bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Flow Rate and Insulin Priming on the Recovery of Insulin From Microbore Infusion Tubing
Authors: Fuloria Mamta , Friedberg Michael A. , DuRant Robert H. , Aschner Judy L. 
Published: August 2004

Background.A retrospective medical record review of 13 consecutive, hyperglycemic, extremely low birth weight (ELBW) infants treated with continuous insulin infusions revealed a 14- to 24-hour delay (mean, 19 hours) in blood glucose normalization despite stepwise increases in insulin infusion rates.Objective.This in vitro study examined the effects of flow rate and insulin priming on insulin recovery from polyvinyl chloride (PVC) tubing and polyethylene (PE)-lined PVC tubing infused with a standard insulin stock solution.Methods.Stock insulin solution (0.2 U/mL) was infused through microbore PVC or PE-lined tubing at flow rates of 0.05 and 0.2 mL/h. To determine if saturation of nonspecific binding sites would alter effluent insulin concentration, we compared insulin recovery from tubing previously flushed with the stock solution and tubing primed with 5 U/mL of insulin for 20 minutes. Effluent samples, which were collected at baseline and at six time points during a 24-hour period, were immediately frozen at −20°C. Insulin concentration was measured by IMx immunoassay. Data were analyzed using general linear modeling with repeated measures.Results.At 0.05 mL/h flow rate, insulin recovery from unprimed PVC tubing at 1, 2, 4, and 8 hours was 17%, 11%, 27%, and 55%, respectively, with 100% recovery at 24 hours. From insulin-primed tubing, insulin recovery was ∼70% at 1, 2, and 4 hours, and close to 100% at 8 hours. At a faster flow rate of 0.2 mL/h, insulin recovery at 1, 2, 4, and 8 hours was 22%, 38%, 67%, and 75% vs 42%, 85%, 91% and 95% from unprimed and insulin-primed PVC tubing, respectively. Similar results were obtained from unprimed and insulin-primed PE-lined tubing at 0.2 mL/h flow rate.Conclusions.Priming of microbore tubing with 5 U/mL of insulin solution for 20 minutes to block nonspecific binding sites enhances delivery of a standard insulin stock at infusion rates typically used to treat hyperglycemic ELBW infants. We conclude that priming the tubing with a higher concentration of insulin before initiation of standard insulin infusion therapy should accelerate achievement of steady-state insulin delivery and correction of hyperglycemia in ELBW infants.
Acid-base Homeostasis in Children With Growth Hormone Deficiency
Authors: Glaser Nicole S. , Shirali Anushree C. , Styne Dennis M. , Jones Kenneth Lee 
Published: August 2004

Background.
Although the primary use of growth hormone (GH) is to promote linear growth, it is also known to affect many metabolic processes and to influence renal function. In laboratory animals, growth hormone deficiency (GHD) causes a mild metabolic acidosis that is corrected by GH treatment. We observed a patient with GHD who initially presented with acidosis of unclear etiology and corrected the acidosis with GH treatment.

Objectives.
To determine: 1) whether children with GHD have lower mean serum bicarbonate concentrations than do children with short stature because of other causes; and 2) whether the presence of a low serum bicarbonate concentration increases the probability of GHD among children with short stature.

Methods.
We collected data from the medical records of 143 children with short stature who had serum electrolyte concentrations measured as part of their initial evaluations, 66 with GHD and 77 with short stature as a result of other causes. We compared mean serum bicarbonate concentrations and bicarbonate standard deviation scores (SDS) between these two groups and determined the probability of GHD for patients according to bicarbonate SDS.

Results.
The mean serum bicarbonate concentration was significantly lower in patients with GHD (mean standard deviation [SD]; 23.9 [0.4] mEq/L vs 25.2 [0.3] mEq/L) as was the bicarbonate SDS (−0.12 [0.14] SD vs 0.38 [0.10] SD). Twelve (75%) of 16 patients with bicarbonate SDS ≤−1 SD had GHD compared with 7 (28%) of 25 patients with bicarbonate SDS &gt;1 SD. Patients with bicarbonate SDS between −1 SD and 1 SD had an intermediate probability of GHD, 46/102 (45%), similar to the overall prevalence of GHD in the study population (46%). Mean bicarbonate concentrations and bicarbonate SDS increased significantly in 9 patients who had repeat electrolyte measurements during treatment with GH (mean bicarbonate; 21.7 [1.1] mEq/L vs 26.9 [0.59] mEq/L, mean bicarbonate SDS; −1.24 [0.43] SD vs 0.55 [0.27] SD).

