bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comprehensive Assessments for Children Entering Foster Care: A National Perspective
Authors: Leslie Laurel K. , Hurlburt Michael S. , Landsverk John , Rolls Jennifer A. , Wood Patricia A. , Kelleher Kelly J. 
Published: August 2004

Objectives. To 1) investigate the status of policies for comprehensive health assessments of children entering out-of-home care, 2) develop a profile for each primary sampling unit (PSU) regarding the comprehensiveness of its assessment policies with respect to physical, mental, and developmental health, and 3) examine the relationship between inclusiveness and the estimated percentage of children assessed, primary assessment location, and principal assessment provider type.Method. In collaboration with the National Survey of Child and Adolescent Well-Being, a national probability sample of 92 PSUs was identified. Detailed telephone survey data, addressing policies for the assessment of physical, mental, and developmental needs of children on entry into out-of-home care, were collected from child welfare key informants. Descriptive statistics were used for analyses, and were weighted to account for the sampling strategy.Results. Over 94% of PSUs surveyed assessed all children for physical health problems. The percentage of PSUs with inclusive policies regarding mental health and developmental assessment was much lower (47.8% and 57.8%, respectively). Only 42.6% of PSUs provided comprehensive physical, mental health, and developmental examinations inclusive of all children entering out-of-home care. Community locations and primary care providers were most often used to conduct assessments for physical and developmental problems.Conclusions. Despite the publication of national guidelines regarding assessment, many PSUs do not have comprehensive policies or routine practices that address all children entering out-of-home care. Given the high use of primary care providers, these providers must be educated regarding the prevalence and types of problems experienced by children entering foster care.
Diagnosis and Treatment of Acute Otitis Media: An Assessment
Authors: Garbutt Jane , Jeffe Donna B. , Shackelford Penelope 
Published: August 2004

Objective. To assess compliance with the Centers for Disease Control and Prevention (CDC) evidence-based guidelines for the judicious use of antimicrobials in children with acute otitis media (AOM).Methods. Compliance with CDC’s recommended diagnostic criteria and antimicrobial treatments for management of AOM was assessed by chart review and self-report for 29 community pediatricians in St. Louis, Missouri. For each physician, a simple random sample of AOM visits was selected and reviewed by trained reviewers. In addition, each physician completed a questionnaire.Results. Compliance with recommended diagnostic criteria was 38% (95% confidence interval: 34%–42%; n = 573) by chart audit and 41% (95% confidence interval: 24%–61%; n = 29) by self-report. Antimicrobial selection assessed by chart audit was consistent with CDC guidelines in 68% (95% confidence interval: 64%–72%) of visits for a new infection, 63% (95% confidence interval: 47%–78%) of visits for treatment failure, and 50% (95% confidence interval: 33%–67%) for recurrent disease. Self-reported compliance with treatment guidelines for new infection was 100% (95% confidence interval: 88%–100%) and 83% (95% confidence interval: 64%–94%) for treatment failure. Noncompliance was most frequently attributable to overuse of broad-spectrum antimicrobials. Most patients treated with amoxicillin received a 10-day course (98%). Subtherapeutic dosing occurred in 26% of patients treated with amoxicillin.Conclusions. Overdiagnosis of AOM is common. Efforts to improve the judicious use of antimicrobials for AOM should focus on improving diagnostic accuracy, limiting the use of broad-spectrum antimicrobials to cases where they offer clinical benefit, and ensuring that amoxicillin dosing regimens are optimal.
Early Physical Activity Intervention Prevents Decrease of Bone Strength in Very Low Birth Weight Infants
Authors: Litmanovitz Ita , Dolfin Tzipora , Friedland Orit , Arnon Shmuel , Regev Rivka , Shainkin-Kestenbaum Ruth , Lis Monika , Eliakim Alon 
Published: August 2004

