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OBJECTIVES: We studied neonatal cortical brain response to 4 types of nonpharmacological analgesia (oral glucose, expressed breast milk, maternal holding plus oral glucose, breastfeeding). We aimed to assess the differential effect of oral solutions (glucose, breast milk) given alone or combined with the maternal-infant relationship (holding, breastfeeding). METHODS: Eighty healthy term newborns undergoing a heel stick were randomly assigned to 4 parallel groups of 20 infants each: group 1, infants received a glucose solution on a changing table; group 2, infants received expressed breast milk on a changing table; group 3, infants received a glucose solution in their mothers' arms; and group 4, infants were breastfed by their mothers. Cortical activation in parietal, temporal, and frontal cortices was assessed by multichannel near-infrared spectroscopy. Pain expression was also evaluated. RESULTS: Oral glucose alone or combined with maternal holding was associated with no cortical activation during heel stick. Expressed breast milk was associated with localized bilateral activation of somatosensory and motor cortices (P < .01). Breastfeeding was associated with extensive bilateral activation of somatomotor, somatosensory, and right parietal cortices (P < .01). Pain expression was lower with the maternal-infant relationship (P = .007). CONCLUSIONS: Oral glucose, either alone or combined with maternal holding, appears to block or weaken cortical pain processing. Breast milk alone is associated with localized cortical activation. Breastfeeding is associated with extensive activation and may act by extending cortical processing. Maternal relationship, both combined with oral glucose and in breastfeeding, shows the greatest analgesic effect, although the neural patterns involved are distributed differently. [ABSTRACT FROM AUTHOR]

CONTEXT: Retinal vessel imaging is a noninvasive diagnostic tool used to evaluate cardiovascular risk. Childhood obesity and elevated blood pressure (BP) are associated with retinal microvascular alterations. OBJECTIVE: To systematically review and meta-analyze associations between obesity, BP, and physical activity with retinal vessel diameters in children. DATA SOURCES: We conducted a literature search through the databases of PubMed, Embase, Ovid, Web of Science, and the Cochrane Register of Controlled Trials. STUDY SELECTION: School- and population-based cross-sectional data. DATA EXTRACTION: General information, study design, participants, exposure, and outcomes. RESULTS: A total of 1751 studies were found, and 30 full-text articles were analyzed for eligibility. Twenty-two articles (18 865 children and adolescents) were used for further assessment and reflection. Eleven articles were finally included in the meta-analysis. We found that a higher BMI is associated with narrower retinal arteriolar (pooled estimate effect size -0.37 [95% confidence interval (CI): -0.50 to -0.24]) and wider venular diameters (0.35 [95% CI: 0.07 to 0.63]). Systolic and diastolic BP are associated with retinal arteriolar narrowing (systolic BP: -0.63 [95% CI: -0.92 to -0.34]; diastolic BP: -0.60 [95% CI -0.95 to -0.25]). Increased physical activity and fitness are associated with favorable retinal vessel diameters. LIMITATIONS: Long-term studies are needed to substantiate the prognostic relevance of retinal vessel diameters for cardiovascular risk in children. CONCLUSIONS: Our results indicate that childhood obesity, BP, and physical inactivity are associated with retinal microvascular abnormalities. Retinal vessel diameters seem to be sensitive microvascular biomarkers for cardiovascular risk stratification in children. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Preterm birth relates to long-term alterations in cardiac morphology and function. Understanding whether preterm postnatal life is a tractable period of cardiovascular development that can be positively altered by nutrition is relevant to long-term outcomes. We hypothesized that being fed human breast milk during early postnatal life is beneficial to long-term cardiac structure and function in preterm-born individuals compared with infant formulas. METHODS: A total of 926 preterm-born infants originally took part in a randomized controlled trial of postnatal milk-feeding regimens between 1982 and 1985 across 5 different UK centers. Preterm-born individuals were randomly assigned to either breast milk donated by unrelated lactating women or nutrient-enriched formulas. We followed 102 individuals from this cohort: 30 of whom had been randomized to being fed exclusively human milk and 16 to being fed exclusively formula. As a comparison group, we recruited an additional 102 individuals born term to uncomplicated pregnancies. Cardiac morphology and function were assessed by MRI. RESULTS: Preterm-born individuals fed exclusively human milk as infants had increased left and right ventricular end-diastolic volume index (+9.73%, P = .04 and +18.2%, P < .001) and stroke volume index (+9.79%, P = .05 and +22.1%, P = .01) compared with preterm-born individuals who were exclusively formula fed as infants. CONCLUSIONS: This study provides the first evidence of a beneficial association between breast milk and cardiac morphology and function in adult life in those born preterm and supports promotion of human milk for the care of preterm infants to reduce long-term cardiovascular risk. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Genetic analyses in humans suggest a role for retinoidrelated genes in the pathogenesis of congenital diaphragmatic hernia (CDH). The goal of this study was to investigate the vitamin A status of mothers and their newborns in association with CDH. METHODS: We conducted a hospital-based, case-control study with 22 case and 34 control mothers and their newborns. In maternal and cord blood samples, retinol and retinol-binding protein (RBP) levels were measured with high-performance liquid chromatography and an enzyme-linked immunosorbent assay, respectively. Univariate and multivariate logistic regression analyses were performed to determine crude and adjusted risk estimates. RESULTS: Case newborns had significantly lower levels of retinol (0.60 vs 0.76 j.LmolIL; P = .003) and RBP (5.42 vs 7.11 mgIL; P = .02) than did control newborns. The multivariate logistic regression analysis showed lower levels of retinol and RBP in association with CDI-I risk; the odds ratio for retinol levels of <15th percentile (<0.61 j.moI/L) was 11.11(95% confidence interval: 2.54-48.66; p = .001), and that for RBP levels of <15th percentile (<4.54 mgIL) was 4.00 (95% confidence interval: 1.00-15.99; P= .05). Retinol and RBP levels were not different between case and control mothers. CONCLUSIONS: CDH is strongly associated with low retinal and RBP levels in newborns, independent of maternal retinol status. This is an important finding supporting the idea that human CDH is linked with abnormal retinoid homeostasis. [ABSTRACT FROM AUTHOR]

