bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experience With the Ketogenic Diet in Infants
Authors: Nordli Douglas R. , Kuroda Maxine M. , Carroll Joanne , Koenigsberger Dorcas Y. , Hirsch Lawrence J. , Bruner Harlan J. , Seidel William T. , De Vivo Darryl C. 
Published: August 2004

Objective.
To evaluate the effectiveness, tolerability, and adverse effects of the ketogenic diet in infants with refractory epilepsy.

Methods.
A retrospective review of 32 infants who had been treated with the ketogenic diet at a large metropolitan institution.

Results.
Most infants (71%) were able to maintain strong ketosis. The overall effectiveness of the diet in infants was similar to that reported in the literature for older children; 19.4% became seizure-free, and an additional 35.5% had &gt;50% reduction in seizure frequency. The diet was particularly effective for patients with infantile spasms/myoclonic seizures. There were concomitant reductions in antiepileptic medications. The majority of parents reported improvements in seizure frequency and in their child's behavior and function, particularly with respect to attention/alertness, activity level, and socialization. The diet generally was well-tolerated, and 96.4% maintained appropriate growth parameters. Adverse events, all reversible and occurring in one patient each, included renal stone, gastritis, ulcerative colitis, alteration of mentation, and hyperlipidemia.

Conclusion.
The ketogenic diet should be considered safe and effective treatment for infants with intractable seizures.
Sedation of Children for Electroencephalograms
Authors: Olson Donald M. , Sheehan Maureen G. , Thompson William , Hall Phyllis T. , Hahn Jin 
Published: August 2004

Objective.
Sedation sometimes is necessary to perform an electroencephalogram (EEG) on a child. A dramatic decline in the need to use conscious sedation in our EEG laboratory prompted this review of our sedation experience. The purpose of this review was to determine the incidence of adverse sedation effects and to determine why the need for sedation had declined.

Methods.
All 513 attempts to administer sedation to children who were undergoing EEG studies during a 4-year period were reviewed retrospectively. Parameters studied included type and amount of the sedative agents, need for repeated dosing, successful completion of the EEG, and complications attributed to the sedative.

Results.
Sedation was attempted in 513 (18%) of 2855 EEGs performed during the 4-year period. Ninety-one percent of the EEGs performed with sedation were completed successfully. Chloral hydrate was the most frequently administered sedative. Complications (transient oxygen desaturation) occurred in 3 children, all of whom had recognized risk factors for airway compromise. The proportion of children who required sedation decreased from 32% to just 2% during that time period.

Conclusion.
Sedation of children who are undergoing EEG examinations is effective and safe. Complications are infrequent. The need for sedation can be decreased greatly by adequate preparation and by creating a less-threatening, child-friendly environment in which to perform the study.
Prediction of Hyperbilirubinemia in Near-Term and Term Infants
Authors: Stevenson David K. , Fanaroff Avroy A. , Maisels M. Jeffrey , Young Betty W. Y. , Wong Ronald J. , Vreman Hendrik J. , MacMahon James R. , Yeung Chap Y. , Seidman Daniel S. , Gale Rena , Oh William , Bhutani Vinod K. , Johnson Lois H. , Kaplan Michael , Hammerman Cathy , Nakamura Hajime 
Published: August 2004