Objective. To evaluate the effect of early range-of-motion intervention on bone strength and bone turnover in very low birth weight infants.
Methods. Twenty-four infants (mean birth weight: 1135 ± 247 g; mean gestational age: 28.5 ± 2.3 weeks) were matched for gestational age and birth weight and then randomly assigned into exercise (n = 12) and control (n = 12) groups. Exercise protocol started at the first week of life and involved daily extension and flexion range of motion against passive resistance of the upper and lower extremities (5 minutes per day, 5 days per week, 4 weeks). Growth parameters, bone strength, and biochemical markers of bone homeostasis were measured at enrollment and after 4 weeks. Bone strength was determined using quantitative ultrasound measurement of bone speed of sound (SOS) at the middle left tibial shaft.
Results. Bone SOS decreased significantly in the control group during the study period (from 2892 ± 30 m/sec to 2799 ± 26), whereas bone SOS of the exercise group remained stable (2825 ± 32 m/sec and 2827 ± 26 m/sec at baseline and 4 weeks, respectively). This significant difference in bone SOS was not expressed in the biochemical markers of bone homeostasis.
Conclusions. There is a significant postnatal decrease in the bone SOS of very low birth weight infants. A brief range-of-motion exercise attenuates the decrease in bone strength and may decrease the risk of osteopenia.
Controversies Concerning Vitamin K and the Newborn
Authors:   Committee on Fetus and Newborn
Published: August 2004

This Policy Statement was revised. See https://doi.org/10.1542/peds.2021-056036.
Prevention of early vitamin K deficiency bleeding (VKDB) of the newborn, with onset at birth to 2 weeks of age (formerly known as classic hemorrhagic disease of the newborn), by oral or parenteral administration of vitamin K is accepted practice. In contrast, late VKDB, with onset from 2 to 12 weeks of age, is most effectively prevented by parenteral administration of vitamin K. Earlier concern regarding a possible causal association between parenteral vitamin K and childhood cancer has not been substantiated. This revised statement presents updated recommendations for the use of vitamin K in the prevention of early and late VKDB.
Prevention and Management of Positional Skull Deformities in Infants
Authors: Persing John , James Hector , Swanson Jack , Kattwinkel John ,   Committee on Practice and Ambulatory Medicine,   Section on Plastic Surgery,   Section on Neurological Surgery
Published: August 2004

This Clinical Report was retired December 2016.
Cranial asymmetry may be present at birth or may develop during the first few months of life. Over the past several years, pediatricians have seen an increase in the number of children with cranial asymmetry, particularly unilateral flattening of the occiput. This increase likely is attributable to parents following the American Academy of Pediatrics “Back to Sleep” positioning recommendations aimed at decreasing the risk of sudden infant death syndrome. Although associated with some risk of deformational plagiocephaly, healthy young infants should be placed down for sleep on their backs. This practice has been associated with a dramatic decrease in the incidence of sudden infant death syndrome. Pediatricians need to be able to properly diagnose skull deformities, educate parents on methods to proactively decrease the likelihood of the development of occipital flattening, initiate appropriate management, and make referrals when necessary. This report provides guidelines for the prevention, diagnosis, and management of positional skull deformity in an otherwise normal infant without evidence of associated anomalies, syndromes, or spinal disease.
Current Practice Regarding the Enteral Feeding of High-Risk Newborns With Umbilical Catheters In Situ
Authors: Tiffany Kenneth F. , Burke Bonnie L. , Collins-Odoms Cynthia , Oelberg David G. 
Published: August 2004