OBJECTIVES: We used the 2001-2004 National Health and Nutrition Examination Survey to examine the association between postnatal environmental tobacco smoke exposure, measured as serum cotinine levels, and attention-deficit/hyperactivity disorder (ADHD) among children 4 to 15 years of age. We further investigated the interactions of race and serum cotinine levels with ADHD. METHODS: Logistic regression models were used to evaluate associations. RESULTS: This study found that the prevalence of ADHD increased as blood cotinine levels increased. The effects of blood cotinine levels on ADHD differed according to race. Compared with children of the same racial group with the lowest blood cotinine levels, the odds ratios were 2.72 (95% confidence interval: 1.25-5.93) for Mexican American children and 5.32 (95% confidence interval: 1.55-1 8.3) for children in other racial groups with the highest blood cotinine levels, with controlling for the effect of maternal smoking during pregnancy. However, no significant associations between blood cotinine levels and ADHD were observed among non-Hispanic white or non-Hispanic black children. CONCLUSIONS: The findings of this study underscore the possibility of racial disparities in the effects of environmental tobacco smoke on behavioral problems in children. These findings warrant further investigation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Exposure to thimerosal, a mercury-containing preservative that is used in vaccines and immunoglobulin preparations, has been hypothesized to be associated with increased risk of autism spectrum disorder (ASD). This study was designed to examine relationships between prenatal and infant ethylmercury exposure from thimerosalcontaining vaccines and/or immunoglobulin preparations and ASD and 2 ASD subcategories: autistic disorder (AD) and ASD with regression. METHODS: A case-control study was conducted in 3 managed care organizations (MCOs) of 256 children with ASD and 752 controls matched by birth year, gender, and MCD. ASD diagnoses were validated through standardized in-person evaluations. Exposure to thimerosal in vaccines and immunoglobulin preparations was determined from electronic immunization registries, medical charts, and parent interviews. Information on potential confounding factors was obtained from the interviews and medical charts. We used conditional logistic regression to assess associations between ASD, AD, and ASD with regression and exposure to ethylmercury during prenatal, birth-to-i month, birthto-7-month, and birth-to-20-month periods. RESULTS: There were no findings of increased risk for any of the 3 ASD outcomes. The adjusted odds ratios (95% confidence intervals) for ASD associated with a 2-SD increase in ethylmercury exposure were 1.12 (0.83-1.51) for prenatal exposure, 0.88 (0.62-1.26) for exposure from birth to 1 month, 0.60 (0.36-0.99) for exposure from birth to 7 months, and 0.60 (0.32-0.97) for exposure from birth to 20 months. CONCLUSIONS: In our study of MCO members, prenatal and early-life exposure to ethylmercury from thimerosal-containing vaccines and immunoglobulin preparations was not related to increased risk of ASDs. [ABSTRACT FROM AUTHOR]

OBJECTIVES: We investigated the association between smoke-free law coverage and cotinine among nonsmoking youth (3-19 years) with and without home secondhand smoke (SHS) exposure. METHODS: We used data from the 1999-2006 National Health and Nutrition Examination Survey, a cross-sectional survey designed to monitor the health and nutritional status of the US population. Serum cotinine levels were available for 11 486 nonsmoking youth from 117 survey locations. Each location was categorized into 1 of 3 groups indicating extensive, limited, and no coverage by a smoke-free law. Cotinine was analyzed both as a dichotomous (⇕0.05 mg/mL) and as a continuous outcome. RESULTS: Among youth without home SHS exposure, those who were living in a county with extensive coverage of a smoke-free air law had an adjusted 0.61 times (95% confidence interval: 0.48-0.78) the prevalence of detectable cotinine and 0.57 (95% confidence interval: 0.410.79) times lower geometric mean compared with youth without a smoke-free air law. Among youth with home SHS exposure, youth with extensive coverage of a smoke-free air law had lower geometric mean cotinine compared with youth who were living in a county without a smoke-free air law, but these differences were no longer observed after adjustment for covariates. CONCLUSIONS: These results suggest that smoke-free laws are an effective strategy for reducing cotinine in youth without home SHS exposure; however, among youth with home SHS exposure, no benefit was detected. [ABSTRACT FROM AUTHOR]