Conclusions.
Serum bicarbonate concentrations are lower in patients with GHD than in patients with short stature as a result of other causes. In addition, serum bicarbonate concentrations rise with GH treatment in patients with GHD. The probability of GHD is increased for patients with bicarbonate SDS ≤−1 SD and decreased for patients with bicarbonate SDS &gt;1 SD. These findings indicate a role for GH in maintaining normal acid-base homeostasis and suggest that GHD should be considered in children whose growth failure is attributed to other causes of acidosis.
Injuries to Children With Attention Deficit Hyperactivity Disorder
Authors: DiScala Carla , Lescohier Ilana , Barthel Martha , Li Guohua 
Published: August 2004

Objectives.To determine differences between hospital admitted injuries to children with preinjury attention deficit hyperactivity disorder (ADHD) and injuries to those with no preinjury conditions (NO).Design.Comparative analysis, excluding fatalities, of ADHD patients (n = 240) to NO patients (n = 21 902), 5 through 14 years of age.Outcome Measures.Demographics, injury characteristics, length of stay, admission to the intensive care unit, surgical intervention, disability, and disposition at discharge.Data Source.Retrospective review of charts submitted by more than 70 hospitals participating in the National Pediatric Trauma Registry between October 1988 and April 1996.Results.Compared with the NO children, the children with ADHD were more likely to be boys (87.9% vs 66.5%), to be injured as pedestrians (27.5% vs 18.3%) or bicyclists (17.1% vs 13.8%), and to inflict injury to themselves (1.3% vs 0.1%). They were more likely to sustain injuries to multiple body regions (57.1% vs 43%), to sustain head injuries (53% vs 41%), and to be severely injured as measured by the Injury Severity Score (12.5% vs 5.4%) and the Glasgow Coma Scale (7.5% vs 3.4%). The ADHD mean length of stay was 6.2 days versus 5.4 in the NO group. In both groups, 40% had surgery, but the ADHD children were admitted more frequently to the intensive care unit (37.1% vs 24.1%). The injury led to disability in 53% of the children with ADHD vs 48% of the NO children. Children with ADHD with any disability were twice as likely to be discharged to rehabilitation/extended care than were the NO children.Conclusions.Injured children with ADHD are more likely to sustain severe injuries than are children without ADHD. More research is needed to identify prevention efforts specifically targeted at this population.
Outcomes of Extremely Premature Infants Related to Their Peak Serum Bilirubin Concentrations and Exposure to Phototherapy
Authors: Yeo Kim Lian , Perlman Max , Hao Yong , Mullaney Paul 
Published: August 2004

Objectives.To analyze, in extremely low birth weight infants, associations between peak bilirubin concentration and evidence of brain damage, and between peak bilirubin concentration and blindness attributable to retinopathy of prematurity.Methods.Retrospective study of 128 infants of ≤800 g birth weight and ≤27 weeks gestation born between 1980 and 1989 and discharged from a tertiary neonatal intensive care unit. After screening analyses, multivariable analyses were conducted to identify associations between blindness and peak bilirubin concentration (dichotomized at different levels to create 3 binary variables), and between severe adverse neurodevelopmental outcome at 18 months postterm age and peak bilirubin levels.Results.Of 128 18-month survivors, 15 had severe visual loss attributable to retinopathy of prematurity, 21 had neurodevelopmental deficit, and 5 were deaf. Visual loss was significantly associated with low-peak serum bilirubin concentration (&lt;9.4 mg/dL (&lt;160 μmol/L) versus ≥9.4 mg/dL (odds ratio [OR] confidence interval [CI] 4.48 [1.15–17.43])), low gestational age (OR [CI] per week 1.95 [1.05–3.63]), and longer duration of phototherapy (OR [CI] per 10 hours 1.17 [1.02–1.33]). The association of neurodevelopmental impairment with grades 3 and 4 intraventricular hemorrhage was statistically significant (OR 5.39 [1.83–15.84]), but with high-peak serum bilirubin concentration ≥11.7 mg/dL (≥200 μmol/L), was not significant (OR 2.89 [0.87–9.53]).Conclusions.In these infants, prolonged phototherapy and low-peak serum bilirubin concentrations were associated with severe visual loss attributable to retinopathy of prematurity. The findings should be interpreted with caution until the evidence is reinforced in other patient populations.
The Newborn With Hearing Loss: Detection in the Nursery
Authors: Finitzo Terese , Albright Kathryn , Neal Joy O' 
Published: August 2004

