bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reduction in Antibiotic Use Among US Children, 1996–2000
Authors: Finkelstein Jonathan A. , Stille Christopher , Nordin James , Davis Robert , Raebel Marsha A. , Roblin Douglas , Go Alan S. , Smith David , Johnson Christine C. , Kleinman Kenneth , Chan K. Arnold , Platt Richard 
Published: August 2004

Background. High rates of antibiotic prescribing to children contribute to antibiotic resistance in the community. The Centers for Disease Control and Prevention, in collaboration with other national and state level organizations, have actively promoted more judicious prescribing for children.Objective. We sought to assess changes in the rate of antibiotic prescribing from 1996–2000 in 9 US health plans, patterns of diagnosis and treatment responsible for these trends, and changes in the use of first-line antimicrobial agents.Design/Methods. We analyzed claims data for dispensed medications and physician visits from 9 health plans. Each provided data on 25 000 children aged 3 months to &lt;18 years enrolled between September 1, 1995, and August 31, 2000. Antibiotic dispensings were linked with an ambulatory visit claim to assign diagnosis. Antibiotic dispensings per person-year (antibiotics/p-y) were calculated for the age groups 3 months to &lt;3 years, 3 years to &lt;6 years, and 6 years to &lt;18 years. The contribution of each diagnosis to changes in the overall rate of antibiotic use was determined. Generalized linear mixed models were used to test for trend and assess differences in rates by site.Results. From 1996–2000, antibiotic rates for children 3 months to &lt;3 years decreased from 2.46 to 1.89 antibiotics/p-y (24%); for children 3 years to &lt;6 years from 1.47 to 1.09 antibiotics/p-y (25%); and for children 6 to &lt;18 years from 0.85 to 0.69 antibiotics/p-y (16%). The reduction varied among health plans from 6% to 39% for children 3 months to &lt;3 years. A decrease in prescriptions for otitis media accounted for 59% of the total decrease, and was primarily accounted for by a decrease in the rate of diagnosis of this condition. The proportion of first-line penicillins increased from 49% to 53%, with health plans with the lowest initial rates increasing most.Conclusions. Antibiotic prescribing decreased significantly between 1996 and 2000, concurrent with decreased frequency of diagnosis of potential bacterial infections, especially otitis media. Attention by public health and professional organizations and the news media to antibiotic resistance may have contributed to changes in diagnostic thresholds, resulting in more judicious prescribing.
Neonatal Candidemia and End-Organ Damage: A Critical Appraisal of the Literature Using Meta-analytic Techniques
Authors: Benjamin Daniel K. , Poole Charles , Steinbach William J. , Rowen Judith L. , Walsh Thomas J. 
Published: August 2004

Objective. Neonatal candidemia is an increasing cause of infant morbidity and mortality. We evaluated the current medical literature in an effort to critique the literature and to document the reported prevalences of end-organ damage after neonatal candidemia.Methods. We analyzed all peer-reviewed articles of neonatal candidemia published in the English language; inclusion criteria included a cohort limited to all neonatal intensive care unit admissions or all episodes of candidemia in neonates. Articles that also incorporated older patients, did not define a numerator and a denominator for at least 1 form of end-organ damage, included patients from other reports, or did not include all episodes of candidemia in the source population were excluded from the analysis.Results. Thirty-four articles reported episodes of candidemia and mortality; 21 articles reported prevalence for at least 1 form of end-organ damage. Only 4 (19%) of 21 articles reported prevalence for &gt;4 forms of end-organ damage from the following list: endophthalmitis, meningitis, brain parenchyma invasion, endocarditis, renal abscesses, positive cultures from other normally sterile body fluids, or hepatosplenic abscesses. The median reported prevalence of endophthalmitis was 3% (interquartile range [IQR]: 0%–17%), of meningitis was 15% (IQR: 3%–23%), of brain abscess or ventriculitis was 4% (IQR: 3%–21%), of endocarditis was 5% (IQR: 0%–13%), of positive renal ultrasound was 5% (IQR: 0%–14%), and of positive urine culture was 61% (IQR: 40%–76%). The medical literature concerning end-organ evaluation after episodes of neonatal candidemia is heterogeneous and consists largely of single-center retrospective studies. Year that the data were collected and prevalence of neonates infected with Candida albicans were associated with observed heterogeneity.Conclusions. Given the heterogeneity of the medical literature, precise estimates of the frequencies of end-organ damage are not possible and a prospective multicenter trial is warranted, but the data from the published literature suggest that the prevalence of neonates with end-organ damage not only is greater than 0 but also is high enough that until such a prospective trial is completed, end-organ studies should be considered before the conclusion of antifungal therapy.
Partial Pressure of Carbon Dioxide in Extremely Low Birth Weight Infants Supported by Nasal Prongs Continuous Positive Airway Pressure
Authors: Nguyen An T. , Aly Hany , Milner Joshua , Patel Kantilal M. , El-Mohandes Ayman 
Published: August 2004