BACKGROUND: Suprapubic aspiration (SPA) and urine catheterization (UC) are performed frequently in preterm neonates to rule out urinary tract infection; however, a comparison of the pain caused by both procedures has not been made previously. OBJECTIVE: To compare pain responses in preterm infants who are undergoing urine collection by using SPA versus UC. METHODS: Prospective, single-blind, randomized clinical trial was conducted in 2 NICUs. Preterm infants who required urine samples for microbiologic analysis were randomly assigned to undergo either SPA or UC. The infants' facial and physiologic responses were videotaped during the procedure and later scored by a research assistant who was blind to the method of urine collection. The primary outcome measure was facial-grimacing during the procedure, which was assessed by measuring the percentage of time the infants displayed brow-bulging. Secondary outcomes included changes in heart rate (beats per minute), oxygen saturation (%), and procedural success rate. RESULTS: Forty-eight preterm infants participated. Characteristics did not differ (P> .05) between groups. The mean (SD) percent browbulging score was higher in the SPA group than in the UC group (67% [341 vs 42% [38]; P = .02). Heart rate and oxygen saturation did not differ (P = .50 and .74, respectively). The procedure-success rate, although lower in the SPA group, was not statistically different (60% vs 78%; P .17). CONCLUSIONS: SPA was more painful than UC, as assessed by browbulging, and had a tendency to be associated with a higher rate of procedure failure. These findings should be taken into consideration when choosing between these 2 procedures for preterm infants who undergo urine sampling. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We tested the efficacy of a cognitive-behavioral intervention in reducing environmental tobacco smoke exposure (ETSE) and improving pregnancy outcomes among black women. METHODS: We recruited 1044 women to a randomized, controlled trial during 2001-2004 in Washington, DC. Data on 691 women with selfreported ETSE were analyzed. A subset of 520 women with ETSE and salivary cotinine levels (SCLs) of <20 ng/mL were also analyzed. Individually tailored counseling sessions, adapted from evidence-based interventions for ETSE and other risks, were delivered to the intervention group. The usual-care group received routine prenatal care as determined by their provider. Logistic regression models were used to predict ETSE before delivery and adverse pregnancy outcomes. RESULTS: Women in the intervention were less likely to self-report ETSE before delivery when controlling for other covariates (odds ratio [OR]: 0.50 [95% confidence interval (Cl): 0.35-0.71]). Medicaid recipients were more likely to have ETSE (OR: 1.97 [95% Cl: 1.31-2.96]). With advancing maternal age, the likelihood of ETSE was less (OR: 0.96 [95% Cl: 0.93-0.99]). For women in the intervention, the rates of very low birth weight (VLBW) and very preterm birth (VPTB) were significantly improved (OR: 0.11 [95% Cl: 0.01-0.86] and OR: 0.22 [95% Cl: 0.07-0.681, respectively). For women with an SCL of <20 ng/mL, maternal age was not significant. Intimate partner violence at baseline significantly increased the chances of VLBW and VPTB (OR: 3.75 [95% Cl: 1.02-13.81] and 2.71 [95% Cl: 1.11-6.62], respectively). These results were true for mothers who reported ETSE overall and for those with an SCL of <20 ng/mL. CONCLUSIONS: This is the first randomized clinical trial demonstrating efficacy of a cognitive-behavioral intervention targeting ETSE in pregnancy. We significantly reduced ElSE as well as VPTB and VLBW, leading causes of neonatal mortality and morbidity in minority populations. This intervention may reduce health disparities in reproductive outcomes. [ABSTRACT FROM AUTHOR]

Endotracheal intubation is a common procedure in newborn care. The purpose of this clinical report is to review currently available evidence on use of premedication for intubation, identify gaps in knowledge, and provide guidance for making decisions about the use of premedication. [ABSTRACT FROM AUTHOR]

CONTEXT: Studies through 6 years have shown no long-term direct effects of prenatal cocaine exposure (PCE) on children's physical growth, developmental test scores, or language outcomes. Little is known about the effects of PCE among school-aged children aged 6 years and older. OBJECTIVE: We reviewed articles from studies that examined the effects of PCE on growth, cognitive ability, academic functioning, and brain structure and function among school-aged children. METHODS: Articles were obtained by searching PubMed, Medline, TOXNET, and Psyclnfo databases from January 1980 to December 2008 with the terms "prenatal cocaine exposure," "cocaine," "drug exposure," "substance exposure," "maternal drug use," "polysubstance," "children," "adolescent," "in utero," "pregnancy," "development," and "behavior." Criteria for inclusion were (1) empirical research on children aged 6 years and older prenatally exposed to cocaine, (2) peer-reviewed English-language journal, (3) comparison group, (4) longitu- dinal follow-up or historical prospective design, (5) masked assessment, (6) exclusion of subjects with serious medical disabilities, and (7) studies that reported nonredundant findings for samples used in multiple investigations. Thirty-two unique studies met the criteria. Each article was independently abstracted by 2 authors to obtain sample composition, methods of PCE assessment, study design, comparison groups, dependent variables, covariates, and results. RESULTS: Associations between PCE and growth, cognitive ability, academic achievement, and language functioning were small and attenuated by environmental variables. PCE had significant negative associations with sustained attention and behavioral self-regulation, even with covariate control. Although emerging evidence suggests PCE-related alterations in brain structure and function, interpretation is limited by methodologic inconsistencies. CONCLUSIONS: Consistent with findings among preschool-aged children, environmental variables play a key role in moderating and explaining the effects of PCE on school-aged children's functioning. After controlling for these effects, PCE-related impairments are reliably reported in sustained attention and behavioral self-regulation among school-aged children. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine the rate of vitamin B supplementation in predominantly breastfed children. To identify patient characteristics, parental beliefs, and practitioner policies associated with supplementation. METHODS: A prospective observational study was conducted in a practice-based research network. Network pediatricians completed a survey regarding their policy on vitamin B supplementation for breastfed infants. Parents of children 6 to 24 months old completed a survey on the initial type of feeding given to the child, length of breastfeeding, formula supplementation, and use of multivitamins. Parents indicated their level of agreement with statements regarding vitamin B supplementation. RESULTS: Among 44 responding pediatricians, 36.4% indicated that they recommended vitamin D supplementation for all breastfed infants. A total of 2364 surveys were completed on age-eligible children; 1140 infants were breastfed for at least 6 months with little or no formula supplementation. The rate of vitamin D use for these infants was 15.9%. Use of vitamin D was significantly associated with parental agreement that their child's pediatrician recommended supplementation (odds ratio [OR]: 7.8), and that vitamins are unnecessary because breast milk has all needed nutrition (OR: 0.12). Among parents of predominantly breastfed infants who indicated that their child's doctor recommended vitamin D, 44.6% gave the supplementation to their child. Conversely, 67% of parents agreed that breast milk has all needed nutrition, and only 3% of these parents gave vitamin D to their children. CONCLUSIONS: A minority of breastfed infants received vitamin D supplementation. Educational efforts directed at both physicians and parents are needed to increase compliance with vitamin B supplementation guidelines. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Because physicians may have difficulty distinguishing accidental fractures from those that are caused by abuse, abusive fractures may be at risk for delayed recognition;therefore,the primary objective of this study was to determine how frequently abusive fractures were missed by physicians during previous examinations. A secondary objective was to determine clinical predictors that are associated with unrecognized abuse. METHODS: Children who were younger than 3 years and presented to a large academic children's hospital from January 1993 to December 2007 and received a diagnosis of abusive fractures by a multidisciplinary child protective team were included in this retrospective review. The main outcome measures included the proportion of children who had abusive fractures and had at least 1 previous physician visit with diagnosis of abuse not identified and predictors that were independently associated with missed abuse. RESULTS: Of 258 patients with abusive fractures, 54 (20.9%) had at least 1 previous physician visit at which abuse was missed. The median time to correct diagnosis from the first visit was 8 days (minimum: 1; maximum: 160). Independent predictors of missed abuse were male gender, extremity versus axially located fracture, and presentation to a primary care setting versus pediatric emergency department or to a general versus pediatric emergency department. CONCLUSIONS: One fifth of children with abuse-related fractures are missed during the initial medical visit. In particular, boys who present to a primary care or a general emergency department setting with an extremity fracture are at a particularly high risk for delayed diagnosis. [ABSTRACT FROM AUTHOR]