Objective. Textbooks recognize the controversy of concomitant enteral nutrition (EN) during umbilical catheter usage in high-risk newborns, but support for the practice varies. There is only one clinical trial examining these practices in a small but randomized, controlled trial of enterally fed newborns with umbilical arterial catheters (UACs) in situ, and that trial did not demonstrate any adverse consequences. We speculate that concomitant EN with umbilical catheter usage is more common than some textbooks suggest—practiced by at least 20% of all US neonatal intensive care units (NICUs). The objective of this study is to determine the prevalence of NICUs where high-risk newborns with UAC or umbilical venous catheter (UVC) placement receive concomitant EN.
Methods. Medical Directors listed in the American Academy of Pediatrics United States Neonatologist and Perinatologist Directory were surveyed by mail. On return of surveys, responses to multiple choice questions were recorded by electronic scanning and validated by manually conducted quality control checks. NICU identities were recorded by code to maintain anonymity.
Results. Following 2 requests for survey participation, 70% (549/785) of surveys were returned. Respectively, 82% and 62% of NICUs with and without training programs were represented. On average, surveyed medical directors had practiced neonatal medicine 18.1 ± 0.3 years. Of surveyed NICUs, 99% reported placement of UVCs and UACs. Of the 92% believing that it is safe to provide trophic EN to newborns with UVCs in place, 51% practiced this some of the time, and 37% practiced it most of the time. By comparison, it was reported that newborns with UACs in place receive trophic EN most of the time (30%), some of the time (49%), or none of the time (22%). Of the 80% believing that it is safe to provide more complete EN to newborns with UVCs in place, 44% practiced this some of the time, and 24% practiced it most of the time. For newborns with UACs in place, more complete EN was provided most of the time (15%), some of the time (36%), or none of the time (49%).
Conclusions. Concurrent UVC and UAC usage with EN is more commonly practiced than suggested in textbooks or published articles. The relative risk-benefit profiles of these practices remain uncertain secondary to the limited number of controlled clinical observations and to the infrequent occurrence of adverse events. A prospective, multicenter, controlled trial would address the continued advisability of these unexpectedly common practices.
Evidence-Based Referral Results in Significantly Reduced Mortality After Congenital Heart Surgery
Authors: Allen Steven W. , Gauvreau Kimberlee , Bloom Barry T. , Jenkins Kathy J. 
Published: August 2004

Objective. Significant interinstitutional variation in mortality after congenital heart surgery has been demonstrated. Noting an association between reduced mortality and higher volume, a center with a small annual case volume began in August 1998 to selectively refer to high-volume surgical centers based on published or “apparent” low mortality rates for specific cardiac lesions. This study was undertaken to evaluate the effect of evidence-based referral in this practice.
Design, Setting, and Participants. A retrospective cohort comparison over a 10-year period for a small Midwestern pediatric cardiology practice. The institutional database was retrospectively reviewed for children (&lt;18 years) undergoing surgery from August 1992 to July 2002. Data were divided into 3 time periods (August 1992 to July 1995, period 1; August 1995 to July 1998, period 2; and August 1998 to July 2002, period 3). Hospital discharge abstract data from 5 states (California, Illinois, Massachusetts, Pennsylvania, and Washington) in 1992, 1996, and 1998 provided contemporaneous benchmarks. Risk adjustment was performed using the Risk Adjustment in Congenital Heart Surgery-1 method. Risk category, age at surgery, prematurity, and major noncardiac structural anomaly were entered into a multivariate logistic regression model to compare in-hospital mortality adjusting for case-mix differences.
Results. A total of 514 congenital heart surgical cases were identified from August 1992 to July 2002; 507 cases (98.6%) were assigned to a risk category and analyzed further. Unadjusted in-hospital mortality rates were 9.3% in period 1, 5.9% in period 2, and 1.3% in period 3. Unadjusted mortality rates for cases from benchmark data were 6.4% in 1992, 4.8% in 1996, and 3.7% in 1998. Risk adjusted mortality was comparable to the benchmark data in periods 1 and 2, but superior outcomes (odds ratio = 0.24) were demonstrated in period 3.
Conclusions. Evidence-based referrals from a small-volume pediatric cardiac center to large-volume institutions resulted in a reduction in mortality after congenital heart surgery.
Effect of Posture on Oxygenation, Lung Volume, and Respiratory Mechanics in Premature Infants Studied Before Discharge
Authors: Bhat Ravindra Yeshwant , Leipälä Jaana Annika , Singh Nanak Raj-Pal , Rafferty Gerrard Francis , Hannam Simon , Greenough Anne 
Published: August 2004

Objectives. To determine if the prone versus the supine posture was associated with higher oxygenation levels in prematurely born infants before discharge, whether any such effect was explained by alterations in lung volume or respiratory mechanics, and if the changes were greater in oxygen-dependent infants.
Patients. Twenty infants (10 oxygen-dependent), median gestational age 30 (range: 27–32) weeks, were studied at a median postconceptional age of 35 weeks (range: 32–38 weeks).
Methods. On 2 successive days, infants were studied both supine and prone; each posture was maintained for 3 hours. Oxygen saturation was continuously monitored and at the end of each 3-hour period; compliance and resistance of the respiratory system and functional residual capacity (FRC) were measured.
Results. Overall, the median oxygen saturation and FRC were significantly higher in the prone position; compliance of the respiratory system and resistance of the respiratory system were not significantly affected by posture. Differences in oxygen saturation and FRC were significantly higher in the prone posture in the oxygen-dependent, but not the nonoxygen-dependent infants.
Conclusions. Superior oxygenation in the prone posture in oxygen-dependent premature infants studied before discharge could be explained by higher lung volumes.
Hemodynamic and Antecedent Risk Factors of Early and Late Periventricular/Intraventricular Hemorrhage in Premature Infants
Authors: Osborn David A. , Evans Nick , Kluckow Martin 
Published: August 2004