Objective.The purpose of this study was to determine whether end-tidal carbon monoxide (CO) corrected for ambient CO (ETCOc), as a single measurement or in combination with serum total bilirubin (STB) measurements, can predict the development of hyperbilirubinemia during the first 7 days of life.Methods.From 9 multinational clinical sites, 1370 neonates completed this cohort study from February 20, 1998, through February 22, 1999. Measurements of both ETCOc and STB were performed at 30 ± 6 hours of life; STB also was measured at 96 ± 12 hours and subsequently following a flow diagram based on a table of hours of age-specific STB. An infant was defined as hyperbilirubinemic if the hours of age-specific STB was greater than or equal to the 95th percentile as defined by the table at any time during the study.Results.A total of 120 (8.8%) of the enrolled infants became hyperbilirubinemic. Mean STB in breastfed infants was 8.92 ± 4.37 mg/dL at 96 hours versus 7.63 ± 3.58 mg/dL in those fed formula only. The mean ETCOc at 30 ± 6 hours for the total population was 1.48 ± 0.49 ppm, whereas those of nonhyperbilirubinemic and hyperbilirubinemic infants were 1.45 ± 0.47 ppm and 1.81 ± 0.59 ppm, respectively. Seventy-six percent (92 of 120) of hyperbilirubinemic infants had ETCOc greater than the population mean. An ETCOc greater than the population mean at 30 ± 6 hours yielded a 13.0% positive predictive value (PPV) and a 95.8% negative predictive value (NPV) for STB ≥95th percentile. When infants with STB &gt;95th percentile at &lt;36 hours of age were excluded, the STB at 30 ± 6 hours yielded a 16.7% PPV and a 98.1% NPV for STB &gt;75th percentile. The combination of these 2 measurements at 30 ± 6 hours (either ETCOc more than the population mean or STB &gt;75th percentile) had a 6.4% PPV with a 99.0% NPV.Conclusions. This prospective cohort study supports previous observations that measuring STB before discharge may provide some assistance in predicting an infant's risk for developing hyperbilirubinemia. The addition of an ETCOc measurement provides insight into the processes that contribute to the condition but does not materially improve the predictive ability of an hours of age-specific STB in this study population. The combination of STB and ETCOc as early as 30 ± 6 hours may identify infants with increased bilirubin production (eg, hemolysis) or decreased elimination (conjugation defects) as well as infants who require early follow-up after discharge for jaundice or other clinical problems such as late anemia. Depending on the incidence of hyperbilirubinemia within an institution, the criteria for decision making should vary according to its unique population.
Intussusception, Rotavirus Diarrhea, and Rotavirus Vaccine Use Among Children in New York State
Authors: Chang Hwa-Gan H. , Smith Perry F. , Ackelsberg Joel , Morse Dale L. , Glass Roger I. 
Published: August 2004

Objective.
To describe epidemiologic features of intussusception and rotavirus diarrhea in New York, to examine the baseline incidence and trends over time, and to ascertain whether an excess of cases occurred in the 9 months of vaccination with the newly licensed rotavirus vaccine.

Methods.
Hospital discharge data from 1989 through 1998 were reviewed for children (&lt;1 year old) whose primary or secondary diagnosis was coded as intussusception or rotavirus diarrhea. Characteristics of patients admitted for intussusception and rotavirus diarrhea were compared, and trends over time were examined. For a subset of patients, medical records and vaccine histories for intussusception hospitalizations from October 1998 through June 1999 were analyzed. The number of intussusception cases attributable to rotavirus vaccine was calculated based on the penetration of the vaccine (21%) and a range of excess risks of intussusception among vaccinated children as estimated by the National Immunization Program (NIP).

Results.
From 1989 through 1998, 1450 intussusception-associated hospitalizations were reported in children &lt;1 year old (average annual incidence 5.4/10 000). Among these children, 47% were treated medically and 53% had surgery, with 9% needing surgical resection. The incidence of intussusception declined over time from 6.1 per 10 000 in 1989 to 3.9 per 10 000 in 1998. Intussusception hospitalizations occurred throughout the year, whereas rotavirus-associated hospitalizations peaked from February to April. Of 20 patients with intussusception whose hospitalization charts were reviewed, 5 had received rotavirus vaccine. All 5 were hospitalized after their first dose of vaccine, were admitted before 7 months of age, were white, and had private insurance. A total of 81 cases of intussusception occurred during the 9-month period of rotavirus vaccination, compared with 78 during the same period in the prevaccination year. The number of excess intussusception cases observed (n = 3) was lower than expected using the NIP estimate of excess risk (1.8) among rotavirus vaccinated children (n = 12) but not significantly different from the risks identified in the NIP cohort studies (1 in 12 000).