Congenital or acquired hearing loss in infants and children has been linked with lifelong deficits in speech and language acquisition, poor academic performance, personal-social maladjustments, and emotional difficulties. Identification of hearing loss through neonatal hearing screening, regular surveillance of developmental milestones, auditory skills, parental concerns, and middle-ear status and objective hearing screening of all infants and children at critical developmental stages can prevent or reduce many of these adverse consequences. This report promotes a proactive, consistent, and explicit process for the early identification of children with hearing loss in the medical home. An algorithm of the recommended approach has been developed to assist in the detection and documentation of, and intervention for, hearing loss. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The goal was to describe the epidemiological features of physical education (PE)-related injuries treated in US emergency departments. METHODS: A retrospective analysis was conducted with data for children and adolescents (5-18 years of age) from the National Electronic Injury Surveillance Study of the US Consumer Product Safety Commission, from 1997 through 2007. Sample weights provided by the National Electronic Injury Surveillance System were used to calculate national estimates of PE-related injuries. Trend significance of the number of PE-related injuries over time was analyzed by using linear regression analysis. RESULTS: An estimated 405 305 children and adolescents were treated in emergency departments for PE-related injuries. The annual number of cases increased 150% during the study period (P = .001). Nearly 70% of PE-related injuries occurred during 8 activities, that is, running, basketball, football, volleyball, soccer, and gymnastics. Boys' injuries were more likely to involve the head, to be diagnosed as a laceration or fracture, to be attributable to contact with a person or structure, and to occur during group activities. Girls' injuries were more likely to involve the lower extremities, to be strains and sprains, to be acute noncontact injuries, and to occur during individual activities. CONCLUSION: More research is needed to identify the cause of the increase in PE-related injuries, to examine the gender difference in PE-related injuries, and to determine appropriate injury prevention solutions and policies. [ABSTRACT FROM AUTHOR]

In this article the author discusses the benefit of tracheal ventilation without intubation, known as nasal intermittent positive pressure ventilation (NIPPV), approach to support premature infants. The author notes that ventilation without tracheal intubation is less invasive than mechanical ventilation (MV) because the use of this approach can lower than morbidity rates of infants. The author also investigated the association of MV with brain injury.

BACKGROUND. Pulmonary disease among infants of <28 weeks' gestation (extremely low gestational age newborns) often has the following pattern: the infant Starts out with little need for supplemental oxygen and ventilatory support in the first postnatal week but then has pulmonary deterioration in the second postnatal week, with an increased need for supplemental oxygen and respiratory support. We evaluated the antecedents and correlates of patterns of early lung disease, with particular emphasis on pulmonary deterioration, in a large cohort study (the Extremely Low Gestational Age Newborn [ELGANI study). PATIENTS AND METHODS. We examined data collected prospectively on 1340 infants born between 2002 and 2004 at 23 to 27 completed weeks of gestation and who survived to 14 days. Pulmonary deterioration was defined as receipt of fraction of inspired oxygen < 0.23 on any day between days 3 and 7 and receipt of fraction of inspired oxygen ⩾ 0.25 on day 14. RESULTS. One fifth (20%) of the infants had consistently low fraction of inspired oxygen, approximately two fifths (38%) had pulmonary deterioration, and the remaining approximately two fifths (43%) had consistently high fraction of inspired oxygen (early and persistent lung dysfunction). Compared with infants who had consistently low fraction of inspired oxygen, infants who experienced pulmonary deterioration had lower gestational ages and lower birth weights, had higher scores for neonatal acute physiology, and received more intensive modes of respiratory support. Gender, multifetal pregnancy, cesarean delivery, antenatal steroids, chorioamnionitis, and funisitis were not associated with pulmonary deterioration. The incidence of chronic lung disease, defined as oxygen therapy at 36 weeks' postmenstrual age, was 17% in the consistently low fraction of inspired oxygen group, 51% in the pulmonary deterioration group, and 67% in the early and persistent pulmonary dysfunction group. The incidence of death in these 3 groups before 36 weeks' postmenstrual age was 1%, 3%, and 5%, respectively. [ABSTRACT FROM AUTHOR]