Objective. Traditionally, delivery room management of extremely low birth weight (ELBW) infants consisted of immediate intubation and mechanical ventilation. There have been recent reports of success using nasal prongs continuous positive airway pressure (NCPAP) in this population. Data on the partial pressure of carbon dioxide (Pco2) in spontaneously breathing ELBW infants is very limited. The objective of this study was to determine the trend of the average Pco2 in the spontaneously breathing ELBW infants, while on NCPAP, during the first week of life and to determine whether a brief period of mechanical ventilation affects the Pco2 levels after extubation.Methods. This is a retrospective cohort study of infants who had birth weights &lt;1000 g and were admitted to the neonatal intensive care unit at our institution. These ELBW infants were divided into groups on the basis of whether they were never intubated (group 1) or were intubated for &lt;48 hours (group 2). Average daily Pco2 levels while on NCPAP were compared between the 2 groups. Minimum and maximum Pco2 levels were also compared with a third group of infants (group 3), who were intubated for &gt;48 hours and treated mainly with mechanical ventilation during the first week of life.Results. Sixty-two ELBW infants were included in this study: 24 infants in group 1, 19 infants in group 2, and 19 infants in group 3. There was no significant difference between the average Pco2 levels of group 1 and group 2 during the first week of life. The daily Pco2 level during the first week of life for infants who were breathing spontaneously on NCPAP had a mean value of 39.73 ± 1.78 mm Hg. There was no difference between the daily average minimum Pco2 levels among the 3 groups. Group 3, however, had significantly higher maximum Pco2 levels compared with the first 2 groups during days 2 through 7 of life.Conclusions. Daily average Pco2 levels in the spontaneously breathing ELBW infants during the first week of life remains at approximately 40 mm Hg. These levels seem to be unaffected by an initial brief period of mechanical ventilation. Infants who are treated with longer periods of mechanical ventilation have higher daily maximum Pco2 levels during the first week of life. Additional studies are required to detect neurodevelopmental outcomes of these 3 groups.
Nelfinavir Pharmacokinetics in Stable Human Immunodeficiency Virus-Positive Children: Pediatric AIDS Clinical Trials Group Protocol 377
Authors: Floren Leslie Carstensen , Wiznia Andrew , Hayashi Sandra , Jayewardene Anura , Stanley Kenneth , Johnson George , Nachman Sharon , Krogstad Paul , Aweeka Francesca T. ,   the Pediatric ACTG 377 Protocol Team
Published: August 2004

Objective. Pharmacokinetic data obtained from children who have human immunodeficiency virus (HIV) infection are essential for the safe and effective use of antiretroviral agents in pediatric populations. The objective of this study was to assess the impact of body weight on the pharmacokinetic disposition of nelfinavir (NFV) in the absence and presence of nevirapine (NVP) and compare the pharmacokinetic profiles of twice-daily (BID) and three-times-daily (TID) NFV regimens.
Methods. This was an intensive pharmacokinetic substudy nested in a phase II, multicenter, randomized, open-label trial. Forty-five HIV-infected children receiving NFV 30 mg/kg TID and 6 HIV-infected children receiving NFV 55 mg/kg BID were enrolled in this study and assigned to 1 of 4 stavudine-containing regimens, 3 containing NFV and 2 containing NVP. Area under the plasma concentration-time curves from 0 to 8 hours (AUC0–8 hours) and from 0 to 12 hours (AUC0–12 hours) for the TID and BID regimens, respectively, were determined. For comparative purposes, the AUC0–24 hours was also calculated for each regimen.
Results. NFV exposure in the absence of NVP was decreased in children who were &lt;25 kg compared with those who were &gt;25 kg (a 2.6-fold difference in median AUC0–8 hours). NFV pharmacokinetics in the presence of NVP did not differ between the &lt;25 kg and &gt;25 kg groups. The AUC0–24 hours for children who were &lt;30 kg and on NFV BID was comparable to the AUC0–24 hours for children who were &gt;25 kg and on NFV TID but was 2.7-fold greater than AUC0–24 hours for children who were &lt;25 kg and on NFV TID.
Conclusions. NFV in the absence of NVP resulted in less than half the drug exposure in children who were &lt;25 kg compared with children who were &gt;25 kg. NFV dosed at 55 mg/kg BID in children who are &lt;30 kg provides comparable exposure to that measured in children who are &gt;25 kg and receiving NFV 30 mg/kg TID.
Neuroimaging of Intraparenchymal Lesions Predicts Outcome in Shaken Baby Syndrome
Authors: Bonnier Christine , Nassogne Marie-Cécile , Saint-Martin Christine , Mesples Bettina , Kadhim Hazim , Sébire Guillaume 
Published: August 2004

