bluuebunny/crossref_metadata_2025_split huggingface dataset:
Plasma 3-Nitrotyrosine Is Elevated in Premature Infants Who Develop Bronchopulmonary Dysplasia
Authors: Banks Beverly A. , Ischiropoulos Harry , McClelland Molly , Ballard Philip L. , Ballard Roberta A. 
Published: August 2004

Objective. Premature infants are susceptible to bronchopulmonary dysplasia (BPD), a chronic lung disease of infancy that appears to be caused in part by oxidative stress from hyperoxia. To investigate the possible role of nitric oxide-derived oxidants such as peroxynitrite in the etiology of BPD, we measured levels of plasma 3-nitrotyrosine, which is produced by the reaction of peroxynitrite with proteins.Patients and Methods. Ten premature infants who developed BPD, defined as requiring supplemental oxygen beyond 36 weeks' postmenstrual age, were identified retrospectively from a group of subjects enrolled in a clinical trial of antenatal therapy. Serial plasma samples had been collected on these infants during the first month of life as part of the trial. Sixteen comparison premature infants were identified from the same population: 5 had no lung disease, 6 had respiratory distress syndrome that resolved, and 5 had residual lung disease at 28 days of life that resolved by 36 weeks' postmenstrual age. Plasma 3-nitrotyrosine levels were measured using a solid phase immunoradiochemical method.Results. All 3-nitrotyrosine values in infants without BPD were &lt;0.25 ng/mg protein, and levels did not change with postnatal age. Plasma 3-nitrotyrosine concentrations were significantly higher in infants with BPD, increasing approximately fourfold during the first month of life. For the 20 infants who had blood samples available at 28 days of life, plasma 3-nitrotyrosine levels correlated with the fraction of inspired oxygen that the infant was receiving (r = 0.7).Conclusion. Plasma 3-nitrotyrosine content is increased during the first month of life in infants who develop BPD. This suggests that peroxynitrite-mediated oxidant stress may contribute to the development of this disease in premature infants and that 3-nitrotyrosine may be useful as an early plasma indicator of infants at risk for developing BPD.
Cystic Fibrosis: When Should High-resolution Computed Tomography of the Chest Be Obtained?
Authors: Santamaria Francesca , Grillo Giacomo , Guidi Guido , Rotondo Antonio , Raia Valeria , de Ritis Giorgio , Sarnelli Paola , Caterino Marinella , Greco Luigi 
Published: August 2004

Objective. To provide indications for high-resolution computed tomography (HRCT) of the chest in patients with cystic fibrosis (CF).
Design. We compared the HRCT and conventional chest radiography (CCR) scores and assessed their correlation with clinical scores and pulmonary function tests.
Setting. Department of Pediatrics, Federico II University, Naples, Italy.
Subjects. A total of 30 patients with CF 6.75 to 24 years of age.
Results. CCR scores correlated highly with HRCT (r = −0.8) and clinical (r = 0.5) scores, whereas total HRCT scores were not related to clinical scores. Of all the specific HRCT findings, only bronchiectasis appeared related significantly to the clinical score (r = 0.6). Most pulmonary function tests were related to CCR and total HRCT scores, but not to HRCT scoring of specific changes. Forced vital capacity and CCR scores appeared the best predictors of the HRCT score (multiple R = 0.58 and 0.79, respectively). In patients with mild lung disease, HRCT detected bronchiectasis and air trapping in 57% and 71% of the cases, respectively. In patients with more abnormal chest radiographs, bronchiectasis and air trapping were demonstrated on HRCT in all cases.
Conclusions. These findings suggest that HRCT of the chest is most useful in the identification of early lung abnormalities in patients with CF with mild respiratory symptoms, whereas for established disease, CCR is still the first-line imaging technique. The advantage of detecting early changes on CT imaging awaits additional confirmation, at least until early therapeutic interventions affecting significantly the final outcome of the disease are demonstrated. In patients with advanced disease, HRCT may be useful in the evaluation of specific lung changes when more aggressive treatment such as chest surgical interventions is indicated. Given the cost of the procedure and the high radiation dosage compared with CCR, a careful assessment of the cost:benefit ratios of HRCT is strongly recommended in CF.
Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome Education in Schools
Authors:   Committee on Pediatric AIDS
Published: August 2004

