bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bacterial Colonization of Toys in Neonatal Intensive Care Cots
Authors: Davies Mark W. , Mehr Samuel , Garland Suzanne T. , Morley FANZCOG‡; and Colin J. 
Published: August 2004

Objectives.
To investigate the bacteria and fungi contaminating toys in neonatal intensive care unit (NICU) cots, the colonization rates, and factors that influence them.

Methods.
A cross-sectional, longitudinal bacteriologic survey of all toys in the cots of infants in an NICU. All the toys in an infant's cot were cultured weekly for 4 weeks. Data were collected on the infant's postnatal age, the type of cot, whether humidity was added, characteristics of the toy, and any infant infections.

Results.
Over the 4-week period, there were 86 cultures from 34 toys of 19 infants. Bacteria were grown from 84/86 (98%): 84 of the cultures grew coagulase-negative Staphylococcus, 50 Micrococcus sp, 21 Bacillus sp, 13 methicillin-resistant Staphylococcus aureus, 12 diphtheroids, 4 group B streptococcus, 3 S aureus, 3 nonhemolytic streptococci, 3 group D streptococci, 4 α-hemolytic streptococci, and 2 coliforms. None grew fungi. The colonization rate did not differ with cot type, presence of humidity, size of the toy, toy fiber length, or the fluffiness score. Eight (42%) of the infants had positive blood culture results and 5/8 of the isolates (63%) were of the same type as that colonizing their corresponding toy.

Implications.
With time, all the toys in NICU cots became colonized with bacteria. Many were potentially pathogenic. Toys may be reservoirs for potential infantile nosocomial sepsis. infant, newborn, toys, infection, neonatal intensive care.
A New Look at Intrauterine Growth and the Impact of Race, Altitude, and Gender
Authors: Thomas Pam , Peabody Joyce , Turnier Virginia , Clark Reese H. 
Published: August 2004

Background.
Growth curves described in the 1960s are used to classify neonate intrauterine growth as normal or abnormal. Our objective was to determine whether continued use of these curves is appropriate.

Methods.
From 1996 to 1998, we collected birth weight, length, head circumference, estimated gestational age (EGA), gender, race, and place of birth (&lt;4000 feet or ≥4000 feet) on 27 229 neonates to evaluate the effects of each on intrauterine growth and the diagnoses of small for gestational age (SGA) and large for gestational age (LGA). We compared the gestation-specific growth parameters derived from our sample with those reported in 1966 and 1969.

Results.
Gestational age had the largest influence on each growth parameter. Race and gender both had effects on birth weight. Female neonates were smaller than male neonates, and black neonates were smaller than Hispanic and white neonates at each EGA.
For neonates with an EGA &lt;30 weeks, our data had a smaller variance and lower average weights, lengths, and head circumferences than those reported in 1966 and in 1969. For neonates &gt;36 weeks, the variance was similar, but our curves showed that neonates in our sample were larger and heavier. Use of the older growth curves to classify neonates as SGA, LGA, and appropriate for gestational age (AGA) led to significantly different rates of each by gender and race.

Conclusions.
Intrauterine growth patterns previously described and commonly used to classify neonates as AGA are inaccurate for use in current populations and lead to gender- and race-specific diagnoses of SGA and LGA that are misleading. neonates, growth, race, gender.
Sexual Behavior Change Among Human Immunodeficiency Virus-Infected Adolescents With Hemophilia
Authors: Brown Larry K. , Schultz Janet R. , Parsons Jeffrey T. , Butler Regina B. , Forsberg Ann D. , Kocik Susan M. , King Gary , Manco-Johnson Marilyn , Aledort Louis ,   for the Adolescent Hemophilia Behavioral Intervention Evaluation Project Study Group
Published: August 2004