Background.Early detection of hearing loss coupled with appropriate early intervention is critical to speech, language, and cognitive development. These competencies serve as the foundation for later academic skills. For these reasons, many states are undertaking aggressive efforts to screen all newborns before hospital discharge. Universal detection of hearing loss in newborns is a three-stage process composed of 1) the birth admission screen, 2) follow-up and diagnosis, and 3) intervention services. Breakdown at any stage jeopardizes the entire effort. The goals of this research are to examine the birth admission screen by reviewing outcome measurements for 54 228 Texas newborns and to evaluate factors that impact outcomes positively or negatively.Methodology.All newborns were screened for hearing loss using a physiologic test of auditory function; either screening auditory brainstem responses or transient evoked otoacoustic emissions. Screening occurred in the newborn and intensive care nurseries, before hospital discharge in 9 sites as part of the nursery protocol.Patients.A total of 54 228 newborns were available for screening.Outcome Measures.Four measures were evaluated and are reported: the number of births screened, the number of newborns who passed the screen before discharge, the number of infants who returned for follow-up, and the number of infants identified with hearing loss. A Birth Screening Performance Index is also calculated.Results.Results are reported for calendar years 1994, 1995, 1996, and through June 1997. A total of 54 228 newborns were available for screening; 52 508 were screened before hospital discharge during their birth admission and 50 721 passed this screen. Infants returning for follow-up screen as outpatients numbered 1224. Over this 3½-year span, 113 infants who failed the birth admission screening had hearing loss that was sensorineural in nature. From these data, the estimated incidence of hearing loss is 3.14/1000 infants.Conclusions.Screening in the nursery with low false-positive rates can be achieved when three elements are present: audiology involvement, hospital support, and automated data and information management. Follow-up measures need improvement. Better tracking methods may help assure that at-risk newborns are connected to services.
Length and Body Mass Index at Birth and Target Height Influences on Patterns of Postnatal Growth in Children Born Small for Gestational Age
Authors: Luo Zhong-Cheng , Albertsson-Wikland Kerstin , Karlberg Johan 
Published: August 2004

Objective.
Previous growth studies on children born small for gestational age (SGA) indicate that birth length, weight, and target height are important predictors for postnatal catch-up growth in SGA. Their influences on different phases of catch-up growth are still not described. The aim of this study was to clarify the influences of target height, length, and nutritional status at birth on different phases of postnatal catch-up growth (infancy, childhood, puberty) in SGA and the long-term consequences.

Methods.
Data were obtained from a longitudinal population-based growth study on Swedish children (N = 2815). Primary outcome measurements include heights, the changes in height standard deviation scores (SDS) during various phases of growth and relative risk for adult shortness.

Results.
The difference in final height in children born SGA was attributable to their difference in target height and the magnitude of catch-up growth during the first 6 months of life, rather than the difference in length or body mass index (BMI) at birth. Length at birth showed negative influence on catch-up growth during infancy (0 to 2 years of age), but no significant influence thereafter. The BMI or weight for length SDS at birth showed no significant influence on catch-up growth during any growth phase. Target height showed positive influence on catch-up growth from the onset of childhood. Neither target height nor length and BMI at birth showed any significant influence on catch-up growth during puberty. The magnitude of catch-up growth during infancy, especially the first 6 months of life, is most critical in decreasing risk at adult shortness. We confirmed that the SGA group had a sevenfold greater risk for adult shortness than the non-SGA group (relative risk = 7.31; 95% confidence interval: 3.96–13.52). However, ∼40% of children who were below −2 in height SDS at 2 years of age remained short at final height in both SGA and non-SGA groups. The mean height SDS of children born SGA increased by 1.65 from birth to final height, but the length deficit in centimeters at birth (−5.4 cm) persisted into adulthood (−5.9 cm).