Objective. Studies of long-term outcome on nonaccidental head injury (NAHI) in young children have shown severe neurodevelopmental sequelae in most cases. For improving the knowledge of outcome and for identifying prognostic factors, additional clinical and cerebral imaging data are needed. The aim of this study was to describe clinical and imaging features over time and to consider their value for predicting neurodevelopmental outcome.
Methods. A retrospective medical record review was conducted of 23 children with confirmed NAHI, for whom an extended follow-up of 2.5 to 13 years (mean: 6 years) was contemplated. Glasgow Coma Scale scores, severity of retinal hemorrhages, presence of skull fractures, cranial growth deceleration, and sequential neuroimaging data (computed tomography and/or magnetic resonance imaging) were compared with patterns of clinical evolution assessed by the Glasgow Outcome Scale.
Results. Clinical outcome showed that 14 (61%) children had severe disabilities, 8 (35%) had moderate disabilities, and 1 (4%) was normal. A low initial Glasgow Coma Scale score, severe retinal hemorrhages, presence of skull fracture, and cranial growth deceleration were significantly associated with poor developmental outcome. Eighteen of the 23 patients had abnormal magnetic resonance imaging scans. This examination disclosed atrophy when performed beyond 15 days of injury. Atrophy seemingly resulted from various brain lesions, namely, contusions, infarcts, and other lesions within the white matter. Presence of intraparenchymal brain lesions within the first 3 months was significantly associated with neurodevelopmental impairment. Severity of motor and cognitive dysfunctions was related to the extent of intraparenchymal lesions.
Conclusions. Early clinical and radiologic findings in NAHI are of prognostic value for neurodevelopmental outcome.
Are Minority Children Under- or Overrepresented in Pediatric Research?
Authors: Walsh Catherine , Ross Lainie F. 
Published: August 2004

Objectives. There is extensive documentation that minority adults are underrepresented in medical research, but there are scant data regarding minority children and their parents.
Methods. All full-length articles published in the paper edition of 3 general pediatric journals between July 1999 and June 2000 were collected and reviewed. Articles were excluded when they did not include at least 1 US researcher, all subjects at US institutions, parents or children as subjects, some prospective data collection, or between 8 and 10 000 subjects. We recorded the number and race/ethnicity (R/E) of all subjects, the type of research, and the type of data collected. Corresponding authors were surveyed to clarify R/E data.
Results. A total of 192 studies qualified. R/E data were reported in 114 (59%) studies, and survey data provided additional or new information in 25 studies resulting in R/E data in 128 (67%) articles accounting for 75% of the subjects. R/E was described by &gt;10 different labels. There was an overrepresentation of black subjects and an underrepresentation of white and Hispanic subjects compared with the census data. When compared with research participation of child subjects, generally, black children were overrepresented and Hispanic children were underrepresented in clinical trials, and both were underrepresented in therapeutic research. Black and Hispanic children were overrepresented in potentially stigmatizing research.
Conclusions. Overall, we found an overrepresentation of black subjects and an underrepresentation of white and Hispanic subjects with significant variations depending on the type of research.
Children Hospitalized With Severe Acute Respiratory Syndrome-Related Illness in Toronto
Authors: Bitnun Ari , Allen Upton , Heurter Helen , King Susan M. , Opavsky Mary Anne , Ford-Jones Elizabeth L. , Matlow Anne , Kitai Ian , Tellier Raymond , Richardson Susan , Manson David , Babyn Paul , Read Stanley ,   Other Members of the Hospital for Sick Children SARS Investigation Team
Published: August 2004