OBJECTIVES. The prevalence and identification of hypertriglyceridemia in youths will likely will increase in the future as a consequence of childhood obesity and increased screening for dyslipidemias. We sought to review our clinical experience with hypertriglyceridemia, evaluate factors associated with increased triglyceride levels, and review treatment options to provide guidance for management. METHODS. Clinical review of data for all patients who had ⩾ 1 elevated triglyceride level (>4 mmol/L [>350 mg/dL]) while being monitored in a specialized lipid disorders clinic was performed. RESULTS. The study population consisted of 76 patients with 761 clinic visits. Hypertriglyceridernia was secondary to lifestyle factors for 13 patients. The rest had primary hypertriglyceridemia, with 32 patients having familial combined hypertriglyceridemia and hypercholesterolemia (type II), 25 patients having primary hypertriglyceridemia (type IV), 4 patients having familial lipase deficiency (type I), and 2 patients having hyperlipoproteinemia E2/E2 phenotype (type III). Triglyceride levels were highest in type land III hypertriglyceridemia (>10 mmol/L [>900 mg/dLI), followed by type IV and adiposity-related hypertriglyceridemia (>4 mmol/L [>350 mg/dL]) and finally type TI familial combined hypertriglyceridemia and hypercholesterolemia (>2 mmol/L [>180 mgIdL]). A total of 34 patients received 37 trials of drug therapy as part of triglyceride level management (bile acid-binding resins, n = 12; fibrates, n = 19; statins, n = 6). Triglyceride levels were found to decrease over time with the use of fibrates, to increase with the use of bile acid-binding resins, and not to change with the use of statins. CONCLUSIONS. Lifestyle modifications remain the primary therapeutic avenue for the management of pediatric hypertriglyceridemia. We propose an algorithm for the management of this heterogeneous population to guide clinicians in their treatment decisions. [ABSTRACT FROM AUTHOR]

OBJECTIVE. Our goal was to evaluate whether language delay at 3 years in premature infants is associated with previous exposure to hyperbilirubinemia during the first 2 weeks after birth. PATIENTS AND METHODS. We performed a retrospective case-control study of infants admitted to the NICU between January and October 2003. Inclusion criteria included a birth weight of ⩽1500 g and follow-up to age 3 years. Exclusion criteria included genetic disorders and hearing loss or recurrent ear infections. Peak total serum bilirubin levels during the first 2 weeks and duration of hyperbilirubinemia (days with total serum bilirubin level at >8 mg/dL) were determined. Infants with language delay and who were receiving speech therapy by 3 years were identified through developmental clinic charts and a tracking program and compared with infants who had normal language development. RESULTS. A total of 125 infants with birth weight of ⩽ 1500 g were admitted to the NICU between January and October 2003. Fifteen infants died, and 110 were discharged from the hospital. A total of 102 (93%) of 110 infants had follow-up to the age of 3 years. Four infants were excluded (1 genetic disorder, 3 delayed hearing loss or recurrent ear infections). Twenty-four infants had a language delay and received speech therapy, whereas 74 infants had normal language development. There was rio significant difference in peak total serum bilirubin level and duration of hyperbilirubinemia between the 2 groups. On logistic regression, only bronchopulmonary dysplasia was associated with language delay. CONCLUSIONS. Hyperbilirubinemia, defined as peak total serum bilirubin level or duration of elevated bilirubin in days, is not associated with language delay in premature infants. However, this issue deserves investigation, because other measures of bilirubin, such as unbound bilirubin, may be associated with language delay. [ABSTRACT FROM AUTHOR]

OBJECTIVE. Our goal is to describe the methods used in the Infant Feeding Practices Study II (IFPS 11), a study of infant feeding and care practices throughout the first year of life. Survey topics included breastfeeding, formula and complementary feeding, infant health, breast-pump use, food allergies, sleeping arrangements, mother's employment, and child care arrangements. In addition, mothers' dietary intake was measured prenatally and postnatally. PARTICIPANTS AND METHODS. The IFPS II sample was drawn from a nationally distributed consumer opinion panel of 500 000 households. All questionnaires were administered by mail, 1 prenatally and 10 postpartum. Qualifying criteria were used to achieve the sample goals of mothers of healthy term and late preterm singleton infants. In addition to the questionnaires about the infants, women were sent a diet-assessment questionnaire prenatally and at ∼4 months after delivery; this questionnaire was also sent to members of a comparison group who were neither pregnant nor postpartum. RESULTS. A sample of 4902 pregnant women began the study, and ∼2000 continued through their infant's first year. Response rates ranged from 63% to 87% for the different questionnaires. Compared with adult mothers of singletons from the nationally representative sample of the National Survey of Family Growth, IFPS II participants had a higher mean education level; were older; were more likely to be middle income, white, and employed; were less likely to smoke; and had fewer other children. Compared with women who participated in the National Immunization Survey who gave birth in 2004, IFPS II mothers were more likely to breastfeed and to breastfeed longer. CONCLUSIONS. The IFPS II provides a valuable database because of its large sample size, the frequency of its questionnaires, and its wide coverage of issues salient to infant feeding. [ABSTRACT FROM AUTHOR]