Purpose.To determine the factors associated with the adoption or maintenance of consistent safer sexual behaviors among human immunodeficiency virus-positive adolescents and young adults with hemophilia.Methods.One hundred eleven adolescents at 10 hemophilia care sites participated in an intervention program designed to increase safer sexual behaviors (abstinence, condom use, or nonpenetrative behavior). The theory-based intervention spanned 1 year. Adolescents attended individual sessions, small group activities, and an intensive group retreat.Results.Patients who maintained or improved safer sexual behaviors were compared with those who relapsed or did not improve. Logistic regression analyses found that improvement and maintenance of safer sexual behavior were significantly associated with perceived peer support for outercourse (odds ratio [OR]: 5.47; confidence interval [CI]: 1.4–20.8), perceived peer support for abstinence (OR: 5.08; CI: 1.2–20.1), and decreased general emotional distress (OR: 4.65; CI: 1.04–20.6). Perceived health status and previous sexual behavior were unrelated to change in safer sexual behavior.Conclusions.These longitudinal data indicate that improvement and maintenance of safer sexual behavior among adolescents during an intervention is strongly associated with perceptions of peer support for safer sex and lesser degrees of emotional distress. Programs for human immunodeficiency virus-infected adolescents may require developmentally appropriate social and psychological approaches to impact peer norms and emotional well-being.
Predictors of Change in the Functional Status of Children With Human Immunodeficiency Virus Infection
Authors: Missmer Stacey A. , Spiegelman Donna , Gorbach Sherwood L. , Miller Tracie L. 
Published: August 2004

Objective.The purpose of this study was to identify important clinical predictors of change in the functional status of children with perinatally acquired human immunodeficiency virus (HIV) infection.Methods.Children who were perinatally exposed to HIV underwent evaluation of growth, nutritional, and functional status parameters as part of a prospective study of HIV and nutrition in children. The main outcome measures for HIV-infected children were change over time in: 1) Total Health, 2) General Health, and 3) Responsiveness as measured by the Functional Status II(R) (FSII[R]). Candidate predictors included anthropometric measurements, social factors, HIV disease stage, CD4 T lymphocyte count, medications, and other clinical markers of illness.Results.The parents or legal guardians of 35 perinatally HIV-infected children completed 2 FSII(R) surveys over a mean of 16 months. Functional Status scores were significantly correlated with number of times and days hospitalized in the past 6 months and with illness at the time of baseline evaluation. Functional status declined overtime on all 3 scales; however, only the change in Total Health score was statistically significant. Total, General Health, and Responsiveness scores declined by ≥5 points in 20.0%, 17.1%, and 14.3% of children, respectively. Significant univariate predictors of change in at least 1 component of the functional status survey included race, guardianship, height z score, prescription of antiviral medications other than antiretrovirals, and illness at time of baseline evaluation. In multivariate models, adjusting for baseline score and biologic relationship of guardian completing survey, significant predictors of a decline in Total Health scores included non-white race and lower baseline height zscore. The General Health score declined with lower baseline absolute CD4 count and lower baseline height z score. Finally, Responsiveness scores declined in children whose guardian was their biologic parent and in children with lower baseline heightz scores.Conclusion.The FSII(R) questionnaire correlates with other markers of disease severity in children with HIV infection. Growth parameters, immune status, and social factors are important predictors of functional status in HIV-infected children.
Predicting the Outcome of Neonatal Bacterial Meningitis
Authors: Klinger Gil , Chin Choy-Nyok , Beyene Joseph , Perlman Max 
Published: August 2004

Objective.
To build predictive models of severe adverse outcome at various times in the course of neonatal bacterial meningitis.

Study Design.
Retrospective cohort study with follow-up to a minimum age of 1 year of term and near-term infants, admitted between 1979 and 1998 to a regional tertiary care center. Predictors of adverse outcome detectable at 1 year of age (death or moderate or severe neurosensory impairment) were identified by univariate analysis. Independent predictors of adverse outcome were identified by multivariate analysis. Predictive tree models were constructed at 12, 24, 48, and 96 hours after admission and at discharge.

Results.
Of 101 infants admitted with definitive bacterial meningitis, 13 died and 17 had moderate or severe disability at 1 year of age. Outcomes are known for all patients, to 1 year of age. Twelve hours after admission the important predictors of adverse outcome were presence of seizures, presence of coma, use of inotropes, and leukopenia (sensitivity: 68%; specificity: 100%). At 96 hours the predictors were seizure duration of &gt;72 hours, presence of coma, use of inotropes, and leukopenia (sensitivity: 88%; specificity: 99%).

