bluuebunny/crossref_metadata_2025_split huggingface dataset:
Actuarial Survival in the Premature Infant Less Than 30 Weeks' Gestation
Authors: Cooper Timothy R. , Berseth Carol L. , Adams James M. , Weisman Leonard E. 
Published: August 2004

Objective. Because survival from admission to discharge does not provide parents and physicians information about future life expectancy in the premature neonate, we characterized the actuarial survival, defined as the future life expectancy from a given postnatal age, in a large inborn population of premature infants &lt;30 weeks' gestation.Study Design. We determined daily actuarial survival of 1925 inborn infants (23 to 29 weeks' gestation) admitted to the Baylor Affiliated Nurseries from July 1986 through December 1994, stratified by 100-g birth weight and by 1-week gestational-age intervals.Results. In the 501- to 600-g birth weight stratum, actuarial survival improved from 31% at birth, to 61% on day of life 7, and then to 75% on day of life 28; in the 901- to 1000-g birth weight stratum, actuarial survival improved from 88%, to 94%, and then to 98% throughout the same times, respectively. Similar trends were obtained when data were stratified by gestational age.Conclusions. Survival in the smallest infants improves dramatically during the first few days of life, but there is a significant risk for late death in the smallest of these infants.
Childhood Drownings and Fencing of Outdoor Pools in the United States, 1994
Authors: Logan Pamela , Branche Christine M. , Sacks Jeffrey J. , Ryan George , Peddicord John 
Published: August 2004

Objectives. To determine the prevalence of proper fencing around outdoor swimming pools among US households and to describe this fencing in relation to demographic and other household factors. To estimate the number of drownings among children &lt;5 years of age that might be prevented by having proper fencing around all residential pools in the United States.Methods. A 1994, randomly dialed national telephone survey contacted 5238 adults who reported demographic information and household characteristics including whether the household had an outdoor swimming pool and the fencing around the pool. Data were weighted to obtain national estimates and percentages. The number of preventable drownings was estimated with a population-attributable risk equation.Results. Approximately 18.5 million American households owned or had access to an outdoor swimming pool in 1994, and 76% (13.9 million) of them appeared to have had adequate fencing. Adequate fencing was associated with household income and type of home. We estimate that 19% of pool-related drownings among children &lt;5 years of age in 1994 (88 drownings) might have been prevented if all residential pools in the United States were properly fenced.Conclusions. Adequate pool fencing prevents a child from having access to a swimming pool if a responsible adult is not present and has been promoted as a method to prevent drowning. Our research suggests that even if all residential pools in the United States were properly fenced, most drownings among children &lt;5 years of age would not be prevented. Thus, additional strategies to prevent drowning will be needed.
Telephone Call Reminders and Attendance in an Adolescent Clinic
Authors: O'Brien Grael , Lazebnik Rina 
Published: August 2004

Objective. To determine the effect of a single telephone call reminder on appointment compliance among adolescents in an inner city, hospital-based clinic.
Methods. A randomized clinical trial was conducted at the Adolescent Clinic, a part of the Ambulatory Pediatric Practice Clinic in Cleveland, Ohio, from December 1995 to November 1996. A total of 703 routine adolescent ambulatory appointments were randomized to receive either a single telephone call reminder 1 day before the appointment or to receive no reminder. A single telephone call attempt was directed primarily to the parent or guardian of the patient in the assignment group. If not available, the reminder message was left with the patient or other family member, or on the answering machine. The study variables selected included age, gender, appointment time, distance from clinic, and payment source, and for the intervention group, the recipient of the reminder telephone call. The outcome measure was the attendance rate.
Results. The intervention group (n= 347) and control group (n = 356) were well balanced for all study variables. The overall attendance rate was 49.8%. Only 204 (58.8%) of the 347 attempted intervention appointments were contacted successfully by telephone. In the attempted intervention analysis, the attendance rate of 55.6% in the intervention group (n = 347), regardless of whether subjects were successfully contacted by telephone, was 26.1% greater than the 44.1% attendance rate in the control group. In the completed intervention analysis, the attendance rate of 65.2% in the successfully contacted individuals within the intervention group (n = 204) was increased by 47.8% over that in the control group. In the univariate analysis, attendance for self-paying patients (25.4%) was worse than that for any group. In the logistic regression analysis, both the reminder telephone call intervention and the payment source were independent predictors of attendance. In the group that was called successfully (n = 204), there was no association between attendance and the recipient of the telephone call.
Conclusions. Telephone reminders are a very effective method of increasing attendance in a hospital-based adolescent clinic. The reminder is a consistently effective intervention whether the message is delivered to the patient, to the parent or other family member, or to a telephone answering machine. Adolescent patients whose visits are not covered by Medicaid or commercial insurance are least likely to attend their clinic appointments, and a telephone call reminder has no effect on this pattern.
Zinc Supplementation Reduces the Incidence of Acute Lower Respiratory Infections in Infants and Preschool Children: A Double-blind, Controlled Trial
Authors: Sazawal Sunil , Black Robert E. , Jalla Sanju , Mazumdar Sarmila , Sinha Anju , Bhan Maharaj K. 
Published: August 2004