OBJECTIVES. Our hypothesis was that morbidity related to overweight/obesity is already evident in infants and young toddlers. The major objectives of this study were (1) to assess the prevalence of overweight in a sample of hospitalized infants and (2) to assess the prevalence of morbidity in overweight infants in a community-based sample. METHODS. The hospital admission study population included 2139 infants, ≤24 months of age, who were admitted for any reason to the pediatric department at the Bnai Zion Medical Center in 2004-2005. For the community-based sample, we identified overweight infants (≥85th weight-for-height percentile in ≥2 measurements, ≥3 months apart), ≤24 months of age, in 8 mother and child health care facilities in the Haifa subdistrict of Israel. Parents of infants were interviewed by using a structured questionnaire. RESULTS. We found that overweight infants (85th to 94th percentiles) had fewer admissions and fewer repeated admissions than expected. Infants of ≥95th percentile had more admissions than expected, as well as a larger number of repeated admissions. In the second part of the study, we found that rates of developmental delays (mainly delayed gross motor skills) and snoring were significantly higher in infants of ≥85th percentile. In addition, although the results were not statistically significant, infants with overweight suffered more frequently from breathing problems, such as asthma and stridor. When the mothers were asked to assess whether their child was overweight, only 31.6% of mothers of overweight children thought that the child was overweight. CONCLUSIONS. The high admission rates for infants of ≥95th percentile and the high incidence rates of respiratory morbidity, snoring, and delayed gross motor skills in overweight infants support our hypothesis regarding early morbidity associated with overweight. [ABSTRACT FROM AUTHOR]

OBJECTIVE. The goal was to determine whether breakfast had effects on the cognitive performance and mood of high school students. METHODS. A crossover trial was performed in boarding schools, involving 104 students between 13 and 20 years of age. The participants were randomly assigned to 2 equal-size groups on the morning of the first testing day. One half of the total sample received a standardized breakfast, whereas the other half received no breakfast. Seven days later, the treatment order was reversed. Measurements of cognitive function included standardized tests of attention and concentration, as well as tests of verbal and spatial memory. In addition, mood was rated with a self-administered questionnaire covering the dimensions of positive and negative affect, information uptake, arousal, and alertness. Statistical analysis consisted of repeated-measures analysis of variance. RESULTS. Breakfast had no effect on sustained attention among high school students. Visuospatial memory was improved in male students. Self-reported. alertness improved significantly in the entire study population. Male students reported feeling more positive after consuming breakfast, compared with the fasting condition. CONCLUSIONS. This crossover trial demonstrated positive short-term effects of breakfast on cognitive functioning and self-reported alertness in high school students. [ABSTRACT FROM AUTHOR]

OBJECTIVE. To mitigate the risks of fatigue-related medical errors, the Accreditation Council for Graduate Medical Education introduced work hour limits for resident physicians in 2003. Our goal was to determine whether work hours, sleep, and safety changed after implementation of the Accreditation Council for Graduate Medical Education standards. METHODS. We conducted a prospective cohort study in which residents from 3 large pediatric training programs provided daily reports of work hours and sleep. In addition, they completed reports of near-miss and actual motor vehicle crashes, occupational exposures, self-reported medical errors, and ratings of educational experience. They were screened for depression and burnout. Concurrently, at 2 of the centers, data on medication errors were collected prospectively by using an established active surveillance method. RESULTS. A total of 220 residents provided 6007 daily reports of their work hours and sleep, and 16 158 medication orders were reviewed. Although scheduling changes were made in each program to accommodate the standards, 24- to 30-hour shifts remained common, and the frequency of residents' call remained largely unchanged. There was no change in residents' measured total work hours or sleep hours. There was no change in the overall rate of medication errors, and there was a borderline increase in the rate of resident physician ordering errors, from 1.06 to 1.38 errors per 100 patient-days. Rates of motor vehicle crashes, occupational exposures, depression, and self-reported medical errors and overall ratings of work and educational experiences did not change. The mean length of extended-duration (on-call) shifts decreased 2.7% to 28.5 hours, and rates of resident burnout decreased significantly (from 75.4% to 57.0%). CONCLUSIONS. Total hours of work and sleep did not change after implementation of the duty hour standards. Although fewer residents were burned out, rates of medication errors, resident depression, and resident injuries and educational ratings did not improve. [ABSTRACT FROM AUTHOR]

OBJECTIVE. There is little information in pediatrics on the persistence of the prehypertension and hypertension classifications or on the progression of prehypertension to hypertension. This study aimed to examine those issues. METHODS. An analysis of data from the National Childhood Blood Pressure database was conducted to examine the longitudinal blood pressure outcomes for adolescents classified after a single measurement of blood pressure. Adolescent subjects (N = 8535) for whom serial single blood pressure measurements were obtained at intervals of 2 years were identified. Subjects were stratified according to blood pressure status at the initial measurement, as having normotension, prehypertension, or hypertension. RESULTS. Among subjects designated as having prehypertension (n = 1470), 14% of boys and 12% of girls had hypertension 2 years later. Among subjects designated as having hypertension, 31% of boys and 26% of girls continued to exhibit hypertension, and 47% of boys and 26% of~girls had blood pressure values in the prehypertensive range. Regression models showed no significant effect of race on blood pressure changes but significant effects of initial BMI and changes in BMI. CONCLUSIONS. These data indicated that the rate of progression of prehypertension to hypertension was -7% per year. Prehypertension can be predictive of future hypertension and may benefit from preventive interventions, especially lifestyle changes. [ABSTRACT FROM AUTHOR]