Objectives. To determine hemodynamic and antecedent risk factors for early and late periventricular/intraventricular hemorrhage (P/IVH) in premature infants.
Methods. Two prospective cohort studies of 126 (1995–1996) and 128 (1998–1999) infants born &lt;30 weeks’ gestation. Head ultrasounds were performed at &lt;6 hours of age, and at 7 and 28 days of age. P/IVH was classified as early (present on initial scan) and late (developed subsequently). Echocardiographic measurement of the superior vena cava (SVC) flow was performed at &lt;6, 10, and 24 hours of age.
Results. Infants with early P/IVH were significantly more likely to be born by vaginal delivery in both cohorts (1995–1996 adjusted odds ratios [OR]: 13.29; 1998–1999 adjusted OR: 18.15). An association with a 1-minute Apgar ≤4 was only significant in the 1998–1999 cohort (adjusted OR: 9.14). Low SVC flow was the only independent risk factor for late P/IVH in both cohorts (1995–1996 adjusted OR: 20.39; 1998–1999 adjusted OR: 5.16). Adjusted for perinatal risk factors, low SVC flow was associated with lower gestation and higher average mean airway pressure in both cohorts, and with a large diameter ductus diameter only in the 1995–1996 cohort.
Conclusions. Early and late P/IVH have distinct and different risk factors. Early P/IVH is associated with vaginal delivery and possibly low Apgar scores. Late P/IVH is associated with antecedent low SVC flow in the first day.
A Model of Determining a Fair Market Value for Teaching Residents: Who Profits?
Authors: Cullen Edward J. , Lawless Stephen T. , Hertzog James H. , Penfil Scott , Bradford Kathleen K. , Nadkarni Vinay M. , Corddry David H. , Costarino Andrew T. 
Published: August 2004

Context. Centers for Medicare & Medicaid Services (CMS) Health Resources and Services Administration Children’s Hospitals Graduate Medical Education (GME) Payment Program now supports freestanding children’s teaching hospitals.
Objective. To analyze the fair market value impact of GME payment on resident teaching efforts in our pediatric intensive care unit (PICU).
Design. Cost-accounting model, developed from a 1-year retrospective, descriptive, single-institution, longitudinal study, applied to physician teachers, residents, and CMS.
Setting. Sixteen-bed PICU in a freestanding, university-affiliated children’s teaching hospital.
Participants. Pediatric critical care physicians, second-year residents.
Main Outcome Measures. Cost of physician opportunity time; CMS investment return; the teaching physicians’ investment return; residents’ investment return; service balance between CMS and teaching service investment margins; economic balance points; fair market value.
Results. GME payments to our hospital increased 4.8-fold from $577 886 to $2 772 606 during a 1-year period. Critical care physicians’ teaching opportunity cost rose from $250 097 to $262 215 to provide 1523 educational hours (6853 relative value units). Residents’ net financial value for service provided to the PICU rose from $245 964 to $317 299. There is an uneven return on investment in resident education for CMS, critical care physicians, and residents. Economic balance points are achievable for the present educational efforts of the CMS, critical care physicians, and residents if the present direct medical education payment increases from 29.38% to 36%.
Conclusions. The current CMS Health Resources and Services Administration Children’s Hospitals GME Payment Program produces uneven investment returns for CMS, critical care physicians, and residents. We propose a cost-accounting model, based on perceived production capability measured in relative value units and available GME funds, that would allow a clinical service to balance and obtain a fair market value for the resident education efforts of CMS, physician teachers, and residents.
Costs of Childhood Physical Abuse: Comparing Inflicted and Unintentional Traumatic Brain Injuries
Authors: Libby Anne M. , Sills Marion R. , Thurston Norman K. , Orton Heather D. 
Published: August 2004