Conclusions.
Most infants at risk for adverse outcome can be identified within 12 hours of admission. Duration of seizures for &gt;72 hours, presence of coma, use of inotropes, and leukopenia were the most important predictors of adverse outcome. Although these models have good predictive accuracy, they need to be validated in a contemporary cohort in large multicenter studies. bacterial meningitis, neonate, prognostic model.
Pacifier as a Risk Factor for Acute Otitis Media: A Randomized, Controlled Trial of Parental Counseling
Authors: Niemelä Marjo , Pihakari Outi , Pokka Tytti , Uhari Marja , Uhari Matti 
Published: August 2004

Objectives.To evaluate the association between pacifier use and the increased occurrence of acute otitis media (AOM) in an intervention trial.Methods.Fourteen well-baby clinics were selected to participate in an open, controlled cohort study. These clinics were paired according to the number of children and the social classes of the parents they served. One clinic in each pair was randomly allocated for an intervention, while the other served as a control. The nurses at the intervention clinics were trained to instruct the parents of children &lt;18 months old to limit pacifier use during their prescheduled visits to the clinic. The intervention consisted of a leaflet explaining the harmful effects of pacifier use and instructions to restrict its use. Two hundred seventy-two children were successfully recruited from the intervention clinics and 212 from the control clinics. The data about pacifier use and the occurrence of respiratory infections and AOM were collected similarly in both groups.Results.After the intervention, a 21% decrease was achieved in continuous pacifier use at the age of 7 to 18 months (P = .0001), and the occurrence of AOM per person-months at risk was 29% lower among children at the intervention clinics. The children who did not use a pacifier continuously in either of the clinics had 33% fewer AOM episodes than the children who did.Conclusion.Pacifier use appeared to be a preventable risk factor for AOM in children. Its restriction to the moments when the child was falling asleep effectively prevented episodes of AOM.
Clinical Performance of an In-Line Point-of-Care Monitor in Neonates
Authors: Widness John A. , Kulhavy Jeff C. , Johnson Karen J. , Cress Gretchen A. , Kromer Irma J. , Acarregui Michael J. , Feld Ronald D. 
Published: August 2004

Objective.
To evaluate the bias, precision, and blood loss characteristics of an ex vivo in-line point-of-care testing blood gas and electrolyte monitor designed for use in critically ill newborn infants.

Study Design.
Study participants included consecutive neonates with an umbilical artery catheter (UAC) in use for clinical laboratory testing. The in-line monitor (VIA LVM Blood Gas and Chemistry Monitoring System, VIA Medical, San Diego, CA) was directly connected to the participant's UAC and the monitor's determinations of pH, Pco2, Po2, sodium, potassium, and hematocrit (Hct) were compared with those simultaneously drawn and measured with a standard bench top laboratory instrument (Radiometer 625 ABL; Radiometer America, Inc, Westlake, OH). The bias (the mean difference from the reference method) and precision (1 standard deviation of the mean difference) performance criteria of the in-line monitor were derived using standard laboratory procedures.

Results.
Sixteen neonates monitored for a total of 37 days had a total of 229 paired blood samples available for comparison by the 2 methods. Bias and precision performance characteristics of the in-line monitor were similar to reports of other point-of-care devices (ie, pH: −.003 ± .024; Pco2: .35 ± 2.84 mm Hg; Po2: .39 ± 7.30 mm Hg; sodium: .52 ± 2.34 mmol/L; potassium: .17 ± .18 mmol/L; and Hct: .61 ± 2.80%). The range of values observed for each parameter included much of the range anticipated among critically ill neonates (ie, pH: 7.15–7.65; Pco2: 25–75 mm Hg; Po2: 25–275 mm Hg; sodium: 127–150 mmol/L; potassium: 2.6–5.5 mmol/L; and Hct: 32%–60%). Mean blood loss (± standard deviation) per sample with the in-line monitor was approximately one-tenth that of the reference method: 24 ± 7 μL versus 250 μL, respectively. There was no evidence of hemolysis and no patient related safety issues were identified with use of the in-line monitor.