OBJECTIVES. The objectives of this study were to compare the birth weight and gestational age distributions and prevalence rates of autism with those of other developmental disabilities and to estimate the birth weight- and gestational age-specific risks for autism. METHODS. For the first objective, a retrospective cohort of children born in Atlanta, Georgia, in 1981-1993 who survived to 3 years of age was identified through vital records. Children in the cohort who had developmental disabilities (autism, mental retardation, cerebral palsy, hearing loss, or vision impairment) and were still residing in metropolitan Atlanta at 3 to 10 years of age were identified through the Metropolitan Atlanta Developmental Disabilities Surveillance Program. A nested case-control sample from the cohort was used for the second objective; all cohort children identified with autism were case participants, and control participants were cohort children who were not identified as having developmental disabilities or receiving special education services. RESULTS. The prevalence of autism in low birth weight or preterm children was markedly lower than those of other developmental disabilities. In multivariate analyses, birth weight of <2500 g and preterm birth at <33 weeks' gestation were associated with an approximately twofold increased risk for autism, although the magnitude of risk from these factors varied according to gender (higher in girls) and autism subgroup (higher for autism accompanied by other developmental disabilities). For example, a significant fourfold increased risk was observed in low birth weight girls for autism accompanied by mental retardation, whereas there was no significantly increased risk observed in low birth weight boys for autism alone. CONCLUSIONS. Gender and autism subgroup differences in birth weight and gestational age, resulting in lower gender ratios with declining birth weight or gestational age across all autism subgroups, might be markers for etiologic heterogeneity in autism. [ABSTRACT FROM AUTHOR]

OBJECTIVES. Our goals were to determine whether prenatal alcohol exposure is associated with an increased incidence of iron-deficiency anemia in infancy and to compare effects of fetal alcohol exposure and iron-deficiency anemia on infant growth. We also tested whether effects of fetal alcohol exposure on growth are mediated or moderated by iron-deficiency anemia. METHODS. A total of 96 infants born to mothers from the Coloured (mixed ancestry) community in Cape Town, South Africa, were recruited prenatally; 42 mothers drank heavily during pregnancy, and 54 abstained or drank small amounts of alcohol. Growth was assessed at birth and 6.5 and i2 months, and iron-deficiency anemia was assessed at 6.5 or 12 months. RESULTS. Infants whose mothers binge drank during pregnancy (≥4 drinks per occasion) were 3.6 times more likely to be diagnosed with iron-deficiency anemia at 12 months than were infants whose mothers did not binge drink. Prenatal alcohol exposure was associated with reduced weight at birth, 6.5 months, and 12 months and with shorter length at 6.5 and 12 months. Iron-deficiency anemia was related to reduced 12-month weight and head circumference and to slower growth velocity between 6 and 12 months. The effects of prenatal alcohol on weight were not mediated by iron-deficiency anemia; however, they were seen primarily in infants with iron-deficiency anemia. CONCLUSIONS. The association of maternal binge drinking with an increased incidence of iron-deficiency anemia may reflect disruption of accumulation of fetal iron stores or postnatal deficiencies in iron uptake, absorption, or intake. Moreover, iron deficiency seems to exacerbate the prenatal alcohol effects on growth. [ABSTRACT FROM AUTHOR]

OBJECTIVE. The objective of this study was to compare the respiratory physiologic features of healthy term infants placed in either a car bed or a car safety seat. METHODS. Within the first 1 week of life, 67 healthy term infants were recruited and assigned randomly to be monitored in either a car bed (33 infants) or a car safety seat (34 infants). Physiologic data, including oxygen saturation and frequency and type of apnea, were obtained and analyzed in a blinded manner. RESULTS. The groups spent similar amounts of time in the devices (car bed: 71.6 minutes; cal seat: 74.2 minutes). The mean oxygen saturation values were not different between the groups (car bed: 97.1%; car seat: 97.3%). The percentages of time with oxygen saturation of <95% were also similar for the 2 groups (car bed: 18.3%; car seat: 11.8%). In both groups, a number of infants spent high percentages of study time with oxygen saturation of <95%. The 6 infants with the most time at this level were all in the car safety seat group (54%-63% of study time). Values for the 6 infants in the car bed group with the most time at this level were lower (20%-42%). This difference in the duration of oxygen saturation of <95% was not statistically significant. The mean end-tidal carbon dioxide levels and the numbers of episodes of apnea were similar for the 2 groups. CONCLUSIONS. The respiratory physiologic features of infants in the 2 car safety devices were observed to be similar. Of note, substantial periods of time with oxygen saturation of <95% were surprisingly common in both groups. [ABSTRACT FROM AUTHOR]