Conclusions.
BMI at birth is not related to postnatal catch-up growth in infants born SGA, but birth length and target height are important. The genetic influence on catch-up growth appears to start from the onset of childhood. Being born short or becoming short during the first 2 years of life is similar in terms of risk for adult short stature.
A Longitudinal Study of Otitis Media With Effusion Among 2- to 5-Year-Old African-American Children in Child Care
Authors: Zeisel Susan A. , Roberts Joanne E. , Neebe Eloise C. , Riggins Rhodus , Henderson Frederick W. 
Published: August 2004

Objective.
To prospectively document the prevalence of otitis media with effusion (OME) in 86 African-American children between ages 2 and 5 years.

Study Design.
Eighty-six children in center-based child care whose ear status had been followed from infancy continued to be observed. Middle ear status was assessed by pneumatic otoscopy and tympanometry biweekly.

Results.
The prevalence of OME decreased as children became older. The mean proportion of examinations demonstrating bilateral OME (BOME) ranged from 12% between 24 to 30 months to 4% between 54 to 60 months of age. The mean proportion of exams revealing bilateral normal ears increased from 77% at 24 to 30 months to 88% at 54 to 60 months of age. Although 60 children had experienced BOME that lasted 4 months or longer in the 6- to 24-month age period, only 8 of these children experienced at least 4 months of continuous BOME between 24 to 60 months.

Conclusions.
The proportion of time with BOME decreased progressively with increasing age in this population. Only 8 of 60 children who had experienced more than 4 consecutive months of BOME before 2 years of age continued to manifest persistent effusion or experience recurrences of prolonged BOME after 2 years of age.
Predictive Ability of a Predischarge Hour-specific Serum Bilirubin for Subsequent Significant Hyperbilirubinemia in Healthy Term and Near-term Newborns
Authors: Bhutani Vinod K. , Johnson Lois , Sivieri Emidio M. 
Published: August 2004

Objective.To assess the predictive ability of a universal predischarge serum bilirubin measurement to screen for risk of subsequent significant hyperbilirubinemia in the direct Coombs negative healthy term and near-term newborn during the first postnatal week.Methods.Total serum bilirubin (TSB) levels were obtained at the time of the routine metabolic screen in all term and near-term newborns cared for in the Pennsylvania Hospital Well Baby Nursery (n = 13 003). Postnatal age (in hours) at the time of TSB measurement was recorded. A percentile-based bilirubin nomogram for the first week was constructed from hour-specific predischarge and postdischarge TSB values of newborns (n = 2840; median BW = 3230 g and median gestational age = 39 weeks) who met classification criteria for healthy newborns (excluding those with a positive direct Coombs test or those requiring phototherapy before age 60 hours) and who were enrolled in a hospital supervised home or outpatient follow-up program. The accuracy of the predischarge TSB as a predictor of subsequent degree of hyperbilirubinemia was determined.Results.The study patients in the nomogram were racially diverse. Nearly 60% were breastfed. Predischarge, 6.1% of the study population (172/2840) had TSB values in the high-risk zone (≥95th percentile) at 18 to 72 hours; of these, 39.5% (68/172) remained in that zone (likelihood ratio [LR] = 14.08, sensitivity = 54%; specificity = 96.2%, probability = 39.5%). Predischarge, 32.1% of the population (912/2840) had TSB values in the intermediate-risk zone. In a clinically significant minority of these newborns (58/912 or 6.4%), the postdischarge TSB moved into the high-risk zone (LR of this move: 3.2 from the upper-intermediate zone and .48 from the lower-intermediate risk zone). The predischarge TSB in 61.8% of the newborns (1756/2840) was in the low-risk zone (&lt;40th percentile) and there was no measurable risk for significant hyperbilirubinemia (LR = 0, sensitivity = 100%; specificity = 64.7%; probability = 0%).Conclusions.An hour-specific TSB before hospital discharge can predict which newborn is at high, intermediate or low risk for developing clinically significant hyperbilirubinemia (specifically defined as TSB levels ≥95th percentile for age in hours). Risk designation and subsequent increases or decreases of in TSB can be easily monitored on an hour-specific percentile based predictive bilirubin nomogram. A predischarge TSB measured as a universal policy would facilitate targeted intervention and follow-up in a safe, cost-effective manner. In conjunction with bilirubin practice parameter of the American Academy of Pediatrics, it could reduce the potential risk for bilirubin-induced neurologic dysfunction.
Dose–Response Effect of Fetal Cocaine Exposure on Newborn Neurologic Function
Authors: Chiriboga Claudia A. , Brust John C. M. , Bateman David , Hauser W. Allen 
Published: August 2004