Background. Increased acute lower respiratory infection incidence, severity, and mortality are associated with malnutrition, and reduced immunological competence may be a mechanism for this association. Because zinc deficiency results in impaired immunocompetence and zinc supplementation improves immune status, we hypothesized that zinc deficiency is associated with increased incidence and severity of acute lower respiratory infection.
Methods. We evaluated the effect of daily supplementation with 10 mg of elemental zinc on the incidence and prevalence of acute lower respiratory infection in a double-blind, randomized, controlled trial in 609 children (zinc, n = 298; control, n = 311) 6 to 35 months of age. Supplementation and morbidity surveillance were done for 6 months.
Results. After 120 days of supplementation, the percentage of children with plasma zinc concentrations &lt;60 μg/dL decreased from 35.6% to 11.6% in the zinc group, whereas in the control group it increased from 36.8% to 43.6%. Zinc-supplemented children had 0.19 acute lower respiratory infection episodes/child/year compared with 0.35 episodes/child/year in the control children. After correction for correlation of data using generalized estimating equation regression methods, there was a reduction of 45% (95% confidence interval, 10% to 67%) in the incidence of acute lower respiratory infections in zinc-supplemented children.
Conclusions. A dietary zinc supplement resulted in a significant reduction in respiratory morbidity in preschool children. These findings suggest that interventions to improve zinc intake will improve the health and survival of children in developing countries.
Family Burden and Adaptation During the Initial Year After Traumatic Brain Injury in Children
Authors: Wade Shari L. , Taylor H. Gerry , Drotar Dennis , Stancin Terry , Yeates Keith Owen 
Published: August 2004

Objective. Traumatic brain injury (TBI) often leads to long-term behavioral and cognitive deficits in children. However, little is known about the burden and psychosocial morbidity of pediatric TBI for families. The purpose of this study was to test the hypothesis that moderate and severe TBI in children has more adverse consequences than orthopedic trauma.Design. The sample was comprised of children between the ages of 6 and 12 recruited from hospital trauma and inpatient units including 53 with severe TBI, 56 with moderate TBI, and 80 with orthopedic injuries not involving central nervous system insult. Measures of injury-related burden, parental distress, and family functioning were administered to the child's primary caregiver at baseline assessment conducted soon after injury and at 6- and 12-month follow-ups. Multivariate repeated measures analysis of covariance was used to examine group differences in these outcomes over time.Results. Caregivers in the severe TBI group reported significantly higher levels of family burden, injury-related stress, and parental psychological symptoms than caregivers in the orthopedic injury group (ORTHO). The groups did not differ with respect to marital distress. Caregivers in the severe TBI group were significantly more likely than caregivers in the ORTHO group to exceed the clinical cutoff on the Brief Symptom Inventory and to report clinically significant levels of family dysfunction at follow-up.Conclusions. The findings suggest that severe TBI is a source of considerable caregiver morbidity, even when compared with other traumatic injuries. Caregivers in the severe TBI group had persistent stress associated with the child's injury, as well as the reactions of other family members, and a relative risk of clinically significant psychological symptoms nearly twice that of the ORTHO comparison group. These findings underscore the need for interventions that facilitate family adaptation after pediatric TBI.
Course of Tic Severity in Tourette Syndrome: The First Two Decades
Authors: Leckman James F. , Zhang Heping , Vitale Amy , Lahnin Fatima , Lynch Kimberly , Bondi Colin , Kim Young-Shin , Peterson Bradley S. 
Published: August 2004

Objective. Prevalence studies indicate a 10-fold higher rate of Tourette syndrome (TS) among children compared with adults. The purpose of this investigation was to examine the course of tic severity during the first 2 decades of life.
Method. A birth-year cohort of 42 TS patients followed at the Yale Child Study Center was recontacted an average of 7.3 years after their initial clinical evaluation. Data concerning the onset and course of tic severity until 18 years of age were available on 36 TS patients. A variety of statistical techniques were used to model aspects of the temporal patterning of tic severity.
Results. Mean (SD) tic onset at 5.6 (2.3) years of age was followed by a progressive pattern of tic worsening. On average, the most severe period of tic severity occurred at 10.0 (2.4) years of age. In eight cases (22%), the frequency and forcefulness of the tics reached a severe level during the worst-ever period such that functioning in school was impossible or in serious jeopardy. In almost every case this period was followed by a steady decline in tic severity. By 18 years of age nearly half of the cohort was virtually tic-free. The onset of puberty was not associated with either the timing or severity of tics.
Conclusions. A majority of TS patients displayed a consistent time course of tic severity. This consistency can be accurately modeled mathematically and may reflect normal neurobiological processes. Determination of the model parameters that describe each patient's course of tic severity may be of prognostic value and assist in the identification of factors that differentially influence the course of tic severity.
Neonatal Circumcision: When Can Infants Reliably Be Expected to Void?
Authors: Narchi Hassib , Kulaylat Naji 
Published: August 2004