This Policy Statement was retired May 2004.
The human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic has grown during the past 15 years. Education remains a critical component of our efforts to prevent HIV infection/AIDS in school children and young adults. To accomplish this goal, school personnel should receive updated information about HIV infection/AIDS so that accurate teaching on this topic can be included in the K–12 health education curriculum. Informed pediatricians and nurses can serve as important resources for school health services and administration to provide current information for the curriculum. Each community should have a school health advisory committee that enlists community support and provides input to health education programs in schools.
The Role of the Pediatrician in Rural EMSC
Authors:   Committee on Pediatric Emergency Medicine
Published: August 2004

This Policy Statement was revised. See https://doi.org/10.1542/peds.2012-2547.
In rural America pediatricians can play a key role in the development, implementation, and ongoing supervision of emergency medical services for children (EMSC). Often the only pediatric resource for a large region, rural access pediatricians are more likely to treat pediatric emergencies in their own offices, and are a vital resource for rural physicians, or other rural health care professionals (physician assistants, nurse practitioners), and emergency medical technicians (EMTs) to improve system-wide EMSC by providing education about issues from prevention to rehabilitation, technical assistance in protocol writing, hospital care, and data accumulation, and as advocates for community and state legislation to support the goals of EMSC.
Adverse Effects of High-dose Vitamin A Supplements in Children Hospitalized With Pneumonia
Authors: Stephensen Charles B. , Franchi Luis Miguel , Hernandez Herminio , Campos Miguel , Gilman Robert H. , Alvarez Jose O. 
Published: August 2004

Objective. To test the hypothesis that high-dose vitamin A supplements will enhance recovery of children hospitalized for the treatment of community-acquired pneumonia.Design. We conducted a randomized, double-blind, placebo-controlled clinical trial of high-dose vitamin A supplements among children 3 months to 10 years of age (N = 95) admitted to hospital with community-acquired pneumonia in Lima, Peru. Children ≤1 year of age received 100 000 IU of water-miscible vitamin A on admission to the hospital and an additional 50 000 IU the next day. Children &gt;1 year of age received 200 000 IU on admission and 100 000 IU the next day.Results. Children receiving vitamin A (n = 48) had lower blood oxygen saturation (the mean difference on day 3 in hospital was 1.1%), higher prevalence rates of retractions (37% in the vitamin A group vs 15% in the placebo group on day 3), auscultatory evidence of consolidation (28% in the vitamin A group vs 17% in the placebo group on day 3), and were more likely to require supplemental oxygen (21% in the vitamin A group vs 8% in the placebo group on day 3) than children in the placebo group (n = 47). Adjustment for baseline severity of disease and nutritional status did not alter the association of vitamin A with increased clinical severity, although the difference in blood oxygen saturation was no longer statistically significant. No differences were seen in duration of hospitalization or in chest x-ray changes 14 days after admission. No deaths occurred, and toxicity of vitamin A was not seen.Conclusions. This study indicates that high-dose vitamin A supplements cause modest adverse effects in children recovering from pneumonia and should not be used therapeutically in such patients unless there is clinical evidence of vitamin A deficiency or concurrent measles infection.
Attitudes of the Physician Membership of the Society for Adolescent Medicine Toward Medical Abortions for Adolescents
Authors: Miller Nancy H. , Miller David J. , Pinkston Koenigs Laura M. 
Published: August 2004