Objectives. To estimate the effect of early childhood abuse (ie, inflicted injury) on medical costs of head trauma.Methods. Abstracts of patient records were drawn from the annual 1993–2000 Colorado state-mandated hospital discharge database maintained by the Colorado Hospital Association. The 2 dependent variables were total charges (TC) and length of stay. Our key independent variable was the nature of injury, ie, inflicted or unintentional; other independent variables were age, severity level, death, and trauma designation of the hospital. Comparisons of variables between patients with inflicted and unintentional head trauma were performed using Student’s t tests or χ2 statistics. Ordinary least squares regression was used to estimate the marginal and total effects of inflicted injury on TC and LOS.Results. Of the 1097 head trauma patients &lt;3 years old, 814 had unintentional and 283 had inflicted head trauma. Head trauma was defined using the Centers for Disease Control definition of traumatic brain injury. Patients with inflicted injuries were younger and had a higher average severity level and overall mortality rate than did patients with unintentional head trauma. The regression models showed that, controlling for age and severity, patients with inflicted head trauma stayed in the hospital 52% longer (2 days), and had a mean total bill 89% higher ($4232 more) than did patients with unintentional head trauma.Conclusions. The findings from multivariate models of TC and length of stay corroborate the simpler univariate findings of earlier studies. By focusing on the impact of those cases of child abuse that lead to a specific, severe clinical entity (traumatic brain injury), we isolated a significant economic impact of abuse on health care expenditures for injury.
Safety and Immunogenicity of a Heptavalent Pneumococcal Conjugate Vaccine in Infants With Human Immunodeficiency Virus Type 1 Infection
Authors: Nachman Sharon , Kim Soyeon , King James , Abrams Elaine J. , Margolis David , Petru Ann , Shearer William , Smith Elizabeth , Moye Jack , Blanchard Suzette , Hawkins Elizabeth , Bouquin Pamela , Vink Peter , Benson Mindy , Estep Scharla , Malinoski Frank ,   for the Pediatric AIDS Clinical Trials Group Study 292 Team
Published: August 2004

Objective. Heptavalent pneumococcal conjugate vaccine (PCV) has been shown to be safe and effective in healthy infants and children. However, little is known about its use in children who have human immunodeficiency virus (HIV) infection and are known to be at increased risk of developing pneumococcal infections. This study was conducted to evaluate the safety and immunogenicity of heptavalent PCV in infants with HIV infection.
Methods. The Pediatric AIDS Clinical Trials Group Study 292 Team randomized infants with HIV infection 2:1 to receive heptavalent PCV or placebo in a double-blinded manner. Infants were vaccinated with 3 doses at 2-month intervals, starting at ages 56 to 180 days. A booster dose was given at 15 months of age. Immunogenicity was evaluated after the third dose of vaccine, before and after the booster dose, and at 24 months of age.
Results. Thirty infants with HIV infection received PCV, and 15 received placebo. No differences in baseline characteristics were found across arms. Five severe acute reactions were experienced by 4 subjects: 3 in the PCV arm and 1 in the placebo arm; all occurred among subjects with symptomatic disease at study entry. No differences were found in the 2 arms with respect to the number or timing of new diagnoses through 24 months of age, including diagnoses of otitis media. However, when symptomatic subjects were examined separately, the first new diagnosis occurred more rapidly among PCV recipients. Three deaths, all judged to be unrelated to study vaccine, occurred during follow-up: 2 in the PCV arm and 1 in the placebo arm. The primary immunogenicity measures were based on composites of 4-fold changes in serotype-specific immunoglobulin G titers from preimmunization levels. We found a highly significant difference between the vaccine and placebo arms, with the PCV arm showing higher rates of response. Asymptomatic and symptomatic subjects who received PCV had similar immunologic responses for all serotypes.
Conclusions. This study demonstrates that heptavalent PCV was well tolerated and not associated with vaccine-associated adverse reactions. Most important, this vaccine was immunogenic in the infant with HIV infection. However, additional studies of this vaccine (or others) must pay special attention to patients with symptomatic HIV disease, as they seem to be at higher risk for adverse events to any antigen.