Background.Studies of fetal cocaine exposure and newborn neurologic function have obtained conflicting results. Although some studies identify abnormalities, others find no differences between cocaine-exposed and cocaine-unexposed infants. To determine the effects of prenatal cocaine exposure on intrauterine growth and neurologic function in infants, we prospectively evaluated 253 infants shortly after birth.Methods.Women who delivered a live singleton &gt;36 weeks by dates were eligible for enrollment. Maternal exclusionary criteria were known parenteral drug use, alcoholism, and acquired immunodeficiency syndrome; infant exclusionary criteria were Apgar scores ≤4 at 5 minutes, obvious congenital malformations, seizures, or strokes. A total of 98% of infants were evaluated between 1 to 7 days of age. Newborns were assessed with the Neurological Examination for Children (NEC) by a pediatric neurologist (C.A.C.) who was blinded to exposure status. Gestational age was determined by Ballard's examination. Cocaine exposure was determined for the last trimester by radioimmunoassay of maternal hair (RIAH). Exposure values ranged from 2 to 4457 ng/10 mg hair. Infants were excluded if a maternal hair sample was missing (N = 13). The sample comprises 240 woman and infant pairs—104 cocaine-exposed and 136 cocaine-unexposed.Results.Compared with unexposed controls, cocaine-exposed infants exhibited higher rates of intrauterine growth retardation (24% vs 8%), small head circumference ([HC] &lt;10th% percentile) (20% vs 5%) and neurologic abnormalities: global hypertonia (32% vs 11%), coarse tremor (40% vs 15%), and extensor leg posture (20% vs 4%). We found increasing odds (odds ratio) of growth and neurologic impairment with increasing level of cocaine exposure in stratified analyses. The odds ratio associated with three levels of cocaine exposure (no exposure, low exposure = RIAH 2–66 ng/mg; and high exposure = RIAH 81–4457 ng/mg) respectively are: 1.0, 3.3, and 6.1 for small head size (χ2 for trend); 1.0, 3.3, and 4.3 for global hypertonia (χ2 for trend); 1.0, 3.4, and 7.4 for extensor leg posturing (χ2 for trend); and 1.0, 3.8, and 3.8 for coarse tremor (χ2 for trend). Significant associations between cocaine exposure and neurologic signs were found in logistic regression equations that controlled for 20 or more variables.Conclusion.We conclude that adverse neonatal effects associated with fetal cocaine exposure follow a dose–response relationship: newborns with higher levels of prenatal cocaine exposure show higher rates of impairments in fetal head growth and abnormalities of muscle tone, movements, and posture. Significant relationships between cocaine exposure and these outcomes remain in controlled analyses.
The Home Environment and Salmonellosis in Children
Authors: Schutze Gordon E. , Sikes James D. , Stefanova Rossina , Cave M. Donald 
Published: August 2004

Objective.
To explore the role of foods and the home environment in the development ofSalmonella infections in infants and children.

Methods.
Home investigations were conducted of patients younger than 4 years of age infected with Salmonella. Cultures were obtained from foods, persons residing in the home, animals/pets/insects, and environmental sources. Like serotypes encountered in the index patients and isolates from the home underwent typing with pulsed-field gel electrophoresis.

Results.
Home inspections were conducted in ∼66% of eligible homes on the average of 3.4 days after the confirmation of theSalmonella isolate. A total of 526 cultures from 50 homes were obtained from foods (120), household members (73), refrigerators (52), water (47), countertops (46), soil (42), can-openers (36), vacuum cleaners (34), animals/pets/insects (26), and others (50). Isolates with a serotype identical to those in the index patient were found in 16 homes, 3 of which included an isolate of a second serotype, and an isolate of a different serotype was recovered in 3 homes. The pulsed-field gel electrophoresis patterns of the isolates of identical serotypes from the subjects and from their environment were indistinguishable in all but 2 patients. Among isolates of the same serotype encountered in different homes, all patterns were different. The identical serotype was found in multiple locations (4), dirt surrounding front doors (4), household members (3), vacuum cleaner (1), animals/pets/insects (1), and a refrigerator shelf (1).

Conclusions.
These data illustrate the importance of the child's environment in the development of salmonellosis. Clinicians should concentrate on educating the parents about the environmental spread of Salmonella. Contaminated foods in the home play a less significant role in the infection of infants and children.