriculum elicited a substantial bone mineral accrual advantage in pubertal girls.
Injection-Site Reactions to Booster Doses of Acellular Pertussis Vaccine: Rate, Severity, and Anticipated Impact
Authors: Skowronski Danuta M. , Remple Valencia P. , Macnabb Jane , Pielak Karen , Patrick David M. , Halperin Scott A. , Scheifele David 
Published: August 2004

Background. Acellular pertussis (aP)-containing vaccines cause fewer adverse events than whole-cell versions for primary doses. Booster doses, however, may be followed by extensive injection-site reactions. This study compares the frequency, severity, and impact of local reactions among children receiving 5 consecutive doses of an aP combination vaccine (including inactivated polio virus, conjugated Haemophilus influenzae type b antigen, and diphtheria and tetanus toxoids) to children receiving a mixed series of whole-cell and aP combination vaccines.
Methods. Participants were parents or guardians of children 4 to 6 years old immunized at public health clinics across British Columbia, Canada. This included 398 children receiving the fifth consecutive dose of an aP combination vaccine and 402 receiving the fifth dose in a mixed series consisting of at least 1 prior dose of whole-cell pertussis combination vaccine with the remainder as aP combination vaccine. A cross-sectional telephone survey evaluated the extent of local reactions 48 to 96 hours after immunization by asking participants to compare the size of redness and swelling with familiar household items such as Oreo cookies or coins. Associated discomfort and impact on recreational activities, health care utilization, parental time off work, and attitudes toward immunization were also assessed.
Results. Children who received the fifth consecutive dose of an aP combination vaccine more often experienced redness (24%) or swelling (16%) the size of an Oreo cookie or larger (≥46 mm) than children given a mixed series (10% and 9%, respectively) but less often experienced tenderness or limitation of movement at the injection site. Related health care utilization was low. There was no discernible effect on participation in recreational activities or parental attitudes toward vaccine; 90% would recommend the same vaccine to others with children of the same age.
Conclusions. We conclude that injection-site reactions are more extensive after the fifth consecutive dose of an aP combination vaccine compared with the fifth dose in a mixed series of whole-cell and aP combination vaccines. These reactions are unlikely to affect parental acceptance of immunization recommendations or health care utilization.
The Effect of Birth Hospital Type on the Outcome of Very Low Birth Weight Infants
Authors: Warner Barbara , Musial M. Judith , Chenier Thomas , Donovan Edward 
Published: August 2004

Objective. To test the hypothesis that the likelihood of death or major morbidity is reduced for very low birth weight (VLBW; &lt;1500 g) infants who are born at hospitals with subspecialty perinatal and neonatal care compared with other available birth sites.
Methods. A population-based cohort study was conducted of all live births of 500 to 1499 g at the 19 hospitals in the greater Cincinnati region from September 1, 1995, through December 31, 1997 (N = 848). Primary outcome was the risk-adjusted, predischarge mortality or morbidity, including bronchopulmonary dysplasia, severe intracranial hemorrhage, severe retinopathy of prematurity, or necrotizing enterocolitis for VLBW infants who were born at subspecialty perinatal centers compared with those who were born at nonsubspecialty centers.
Results. The odds of death or major morbidity for VLBW infants who are born at nonsubspecialty perinatal centers is twice that of infants who are born at subspecialty centers despite controlling for demographic (odds ratio [OR]: 2.64; 95% confidence interval [CI]: 1.7–4.2) and practice characteristics (OR: 1.96; 95% CI: 1.2–3.2). The effect of birth hospital type on death or major morbidity was greater for infants of 1000 to 1499 g birth weight (OR: 3.42; 95% CI: 2.0–6.1) than for infants of 500 to 999 g birth weight (OR: 2.1; 95% CI: 1.0–4.8).
Conclusion. The current study lends strong support to existing Academy of Pediatrics and American College of Obstetricians and Gynecologists recommendations that deliveries at &lt;32 weeks’ gestational age occur at subspecialty perinatal centers.