Objective. Analysis of factors influencing voiding after neonatal circumcision.Design. Prospective study of the following factors in 200 circumcised infants: birth weight, gestational and postnatal age, type and timing of feeding before the procedure, and timing of last voiding before circumcision.Results. There was no significant difference in the age when circumcision was performed between breastfed infants (6 and 60 hours) and in those formula-fed (8 and 130 hours). All infants voided after circumcision, with 75% of breastfed infants and 100% of formula-fed infants voiding within 8 hours of the procedure. Breastfed infants voided up to 8 hours after the procedure, compared with up to 6 hours in formula-fed infants, but without a significant difference.The interval between last feed before the procedure and the time of voiding after circumcision was significantly shorter in formula-fed infants (1 to 9 hours) than in breastfed infants (2 to 21 hours). The interval between precircumcision and postcircumcision voiding was also significantly shorter in formula-fed infants (3 to 12 hours) than in breastfed infants (1 to 23 hours). Ninety percent of formula-fed and 64% of breastfed infants voided within 10 hours of the last voiding before circumcision.No infants aspirated during the procedure, regardless of the time of the last feed. No hemorrhagic, infectious, or surgical complications of circumcision were observed.Conclusion. Postoperative voiding time is predictable. Healthy infants who undergo an uncomplicated circumcision can be discharged before voiding occurs.
Should Fewer Premature Infants Be Screened for Retinopathy of Prematurity in the Managed Care Era?
Authors: Wright Kelly , Anderson Mark E. , Walker Esteban , Lorch Vichien 
Published: August 2004

Objective. To determine appropriate upper limits for gestational age and birth weight when screening infants for retinopathy of prematurity (ROP).Design. Retrospective survey.Setting. Tertiary neonatal intensive care nursery.Patients. Seven hundred seven infants born July 1, 1990 to June 30, 1996 and screened for ROP according to the 1988 to 1996 American Academy of Pediatrics guidelines.Outcome Measures. Maximum stage of ROP with respect to birth weight and gestational age.Results. No ROP more than Stage 1 was observed in infants with gestational ages ≥32 weeks or birth weights ≥1500 g. All cases of threshold and Stage 4 ROP were confined to infants with gestational ages ≤30 weeks or birth weights &lt;1200 g.Conclusions. The latest American Academy of Pediatrics screening guidelines for ROP are discretionary for infants with birth weights &gt;1500 g or gestational ages &gt;28 weeks. If ROP screening is limited to infants with birth weights of ≤1500 g, 34.2% fewer infants would require screening compared with the previous &lt;1800 g recommendation, while missing no cases of ROP more than Stage 1. A gestational age cut-off of ≤28 weeks, however, is less desirable, and could potentially miss several infants with more advanced retinopathy (including Stage 4). If ROP screening criteria were instead modified to include infants of gestational ages &lt;32 weeks, the number of patients requiring screening could be reduced 29.1% compared with the previous recommendation of &lt;35 weeks, again without missing any cases of ROP more than Stage 1. Use of such a screening strategy (birth weight &lt;1500 g or gestational age &lt;32 weeks) is predicted to save in excess of 1.5 million dollars annually in the United States, while missing no cases of ROP more than Stage 1.
Occult Bacteremia With Group B Streptococci in an Outpatient Setting
Authors: Peña Barbara M. Garcia , Harper Marvin B. , Fleisher Gary R. 
Published: August 2004