Objective. To document the practices and attitudes of the US physician members of the Society for Adolescent Medicine (SAM) regarding adolescent abortion and contraception, as well as physician willingness to prescribe medical abortion if approved by the Food and Drug Administration (FDA).Design. Cross-sectional questionnaire survey.Participants. The entire physician membership of SAM (N = 1001) was surveyed. A total of 713 physicians responded, with 668 usable surveys yielding an adjusted response rate of 70%.Results. Of the respondents, 81% were trained as pediatricians; 58% had additional adolescent medicine training. Ninety-six percent prescribed contraception for their patients. Sixty-one percent of respondents identified abortion as an option for pregnant adolescents in all circumstances, whereas 4% believed abortion should never be an option. Eighty-nine percent referred their patients for abortions; 90% were aware of medications to induce abortions medically. If these medications (methotrexate and misoprostol, RU-486) were FDA-approved, 42% would prescribe them for their patients; 34% were unsure. Fifty-four percent believed if medical abortions were routinely available, they should be available from primary care physicians.Physicians were significantly more likely to consider prescribing medical abortions if the physician were female, offered postcoital contraception, performed Norplant insertions, referred adolescents for abortions, or performed postabortion medical checkups. Physicians were no more likely to consider prescribing medical abortions according to physician age, specialty training, or date of residency training. Religious affiliation per se was not associated with likelihood of prescribing medical abortions, but Catholic physicians were significantly less likely to consider prescribing medical abortions.Conclusions. Virtually all SAM physician respondents (96%) reported that abortion for pregnant adolescents should be available under some circumstances. Forty-two percent would prescribe medical abortion if the medications were FDA-approved, suggesting that medical abortion would potentially be available to adolescents from a larger group of physicians than is currently available.
Anabolic Steroid Use by Male and Female Middle School Students
Authors: Faigenbaum Avery D. , Zaichkowsky Leonard D. , Gardner Douglas E. , Micheli Lyle J. 
Published: August 2004

Background. The prevalence of anabolic steroid use by high school and college students has been reported in the literature. However, rumors persist regarding the use of steroids by younger populations.Objective. To assess the extent of steroid use by male and female middle school students and to explore their attitudes and perceptions about these drugs.Methods. A confidential self-report questionnaire was administered to 466 male and 499 female students between 9 and 13 years of age (mean ± SD, 11.4 ± 0.9 years) in 5th, 6th, and 7th grades from four public middle schools in Massachusetts. The number of students reporting steroid use and differences between users' and nonusers' underlying attitudes and perceptions about these drugs were evaluated.Results. The response rate was 82% (965/1175 eligible). Results indicated that 2.7% of all middle school students reported using steroids; 2.6% were males and 2.8% were females. When steroid users were compared with nonusers, 47% versus 43% thought that steroids make muscles bigger; 58% versus 31% thought that steroids make muscles stronger; 31% versus 11% thought that steroids improve athletic performance; 23% versus 13% thought that steroids make one look better; 23% versus 9% knew someone their own age who currently took steroids; 38% versus 4% were asked by someone to take steroids; 54% versus 91% thought that steroids were bad for them; and 35% versus 2% indicated that they would take steroids in the future. Additional analyses determined steroid user involvement in sports and activities.Conclusion. The results of this study suggest that the problem of illicit steroid use extends to children and young adolescents and that a segment of this population is mindful of the potential physiologic effects of steroids. This information will be useful to pediatricians, sport authorities, and school teachers whose guidance will become increasingly more important as steroid educational interventions for male and female middle school students are developed.
Early Dexamethasone Therapy in Preterm Infants: A Follow-up Study
Authors: Yeh Tsu F. , Lin Yuh J. , Huang Chao C. , Chen Yung J. , Lin Chyi H. , Lin Hong C. , Hsieh Wu S. , Lien Yu J. 
Published: August 2004