Conclusion.
Our data suggest that in New York the rate of intussusception has declined, and approximately 1 child in 2600 develops intussusception before 1 year of age. The different seasonality between intussusception and rotavirus-related hospitalizations suggests that if any causal association exists, it must be small. Unlike other studies, analysis of New York hospitalized discharge data failed to show an appreciable increase in the incidence of intussusception after introduction of the rotavirus vaccine.
Utilization and Cost of Health Care Services for Children With Attention-Deficit/Hyperactivity Disorder
Authors: Guevara James , Lozano Paula , Wickizer Thomas , Mell Loren , Gephart Harlan 
Published: August 2004

Background.Despite an increasing prevalence of diagnosed attention-deficit/hyperactivity disorder (ADHD) among children, the impact of ADHD on utilization and costs of health care services is largely unknown.Objective.To examine differences in health care utilization and costs between children with and without ADHD.Design.Retrospective matched cohort study conducted from January 1 to December 31, 1997.Setting.Health maintenance organization in western Washington State.Participants.Children aged 3 through 17 years who were continuously enrolled in the health maintenance organization and used services during 1997 were eligible. Children were identified with ADHD if they had a diagnosis of ADHD or a prescription for a stimulant medication using automated patient files. Children without ADHD were randomly selected as controls and matched 4:1 to children with ADHD on age and sex.Outcome Measure.Utilization and costs of specific categories of health care services.Results.A total of 2992 children (5.2%) were identified with ADHD. Children with ADHD incurred significantly greater per capita total costs ($1465 vs $690) than children without ADHD. Children with ADHD had 9.9 times more outpatient mental health visits (1.35/year vs 0.14/year), 3.4 times more pharmacy fills (11.25/year vs 3.30/year), and 1.6 times more primary care visits (3.84/year vs 2.36/year) than children without ADHD. The adjusted incremental costs were estimated to be $375 (95% confidence interval: $336–$416) for children with ADHD alone and $812 (95% confidence interval: $671–$973) for children with ADHD plus coexisting mental health disorders.Conclusions.Children with ADHD use significantly more health care resources and incur significantly higher costs than children without ADHD. Coexisting mental health disorders substantially increase the cost of treating ADHD. Resource allocation decisions should consider the contributions of primary care, outpatient mental health, and pharmacy costs to the overall costs of care for children with ADHD.
Adult Outcomes of Pediatric Recurrent Abdominal Pain: Do They Just Grow Out of It?
Authors: Campo John V. , Di Lorenzo Carlo , Chiappetta Laurel , Bridge Jeff , Colborn D. Kathleen , Gartner J. Carlton , Gaffney Paul , Kocoshis Samuel , Brent David 
Published: August 2004

Objective.To determine whether medically unexplained recurrent abdominal pain (RAP) in childhood predicts abdominal pain, irritable bowel syndrome (IBS), other somatic complaints, and psychiatric symptoms and disorders in young adulthood.Methods.A sample of 28 young adults evaluated for RAP between the ages of 6 and 17 years were compared with 28 individually matched former childhood participants in a study of tonsillectomy and adenoidectomy. RAP caseness was established by structured retrospective chart review requiring agreement by 2 independent reviewers. Standardized assessments of abdominal pain, IBS, other somatic symptoms, psychopathology, perceived health, and history of maltreatment were performed an average of 11.1 years after the index visit.Results.Former RAP patients were significantly more likely than controls to endorse anxiety symptoms and disorders, hypochondriacal beliefs, greater perceived susceptibility to physical impairment, poorer social functioning, current treatment with psychoactive medication, and generalized anxiety in first degree relatives. There were trends suggesting associations between childhood RAP and lifetime psychiatric disorder, depression, migraine, and family history of depression, but group differences on abdominal pain, IBS, other somatic symptoms, and history of maltreatment were not statistically significant.Conclusions.There is a strong and relatively specific association between childhood RAP and anxiety in young adulthood. Affected children may be at special risk to perceive physical symptoms as threatening, and should be evaluated for psychiatric disorder on initial presentation.
Obsessive-Compulsive Scale of the Child Behavior Checklist: Specificity, Sensitivity, and Predictive Power
Authors: Nelson Elliot C. , Hanna Gregory L. , Hudziak James J. , Botteron Kelly N. , Heath Andrew C. , Todd Richard D. 
Published: August 2004