Objectives. We undertook this study to determine the relative frequency of occult bacteremia with group B streptococci (GBS) and to define the clinical features of infants with occult bacteremia attributable to GBS at the time of initial clinical contact.Design. The logs of the microbiology laboratory were reviewed for blood and cerebrospinal fluid isolates of GBS from 1982 to 1996. Records of patients identified with GBS were abstracted. Patients were classified as having occult bacteremia if GBS were isolated from their blood and they seemed nontoxic and had no apparent clinical or laboratory evidence of focal infection. All other patients were diagnosed with sepsis, meningitis, or nonmeningeal foci.Results. We reviewed the medical records of 147 children with GBS and identified 108 outpatients, including 47 (44%) with occult bacteremia, 42 (39%) with meningitis, 11 (10%) with nonmeningeal foci, and 8 (7%) with sepsis. Compared with patients with sepsis or focal infections, those with occult bacteremia were older (61.1 vs 39.1 days) and had slightly, although not significantly, higher white blood cell (WBC) counts (13 280 ± 6854 vs 10 688 ± 8574), but similar degrees of fever. Among the 47 patients with occult bacteremia, none died, as compared with 2 of 61 with serious infections, and fewer had neurologic sequelae (0/47 vs 11/61). Patients with occult bacteremia &gt;90 days of age generally had temperatures &gt;39°C (9/11, mean 39.3°C) and WBC counts &gt;15 000/mm3 (7/10, mean 19 070/mm3), both of which differed significantly compared with those who were &lt;90 days of age. Thirty of the 47 patients with occult bacteremia received intravenous antibiotics and recovered. One of 8 patients discharged without antibiotics and none of 8 with antibiotics developed a focal complication; 1 discharged patient was lost to follow-up.Conclusions. Almost one-half of the children with GBS disease beyond the immediate neonatal period had occult bacteremia. Among 8 untreated patients with bacteremia, 1 developed a focal complication. Although the small proportion of children with GBS occult bacteremia who were &gt;90 days of age usually had the risk factors of temperature &gt;39°C and WBC &gt;15 000/mm3, as seen with occult bacteremia attributable to other organisms, the majority of the patients who were younger did not have a characteristic clinical syndrome. Prevention of sequelae in these young infants will require a low threshold for diagnosis and treatment.
A Retrospective Review of Pediatric Patients With Epididymitis, Testicular Torsion, and Torsion of Testicular Appendages
Authors: Kadish Howard A. , Bolte Robert G. 
Published: August 2004

Study Objective. To compare historical features, physical examination findings, and testicular color Doppler ultrasound in pediatric patients with epididymitis, testicular torsion, and torsion of appendix testis.
Methods. A retrospective review of patients with the diagnosis of epididymitis, testicular torsion, or torsion of appendix testis.
Results. Ninety patients were included in the study (64 with epididymitis, 13 with testicular torsion, and 13 with torsion of appendix testis). Historical features did not differ among groups except for duration of symptoms. Of 13 patients with testicular torsion all had a tender testicle and an absent cremasteric reflex. When compared with the testicular torsion group, fewer patients with epididymitis had a tender testicle (69%) or an absent cremasteric reflex (14%). 62 (97%) patients with epididymitis had a tender epididymis and 43 (67%) had scrotal erythema/edema. By comparison, 3 (23%) and 5 (38%) patients with testicular torsion had a tender epididymis or scrotal erythema/edema, respectively. Doppler ultrasound showed decreased or absent blood flow in 8 patients, 7 of whom were diagnosed with testicular torsion. Ten out of 13 patients with testicular torsion had a salvageable testicle at the time of surgery.
Conclusion. The physical examination is helpful in distinguishing among epididymitis, testicular torsion, and torsion of appendix testis. Patients presenting with a tender testicle and an absent cremasteric reflex were more likely to have a testicular torsion rather than epididymitis or torsion of appendix testis. An absent cremasteric reflex was the most sensitive physical finding for diagnosing testicular torsion. Color Doppler ultrasound is a useful adjunct in the evaluation of the acute scrotum when physical findings are equivocal.
Maternal Asthma and Transient Tachypnea of the Newborn
Authors: Demissie Kitaw , Marcella Stephen W. , Breckenridge Mary B. , Rhoads George G. 
Published: August 2004

Objective. To examine the relationship between transient tachypnea of the newborn and asthma complicating pregnancy.Design. Historical cohort analysis.Setting. Singleton live deliveries in New Jersey hospitals during 1989 to 1992 (n = 447 963).Patients. Mother-infant dyads were identified from linked birth certificate and maternal and infant hospital claims data. Women with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code (493) for asthma (n = 2289) were compared with a four-fold larger randomly selected control sample (n = 9156) from the remaining pool of women.Main Outcome Measure. Transient tachypnea of the newborn.Results. In the overall sample, after controlling for the confounding effects of important variables, infants of asthmatic mothers were more likely [odds ratio (OR), 1.79; 95% confidence interval (CI), 1.35–2.37] than infants of control mothers to exhibit transient tachypnea of the newborn. A stratified analysis by gestational age and sex revealed larger and statistically significant associations in term infants (OR, 2.02; 95% CI, 1.42–2.87) as opposed to preterm infants (OR, 1.51; 95% CI, 0.94–2.43) and in male infants (OR, 1.91; 95% CI, 1.35–2.71) as opposed to female infants (OR, 1.51; 95% CI, 0.92–2.47). On the other hand, after adjusting for important confounding variables, respiratory distress syndrome and maternal asthma were not found to be associated (OR, 1.14; 95% CI, 0.79–1.64).Conclusion. The results of this study provide evidence that maternal asthma is a risk factor for transient tachypnea of the newborn and differences in gestational age and sex were apparent in this association. The mechanism for this association remains to be determined.