Objectives. To study the outcome at 2-year corrected age of infants who participated in a double-blind controlled trial of early (&lt;12 hours) dexamethasone therapy for the prevention of chronic lung disease (CLD).Methods and Materials. A total of 133 children (70 in the control group, 63 in the dexamethasone-treated group) who survived the initial study period and lived to 2 years of age were studied. All infants had birth weights of 500 to 1999 g and had severe respiratory distress syndrome requiring mechanical ventilation within 6 hours after birth. For infants in the treatment group, dexamethasone was started at a mean age of 8.1 hours and given 0.25 mg/kg every 12 hours for 1 week and then tapered off gradually over a 3-week period. The following variables were evaluated: interim medical history, socioeconomic background, physical growth, neurologic examinations, mental and psychomotor development index score (MDI and PDI), pulmonary function, electroencephalogram, and auditory and visual evoked potential.Results. Infants in the control group tended to have a higher incidence of upper respiratory infection and rehospitalization than did the dexamethasone-treated group because of respiratory problems. Although there was no difference between the groups in somatic growth in girls, the dexamethasone-treated boys had significantly lower body weight and shorter height than the control boys (10.7 ± 3.0 vs 11.9 ± 2.0 kg; 84.9 ± 5.7 vs 87.5 ± 4.8 cm). The dexamethasone-treated group had a significantly higher incidence of neuromotor dysfunction (25/63 vs 12/70) than did the control group. The dexa-methasone-treated infants also had a lower PDI score (79 ± 26) than did the control group (87 ± 23), but the difference was not statistically significant. Both groups were comparable in MDI, incidence of vision impairment, and auditory and visual evoked potential. Significant handicap, defined as severe neurologic defect and/or intellectual defect (MDI and/or PDI ≤ 69), was seen in 22 children (31.4%) in the control group and 26 (41.2%) in the dexamethasone-treated group.Conclusions. Although early postnatal dexamethasone therapy for 4 weeks significantly reduces the incidence of CLD, this therapeutic regimen cannot be recommended at present because of its adverse effects on neuromotor function and somatic growth in male infants, detected at 2 years of age. A longer follow-up is needed. If early dexamethasone therapy is to be used for the prevention of CLD, the therapeutic regimen should be modified. The proper route of administration, the critical time to initiate the therapy, and the dosage and duration of therapy remain to be defined further.
Valproate Therapy Does Not Deplete Carnitine Levels in Otherwise Healthy Children
Authors: Hirose Shinichi , Mitsudome Akihisa , Yasumoto Sawa , Ogawa Atsushi , Muta Yukiko , Tomoda Yasuko 
Published: August 2004

Objective. To determine whether children with epilepsy undergoing valproate (VPA) antiepileptic therapy and who are otherwise healthy have a lower serum level of carnitine (CAR) and a higher plasma level of plasma ammonia than do normal children.Methodology. A total of 45 children with epilepsy, 6.3 to 21.7 years of age, who were treated solely with VPA and were free of abnormal neurologic findings or nutritional problems were randomly selected (VPA-treated group). An age-matched control group (n = 45) was selected from subjects without epilepsy (control group). Total (T) and free (F) serum CAR, serum VPA concentration, and the plasma ammonia level were measured and analyzed.Results. Serum VPA concentration exhibited a weak negative correlation with both T- (r = −0.34) and F-CAR (r = −0.41). The T-CAR levels were 55.7 ± 12.4 and 57.6 ± 12.1 mM, and the F-CAR levels 42.7 ± 9.9 and 44.4 ± 9.9 mM in the VPA-treated and control groups, respectively. Thus, there was no significant difference in T- or F-CAR levels between the VPA-treated and control groups. Plasma ammonia levels were the same in the two groups: 26 ± 9.2 and 29.4 ± 11.8 mM in the VPA-treated and control groups, respectively. There was no significant correlation between blood ammonia and either T- (r = +0.024) or F-CAR (r = −0.026).Conclusion. Children on a regular diet ingest a sufficient amount of CAR that more than meets their daily CAR requirement. The level of neither T- nor F-CAR in patients with epilepsy and without severe neurologic or nutritional problems being treated with VPA appeared to be affected by VPA therapy. Because the blood CAR level depends on nutritional condition rather than on blood VPA concentration, CAR deficiency caused by VPA is not likely to occur in this population. The usefulness of supplementation of CAR for this type of patient with epilepsy, therefore, must be reevaluated carefully.
Baclofen Overdose: Drug Experimentation in a Group of Adolescents
Authors: MD Holly E. Perry , MD Robert O. Wright , MD Michael W. Shannon , MD Alan D. Woolf 
Published: August 2004