Objective.To create an obsessive-compulsive disorder subscale (OCS) of the Child Behavior Checklist (CBCL) and to determine its internal consistency, sensitivity, specificity, and positive and negative predictive power to identify obsessive-compulsive disorder (OCD) in children and adolescents.Methods.Three samples of equal size (n = 73) of children and adolescents, matched for age, gender, and race, were selected for these analyses: 1) a clinically ascertained OCD group, 2) a psychiatrically treated group whose records revealed no evidence of OCD, and 3) a general population control group. An OCS was created by applying factor analysis to 11 CBCL items. Examinations of internal consistency, sensitivity, specificity, and positive and negative predictive value were undertaken.Results.Of 11 items hypothesized to predict OCD, 8 items were retained after factor analyses (smallest factor loading: 0.49) and used to calculate OCS scores. The retained items displayed excellent internal consistency (Cronbach's α coefficient = 0.84). OCD participants had significantly higher OCS scores than either psychiatrically treated or general population control groups. With the use of the 2 cutoff scores closest to the true rate of OCD in the overall sample, sensitivity was 75.3% to 84.9%, specificity was 82.2% to 92.5%, positive predictive value was 70.5% to 83.3%, and negative predictive value was 88.2% to 91.6%.Conclusion.The performance of the proposed CBCL OCS compares favorably with that of the only previously studied screening instrument for OCD, the Leyton Obsessional Inventory–Child Version. Unlike the Leyton Obsessional Inventory–Child Version, the CBCL is already in widespread use as a screen for most other forms of psychopathology. As the performance of the CBCL OCS will need to be replicated in other sample populations, data with various cutoff levels are provided to enable investigators and clinicians to tailor its use to specific study populations.
Rational Testing of the HIV-Exposed Infant
Authors: Benjamin Daniel K. , Miller William C. , Fiscus Susan A. , Benjamin Daniel K. , Morse Michele , Valentine Megan , McKinney Ross E. 
Published: August 2004

Objectives.
The objectives of this study were 1) to evaluate testing regimens of human immunodeficiency virus (HIV)-exposed infants and 2) to determine optimal methods of follow-up by enzyme-linked immunosorbent assay (ELISA) testing.

Methods.
We reviewed the results from 742 HIV-exposed infants in the state of North Carolina; 2474 samples were tested for HIV by DNA polymerase chain reaction (PCR) at the University of North Carolina Retrovirology Core Laboratory. We then reviewed the utility and costs of ELISA testing of all HIV-exposed infants who were seen at the Duke University Pediatric Infectious Disease Clinic between January 1, 1993, and May 5, 1998. We used likelihood ratios to model probability of HIV infection given 3 negative DNA (PCR) tests and to provide recommendations on the use of ELISA follow-up.

Results.
The overall sensitivity of the DNA PCR was 87.1%, and its specificity was 99.9%. We evaluated 224 HIV-exposed infants who were seen at Duke University and who had at least 3 negative diagnostic tests using either DNA PCR tests or HIV blood cultures. All 178 infants who subsequently underwent ELISA testing ultimately demonstrated seroreversion. The Duke University Pediatric Infectious Disease Clinic transferred the care of 65 patients to primary care physicians before ELISA testing and retained the care of the remaining 159 patients. Children who remained in Duke's care were more likely to have documentation of seroreversion (158 of 159 vs 20 of 65). We reviewed costs of travel, physician appointment, and HIV antibody testing in a tertiary care setting. Given 3 negative PCR tests, the expected cost per case of HIV detected by a positive ELISA assay is $23.8 million.

Conclusions.
Documentation of seroreversion in this cohort was nearly complete in the multidisciplinary subspecialty clinic but not when such responsibility was left to the primary care physician. Given the low probability of disease in patients who have had 3 negative PCR tests, documentation of a negative ELISA may not be an appropriate use of medical resources.
The Decision to Breastfeed in the United States: Does Race Matter?
Authors: Forste Renata , Weiss Jessica , Lippincott Emily 
Published: August 2004