Objective. An outbreak of severe acute respiratory syndrome (SARS) occurred in the greater Toronto area between February and June 2003. We describe the clinical, laboratory, and epidemiologic features of children who were admitted to the Hospital for Sick Children, Toronto, with a presumptive diagnosis of suspect or probable SARS.
Methods. A prospective investigational study protocol was established for the management of children with a presumptive diagnosis of suspect or probable SARS. All were ultimately classified as having probable SARS, suspect SARS, or another cause on the basis of their epidemiologic exposure, clinical and radiologic features, and results of microbiologic investigations.
Results. Twenty-five children were included; 10 were classified as probable SARS and 5 were classified as suspect SARS, and in 10 another cause was identified. The exposure consisted of direct contact with at least 1 adult probable SARS case in 11 children, travel from a World Health Organization-designated affected area in Asia in 9 children, and presence in a Toronto area hospital in which secondary SARS spread had occurred in 5 children. The predominant clinical manifestations of probable cases were fever, cough, and rhinorrhea. With the exception of 1 teenager, none of the children developed respiratory distress or an oxygen requirement, and all made full recoveries. Mild focal alveolar infiltrates were the predominant chest radiograph abnormality. Lymphopenia; neutropenia; thrombocytopenia; and elevated alanine aminotransferase, aspartate aminotransferase, and creatine kinase were present in some cases. Nasopharyngeal swab specimens were negative for the SARS-associated coronavirus by an in-house reverse transcriptase-polymerase chain reaction in all 25 children.
Conclusions. Our results indicate that SARS is a relatively mild and nonspecific respiratory illness in previously healthy young children. The presence of fever in conjunction with a SARS exposure history should prompt one to consider SARS as a possible diagnosis in children irrespective of the presence or absence of respiratory symptoms. Reverse-transcriptase polymerase chain reaction analysis of nasopharyngeal specimens seems to be of little utility for the diagnosis of SARS during the early symptomatic phase of this illness in young children.
Parental Knowledge, Attitudes, and Practices Associated With Not Receiving Hepatitis A Vaccine in a Demonstration Project in Butte County, California
Authors: Bardenheier Barbara , González Idalia M. , Washington Michael L. , Bell Beth P. , Averhoff Francisco , Massoudi Mehran S. , Hyams Insu , Simard Edgar P. , Yusuf Hussain 
Published: August 2004

Objective. To determine hepatitis A vaccination coverage and factors associated with not receiving hepatitis A vaccine among children.Methods. A random cluster sample survey was conducted of parents of children who attended kindergarten in Butte County, California, in 2000. Because of a history of recurrent epidemics, an aggressive hepatitis A vaccination program was ongoing during the time this study was conducted. Receipt of 1 or 2 doses of hepatitis A vaccine was studied.Results. Of 896 surveys sent, 648 (72%) were completed. The vaccination coverage for at least 1 dose of hepatitis A vaccine was 398 (62%) and for 2 doses was 272 (42%). Factors associated with not receiving the vaccine included lack of provider recommendation (vs having recommendation; odds ratio [OR]: 7.8; 95% confidence interval [CI]: 4.9–12.2), not having heard of the vaccine (OR: 2.4; 95% CI: 1.2–4.9), and parent’s not perceiving child is likely to get hepatitis A (vs perceiving child might get disease; OR: 2.1; CI: 1.6–2.9).Conclusions. Vaccination coverage among kindergartners did not reach high levels (ie, &gt;90%), despite aggressive vaccination efforts in this community. Lack of provider recommendation and lack of parental awareness of hepatitis A vaccine were the 2 most significant factors associated with failure to receive vaccine. These findings will facilitate the development of vaccination strategies for communities in which hepatitis A vaccination is recommended.
Keeping Children Out of Hospitals: Parents’ and Physicians’ Perspectives on How Pediatric Hospitalizations for Ambulatory Care-Sensitive Conditions Can Be Avoided
Authors: Flores Glenn , Abreu Milagros , Chaisson Christine E. , Sun Donglin 
Published: August 2004