Conclusions.
Repeated laboratory testing of critically ill neonates using an ex vivo in-line monitor designed for use in neonates provides reliable laboratory results. The blood loss and hemolysis data obtained suggests that this monitoring device offers potential for reducing neonatal blood loss—and possibly transfusion needs—during the first weeks of life. Before this promising technology can be routinely recommended for care of critically ill neonates, greater practical experience in a variety of clinical settings is needed.
Occult Bacteremia From a Pediatric Emergency Department: Current Prevalence, Time to Detection, and Outcome
Authors: Alpern Elizabeth R. , Alessandrini Evaline A. , Bell Louis M. , Shaw Kathy N. , McGowan Karin L. 
Published: August 2004

Objective.To evaluate selected characteristics of occult bacteremia in the post-Haemophilus influenzae type b (HIB) vaccine era.Methods.A retrospective cohort study was performed involving 5901 children 2 to 24 months old with fever ≥39.0°C evaluated with a blood culture at an urban tertiary care children's hospital emergency department (ED) between February 1993 and June 1996. Patients were excluded if immune-suppressed, diagnosed with a focal infection, evaluated by lumbar puncture, or admitted to the hospital during initial evaluation. Prevalence of occult bacteremia, distribution of current pathogenic organisms, and time to positive culture in a continuously monitored system were determined. All patients with cultures positive for pathogenic bacteria were reevaluated and serious adverse outcomes were documented.Results.The prevalence of occult bacteremia was 1.9% (95% confidence interval: 1.5%–2.3%). Streptococcus pneumoniae accounted for 82.9% of all pathogens and H influenzae was not a causative organism in this cohort.The mean time to positive culture was significantly shorter for pathogens compared with contaminants (14.9 hours vs 31.1 hours). A culture that was positive in ≤18 hours was 13.0 (6.3–26.6) times more likely to contain a pathogen than a contaminant.The average time from positive culture notification to reevaluation in the ED was 10.6 hours and over half of the patients recalled to the ED for positive cultures were admitted to the hospital. Of patients with occult pneumococcal bacteremia, 95.7% had resolution of their bacteremia without the use of parenteral antibiotics. Two patients had serious adverse outcomes. The rate of meningitis or death was .03% (.004%–.12%).The contamination rate of blood cultures was 2.1% (1.7%–2.5%). Most (85%) of these patients were reevaluated in the ED and more than one third were admitted to the hospital before full identification of the organism.Conclusions.Prevalence of occult bacteremia in the post-HIB vaccine era is lower than previously reported.S pneumoniae is the most common causative organism and resolves without parenteral antibiotics in the vast majority of cases. Continuously monitoring blood culture systems allow for early identification and can aid in differentiating contaminated from true pathogenic cultures by time to positive culture. Serious adverse outcome is an uncommon result of occult bacteremia. Updated epidemiology and microbiologic technology may impact the evaluation and treatment of children at risk for occult bacteremia.
Nosocomial Respiratory Syncytial Virus Infections: The Cost-Effectiveness and Cost-Benefit of Infection Control
Authors: Macartney Kristine K. , Gorelick Marc H. , Manning Mary Lou , Hodinka Richard L. , Bell Louis M. 
Published: August 2004

Objective.
To determine the cost-effectiveness and cost-benefit of an infection control program to reduce nosocomial respiratory syncytial virus (RSV) transmission in a large pediatric hospital.

Design.
RSV nosocomial infection (NI) was studied for 8 years, before and after intervention with a targeted infection control program. The cost-effectiveness of the intervention was calculated, and cost-benefit was estimated by a case–control comparison.

Setting.
Children's Hospital of Philadelphia, a 304-bed pediatric hospital.

Patients.
All inpatients with RSV infection, both community- and hospital-acquired.

Intervention.
Consisted of early recognition of patients with respiratory symptoms, confirmation of RSV infection by laboratory testing, establishing cohorts of patients and nursing staff, gown and glove barrier precautions, and monitoring and education of staff.

Outcome Measures.
The incidence density of RSV NI before and after the intervention was calculated as the rate per 1000 patient days-at-risk for infection. Intervention costs included laboratory testing, isolation, and administration of the program. The cost of RSV NI was estimated by comparing hospital charges for 30 cases and matched uninfected controls.

Results.
A total of 148 patients acquired NI (88 before and 60 after the intervention). The Mantel-Haenszel stratified relative risk for NI in the period before the infection control program, compared with the postintervention period, was .61 (95% confidence interval: .53–.69). By applying the preintervention stratum-specific rates of infection to the days-at-risk in the postintervention period, an estimated 100 NIs would have been expected, which in comparison to the 60 NIs observed, yielded an estimated program effectiveness of 10 RSV NIs prevented per season. The total cost of the program per season was $15 627 or $1563/NI prevented. In comparison, the mean cost to the hospital was $9419/case of RSV NI, resulting in a cost-benefit ratio of 1:6.