Background. Baclofen, a lipophilic analog of gamma-aminobutyric acid, is clinically used to control spasticity. We report a mass exposure to baclofen in adolescents seeking intoxication; toxicokinetic data are included.
Case Series. A group of adolescents became symptomatic after ingesting 3 to 30 20-mg tablets of baclofen during a party at a suburban Boys' Club. Several children were noted to be very lethargic by chaperones, ingestion was suspected, and paramedics were called. Some white tablets were found in a couch at the site of the party. The Massachusetts Poison Control Center was called, and the tablets were identified as baclofen (20 mg). Fourteen patients were taken to local hospitals; 9 required intubation. Eight adolescents were transferred to our institution. In these 8 patients, symptoms were noted within 1 to 2 hours after overdose. The most common clinical findings included coma (7), hypothermia (6), bradycardia (5), hypertension (4), and hyporeflexia (8). Mean length of mechanical ventilation was 40 hours. Three patients had unifocal premature ventricular contractions. Two patients had tonic–clonic seizures. A single dose of activated charcoal was given to all patients. Drugs administered included nifedipine (1), flumazenil (1), naloxone (1), lorazepam (2), and phosphenytoin (2). All patients recovered and were discharged home within 5 days of ingestion.
Serial serum baclofen levels were obtained in all intubated patients (range, 0.049 to 6.0; normal, 0.08 to .40 μg/mL). Levels obtained 14 hours after ingestion showed a linear correlation with length of mechanical ventilation (R2 = 0.9863). Persistent symptoms were noted in some patients, despite nondetectable baclofen levels. Toxicologic screening for drugs of abuse was negative except in 2 patients with ethanol levels, both &lt;5 mg/dL.
Conclusion. Baclofen overdose may result in coma, apnea, autonomic disturbances, cardiac conduction abnormalities, and seizures. Levels obtained shortly after overdose correlate with length of mechanical ventilation.
The Potential Benefits of the Pediatric Nonheartbeating Organ Donor
Authors: Koogler Tracy , Costarino Andrew T. 
Published: August 2004

Objective. To examine the population of the pediatric intensive care unit in a large children's hospital to determine the potential importance of pediatric nonheartbeating organ donors (NHBDs).Study Design. We analyzed retrospectively the 6307 admissions to the pediatric intensive care unit at the Children's Hospital of Philadelphia from January 1992 to July 1996 to identify all deaths. The hospital records of the children who had died were then reviewed to determine the mode of death, organ donation rate of heartbeating donors, and the number of potential NHBDs. Criteria for the NHBD included the decision to forgo life-sustaining therapy, death occurring within 2 hours of withdrawal of life support, and the absence of sepsis, HIV, hepatitis, or extracranial malignancy.Results. Of 319 deaths, 102 (32.0%) died with resuscitation, 84 (26.3%) were brain-dead, 111 (34.8%) had withdrawal of life support, and 22 (6.9%) were on do-not-resuscitate orders. Of the 84 brain-dead children, 74 (88.1%) were medically suitable heartbeating donors, and 43 (58.1%) donated organs. Of the 111 patients who had life support withdrawn, 31 (27.9%) qualified for NHBDs.Conclusions. The routine use of the NHBD has the potential to increase organ donation at our institution by 42%. We discuss the ethical issues relating to NHBDs required to properly include these patients as potential organ donors.
Initiating the First DTP Vaccination Age-appropriately: A Model for Understanding Vaccination Coverage
Authors: Ross Alan , Kennedy Anne Baber , Holt Elizabeth , Guyer Bernard , Hou William , Hughart Nancy 
Published: August 2004

Objective. Our earlier research found that the strongest predictor of not being up to date on the full series of immunizations by 24 months is failure to receive the first diphtheria vaccine and tetanus toxoid and pertussis vaccine (DTP1) on time. To learn more about the relationship between successful vaccination during the DTP1 age-appropriate (DTP1-AA) period (between 42 and 92 days of life, inclusive) and an infant's early visit to the physician (before 42 days of life), we quantified children's progression through a sequence of provider visits and outcomes.Design. This study analyzed data from 426 children living in the 57 poorest census tracts in Baltimore. For each DTP1-AA visit, we calculated the percentage of times a DTP1-AA vaccination, provider missed opportunity, or deferral for a valid contraindication occurred. Relative and attributable risks were computed to assess associations between DTP1-AA vaccination and early visits and missed opportunities.Results. We found the following: 1) Children who made a visit before 42 days of life were more than twice as likely to receive a DTP1-AA vaccination; 2) the missed opportunity rate for children who did not make an early visit was approximately twice that of the early-visit group; and 3) well visits were more likely to result in DTP1-AA immunization than sick visits. Attributable risk calculations show that DTP1-AA vaccination rates could be increased in this population by one third if all infants had an early visit.Conclusions. Early in-office visits seem to make DTP1-AA vaccination more likely. These rates may be amenable to intervention by increasing early visits and reducing DTP1-AA missed opportunities. Introduction of the hepatitis B vaccine to the recommended series may place more emphasis on early visits and result in increased DTP1-AA rates and, ultimately, higher vaccination coverage rates.