Background. Avoidable hospitalization conditions (AHCs) are hospitalizations that potentially can be avoided with timely, appropriate outpatient care. The specific reasons for avoidability, and parents and physicians’ perspectives on the proportion of actually avoidable pediatric AHCs, have not been examined adequately.Objectives. To identify how pediatric hospitalizations might be avoided, and to determine the proportion of avoidable AHCs according to parents and physicians of hospitalized children.Methods. Cross-sectional survey of parents, primary care physicians (PCPs), and inpatient attending physicians (IAPs) of a consecutive series of children who were admitted with AHCs to an urban hospital in a 14-month period.Results. The 554 hospitalized children had a median age of 4 years; most were poor (median annual family income: $12 000), nonwhite (91%), and had public (73%) or no (16%) health insurance. The most frequent AHC diagnoses were asthma (43%), dehydration/gastroenteritis (16%), pneumonia (11%), seizure disorder (8%), and skin infections (8%). Only 25% of parents said that their child’s admission was avoidable, compared with 29% of PCPs and 32% of IAPs. The proportion of AHC hospitalizations assessed as avoidable varied according to the source or combination of sources, from 13% for agreement among all 3 sources to 46% as identified by any 1 of the 3 sources. PCPs (71%) and IAPs (48%) significantly more often than parents (35%) cited parent/patient-related reasons for how hospitalizations could have been avoided, including adhering to and refilling medications, better outpatient follow-up, and avoiding known disease triggers. Parents (48%) significantly more often than PCPs (18%) and IAPs (37%) cited physician-related reasons for how hospitalizations could have been avoided, including better education by physicians about the child’s condition, and better quality of care. Multivariate analyses revealed that an age ≥11 years, an asthma diagnosis, working poor family income, and having no health insurance were associated with approximately double to triple the odds of an avoidable hospitalization.Conclusions. The proportion of AHCs assessed as avoidable varies from 13% to 46%, depending on the source. Adolescents, children with asthma, children from working-poor families, and uninsured children are at greatest risk for avoidable hospitalizations. Many pediatric hospitalizations might be avoided if parents and children were better educated about the child’s condition, medications, the need for follow-up care, and the importance of avoiding known disease triggers. Direct assessment by parents and physicians of hospitalized children can be an informative way to examine the proportion of avoidable pediatric hospitalizations and how they can be prevented.
Bedside Procalcitonin and C-Reactive Protein Tests in Children With Fever Without Localizing Signs of Infection Seen in a Referral Center
Authors: Galetto-Lacour Annick , Zamora Samuel A. , Gervaix Alain 
Published: August 2004

Objective. To assess the value of bedside tests for predicting the occurrence of severe bacterial infections (SBIs) in children with fever without source.Methods. We conducted a prospective study of 99 children, aged 7 days to 36 months, who were seen for fever &gt;38°C and no localizing sign of infection at the emergency department of the University Children’s Hospital of Geneva. Blood procalcitonin (PCT), C-reactive protein (CRP), and interleukin-6 (IL-6) values were determined using rapid tests and were compared with the total white blood cell (WBC) count with differential and clinical score. Specificity, sensitivity, predictive values, and multilevel likelihood ratios (LRs) with posttest probabilities of disease were calculated.Results. Twenty-nine (29%) children received a diagnosis of having an SBI. PCT had the best sensitivity (93%) and negative predictive value (96%). Band count had the best specificity (93%), but its positive predictive value was only 38%. Multilevel LRs revealed that a PCT concentration &lt;0.5 ng/mL (LR: 0.093) almost ruled out SBI (posttest probability of disease: 3.7%) in 54 (54%) subjects, whereas a value &gt;2 ng/mL (LR: 5.2) increased the probability of SBI to 68% in 19 (19%) children. For CRP, values &lt;40 mg/L (LR: 0.263) and &gt;100 mg/L (LR: 14.483) generated posttest probabilities for SBI of 9.7% (61 subjects) and 86.5% (14 subjects), respectively. For WBC count, the posttest probabilities of SBI were modestly changed from the pretest prevalence.Conclusions. PCT and CRP performed better than IL-6, WBC, and/or band count in predicting the occurrence of SBI. PCT and CRP bedside tests may be useful tools for emergency and private practice doctors and should be considered in the initial work-up of children with fever without source.