Conclusions.
A targeted infection control intervention was cost-effective in reducing the rate of RSV NI. For every dollar spent on the program, approximately $6 was saved.
Neuroimaging in Children With Newly Diagnosed Epilepsy: A Community-Based Study
Authors: Berg Anne T. , Testa Francine M. , Levy Susan R. , Shinnar Shlomo 
Published: August 2004

Background.Neuroimaging is generally considered a part of the evaluation of seizures and epilepsy. There is limited information about its current use in the initial evaluation of pediatric epilepsy and about its yield during the initial diagnosis of epilepsy. We describe the patterns in the use and yield of diagnostic imaging in children with newly diagnosed epilepsy in a community-based study.Methods.Children were recruited when first diagnosed with epilepsy by participating physicians in Connecticut (1993–1997). Definitions for etiology and underlying epilepsy syndromes are as published by the International League Against Epilepsy.Results.Of 613 children, 488 (79.6%) had imaging: 388 (63.3%) magnetic resonance imaging, 197 (32.1%) computed tomography scans, and 97 (15.8%) both. Half of children with idiopathic generalized epilepsy had imaging studies compared with 70% to 100% of children with other forms of epilepsy, depending on the specific type. Etiologically relevant abnormalities were found in 62 (12.7% of those imaged). Fourteen of these children had otherwise completely normal presentations and histories. Their abnormalities included tuberous sclerosis (N = 4), tumors (N = 2), an arteriovenous malformation later diagnosed as a tumor, a cavernous angioma, cerebral malformations (N = 3), and other abnormalities (N = 3). Thirteen of the 14 had partial seizures and 12 had focal electroencephalographic (EEG) findings. Only 1 had neither.Conclusions.In children with newly diagnosed epilepsy, neuroimaging reveals a small but significant number of serious abnormalities not previously suspected. Most of these children have partial seizures or focal EEG abnormalities. Neuroimaging should be considered during the evaluation of children with newly diagnosed epilepsy, especially for those with neurologic deficits or partial seizures or focal EEG abnormalities that are not part of an idiopathic localization-related epilepsy syndrome.
Functional Hyperactivity of Hepatic Glutamate Dehydrogenase as a Cause of the Hyperinsulinism/Hyperammonemia Syndrome: Effect of Treatment
Authors: Huijmans Jan G. M. , Duran Marinus , de Klerk Johannis B. C. , Rovers Marinus J. , Scholte Hans R. 
Published: August 2004

Objective.The combination of persistent hyperammonemia and hypoketotic hypoglycemia in infancy presents a diagnostic challenge. Investigation of the possible causes and regulators of the ammonia and glucose disposal may result in a true diagnosis and predict an optimum treatment.Patient.Since the neonatal period, a white girl had been treated for hyperammonemia and postprandial hypoglycemia with intermittent hyperinsulinism. Her blood level of ammonia varied from 100 to 300 μmol/L and was independent of the protein intake.Methods.Enzymes of the urea cycle as well as glutamine synthetase and glutamate dehydrogenase (GDH) were assayed in liver tissue and/or lymphocytes.Results.The activity of hepatic GDH was 874 nmol/(min·mg protein) (controls: 472–938). Half-maximum inhibition by guanosine triphosphate was reached at a concentration of 3.9 μmol/L (mean control values: .32). The ratio of plasma glutamine/blood ammonia was unusually low. Oral supplements withN-carbamylglutamate resulted in a moderate decrease of the blood level of ammonia. The hyperinsulinism was successfully treated with diazoxide.Conclusion.A continuous conversion of glutamate to 2-oxoglutarate causes a depletion of glutamate needed for the synthesis of N-acetylglutamate, the catalyst of the urea synthesis starting with ammonia. In addition, the shortage of glutamate may lead to an insufficient formation of glutamine by glutamine synthetase. As GDH stimulates the release of insulin, the concomitant hyperinsulinism can be explained. This disorder should be considered in every patient with postprandial hypoglycemia and diet-independent hyperammonemia.