Objectives.To estimate the effects of maternal and birth characteristics on the decision to breastfeed and to relate breastfeeding practices to racial differences in infant mortality.Methods.Using a sample of women with young children from the National Survey of Family Growth (NSFG), Cycle V, 1995, the likelihood of breastfeeding was modeled using logistic regression techniques. In addition, single, live births from the NSFG 1988 and 1995 surveys were analyzed to model the effects of race and breastfeeding on infant mortality using Cox regression methods.Results.After controlling for socioeconomic background and birth characteristics, race remained a strong predictor of breastfeeding. Black women were less likely to breastfeed than nonblack women were, and the primary reason indicated by black women for not breastfeeding was that they “preferred to bottle-feed.” Analyses of infant mortality indicated that breastfeeding accounts for the race difference in infant mortality in the United States at least as well as low birth weight does.Conclusions.Race is an important predictor of breastfeeding, with most black women reporting that they “preferred bottle-feeding.” Efforts to increase breastfeeding of infants in the black community should help narrow the racial gap in infant mortality.
Driveway Injuries in Children: Risk Factors, Morbidity, and Mortality
Authors: Nadler Evan P. , Courcoulas Anita P. , Gardner Mary J. , Ford Henri R. 
Published: August 2004

Background/Purpose.Injuries that occur around the driveway are not typically regarded as reportable to the police and thus are often underrecognized. The aim of this study was to characterize the pattern and consequences of motor vehicle collisions that occur in the driveway.Methods.Over the past 13 years, 64 patients admitted to the Children's Hospital of Pittsburgh sustained motor vehicle-related injuries in a driveway. These injuries resulted from a vehicle driven by an adult driver striking a child (group 1) or a child shifting an idle vehicle out of gear (group 2). We compared demographic variables and outcome measures between the 2 groups.Results.There was no difference in gender, injury pattern, Injury Severity Score, length of stay, or operations performed between the groups. Patients in group 1 were younger, smaller, had a lower Glasgow Coma Scale, and had poorer outcomes. The majority of collisions (∼65%) in group 1 resulted from a truck or sport-utility vehicle going in reverse.Conclusions.Younger children are more severely injured in driveway-related crashes, which are most likely to be caused by a truck or sport-utility vehicle going in reverse. These vehicles should be equipped with additional safety features such as extended mirrors to visualize small children.
Comparative Practice Patterns of Emergency Medicine Physicians and Pediatric Emergency Medicine Physicians Managing Fever in Young Children
Authors: Isaacman Daniel J. , Kaminer Kimberly , Veligeti Hari , Jones Michael , Davis Paris , Mason Jon D. 
Published: August 2004

Background/Objective.The management of fever in young children is a controversial topic. This study seeks to compare the management approaches between general emergency medicine physicians (GEMPs) and pediatric emergency medicine physicians (PEMPs) and correlate them to existing practice guidelines.Design/Methods.All charts of children age 3 to 36 months presenting with the complaint of fever at both a children's hospital emergency department (ED) and a general ED from June 1, 1998 to September 1, 1998; December 1, 1998 to April 1, 1999; and June 1, 1999 to September 1, 1999 were retrospectively reviewed. Fever was defined as ≥39°C. Patients with a history of immunodeficiency, chronic illness, ventriculoperitoneal shunt, antibiotic use in the past 48 hours, or focal infection noted on examination were excluded. Data collected included focal exam findings, laboratory tests, diagnosis, treatment, and disposition. Variances from the practice guidelines were tabulated and compared.Results.One thousand three hundred twenty-three eligible children met exclusion criteria and were seen by PEMPs; 755 were eliminated because of exclusion criteria (526 because of focal infection). Twenty-two (4%) of 568 remaining patients were admitted to the hospital. Two hundred twenty-eight eligible children were seen by GEMPs; 147 were excluded (109 because of focal infection). No patients were admitted to the hospital. PEMPs ordered more complete blood counts (324/568 vs 27/81), more blood cultures (321/568 vs 27/81), and more urine cultures (208/568 vs 20/81) than GEMPs. GEMPs ordered more chest radiographs and cerebrospinal fluid analyses than PEMPs; GEMPs ordered less complete blood counts, blood cultures, and urine cultures than PEMPs. GEMPs diagnosed more focal infections (109/228 vs 526/1323), and conflicted more often with the practice guidelines (66/79 vs 225/498) than PEMPs. Patients spent an average of 2.26 ± 0.16 hours in the pediatric ED versus 3.0 hours ± 0.18 hours in the general ED.Conclusions.Significant differences in the management of the young child with fever and no source exist between these two groups of physicians. These variations affect both cost and standard of care. Future studies assessing whether these strategies affect patient outcomes would further elucidate their clinical implication.