Objective. To determine whether an individualized, prenatal and postnatal, lactation consultant intervention resulted in increased cumulative intensity of breastfeeding up to 52 weeks. Design. The randomized, nonblinded, controlled trial recruited women from prenatal care. Baseline prenatal interviews covered demographic data and breastfeeding experience, intention, and knowledge. Interviews at 1, 2, 3, 4, 6, 8, 10, and 12 months after birth collected data on weekly feeding patterns, infant illness, and infant health care use. Setting. Two community health centers serving low-income, primarily Hispanic and/or black women. Participants. The analytic sample included 304 women (intervention: n = 145; control: n = 159) with ≤1 postnatal interview. Intervention. Study lactation consultants attempted 2 prenatal meetings, a postpartum hospital visit, and/or home visits and telephone calls. Control subjects received the standard of care. Outcome Measures. Cumulative breastfeeding intensity at 13 and 52 weeks, based on self-reports of weekly feeding, on a 7-level scale. Results. The intervention group was more likely to breastfeed through week 20 (53.0% vs 39.3%). Exclusive breastfeeding rates were low and did not differ according to group. In multivariate analyses, control subjects had lower breastfeeding intensity at 13 weeks (odds ratio [OR]: 1.90; 95% confidence interval [CI]: 1.13-3.20) and 52 weeks (OR: 2.50; 95% CI: 1.48-4.21). US-born control subjects had lowest breastfeeding intensity at 13 weeks (OR: 5.22; 95% CI: 2.43-11.22) and 52 weeks (OR: 5.25; 95% CI: 2.44-11.29). There were no significant differences in breastfeeding intensity among the US-born intervention, foreign-born intervention, and foreign-born control groups. Conclusions. This "best-practices" intervention was effective in increasing breastfeeding duration and intensity. Breastfeeding promotion should focus on US-born women and exclusive breastfeeding. [ABSTRACT FROM AUTHOR]

Focuses on the physiological significance of serum bilirubin. Isomers of fetal bilirubin; Impact of oxidative stress on the levels of bilirubin; Mechanism of the biliverdin reductase antioxidant cycle; Clinical relevance of serum bilirubin.

Objective. To demonstrate the clinical characteristics, radiologic findings, and neuropathological features of tetrahydrocannabinol-related posterior fossa ischemic stroke in adolescent patients. Design. A retrospective case and chart review of 3 cases encountered at a tertiary care institution over a span of 5 years. Setting. Inpatient and intensive care hospitalization units managing children and adolescents. Subjects. Male adolescent patients with ischemic cerebellar stroke after use of marijuana. Diagnostic Investigations. Computed tomography brain scans (3 subjects), magnetic resonance imaging brain study (1 subject), cerebral arteriography (1 subject), cerebellar biopsy (1 subject), and necropsy (2 subjects). Results. Three adolescent males had similar presentations of headache, fluctuating level of consciousness or lethargy, visual disturbance, and variable ataxia after self-administration of marijuana. They developed primary cerebellar infarctions within days after the exposure that could not be attributed to supratentorial herniation syndromes and only minimally involved brainstem structures. Conclusions. Episodic marijuana use may represent a risk factor for stroke in childhood, particularly in the posterior circulation. Early recognition of the cerebellar stroke syndrome may allow prompt neurosurgical intervention, reducing morbidity. [ABSTRACT FROM AUTHOR]

Conclusions. Ultrasound is an objective, noninvasive technique for detecting milk ejection by observing an increase in milk-duct diameter. However, this technique requires an experienced ultrasonographer, adequate im-aging time, and surroundings conducive to breastfeed-ing. Multiple milk ejections were common during breast-feeding, although they were not sensed by mothers. The number of milk ejections influenced the amount of milk the infant consumed. Pediatrics 2004;113:361--367; milk ejection, ultrasound, milk duct, breast. [ABSTRACT FROM AUTHOR]

Objective. Some mothers have difficulty initiating lactation even when highly motivated to breastfeed. The purpose of this study was to determine the incidence of and risk factors for suboptimal infant breastfeeding behavior (SIBB), delayed onset of lactation, and excess neonatal weight loss among mother-infant pairs in a population with high educational levels and motivation to breastfeed. Methods. All mothers residing in Davis, California, who gave birth to a healthy, single, term infant at 1 of 5 area hospitals during the 10-month recruitment period in 1999 were invited to participate if they were willing to attempt to breastfeed exclusively for at least 1 month. Lactation guidance was provided and data were collected in the hospital (day 0) and on days 3, 5, 7, and 14. Infant breastfeeding behavior was evaluated by trained lactation consultants using the Infant Breastfeeding Assessment Tool. Onset of lactation was defined based on maternal report of changes in breast fullness. Infant weight loss was considered excessive if it was ≥10% of birth weight by day 3. Results. Of the 328 eligible mothers, 280 (85%) participated in the study. The prevalence of SIBB was 49% on day 0, 22% on day 3, and 14% on day 7. SIBB was significantly associated with primiparity (days 0 and 3), cesarean section (in multiparas, day 0), flat or inverted nipples, infant status at birth (days 0 and 3), use of nonbreast milk fluids in the first 48 hours (days 3 and 7), pacifier use (day 3), stage II labor >1 hour (day 7), maternal body mass index >27 kg/m² (day 7) and birth weight <3600 g (day 7). Delayed onset of lactation (>72 hours) occurred in 22% of women and was associated with primiparity, cesarean section, stage II labor >1 hour, maternal body mass index >27 kg/m² , flat or... [ABSTRACT FROM AUTHOR]

Circadian rhythms are endogenously generated rhythms with a period length of approximately 24 hours. Evidence gathered during the past decade indicates that the circadian timing system develops prenatally and the suprachiasmatic nuclei, the site of a circadian clock, is present by midgestation in primates. Recent evidence also shows that the circadian system of primate infants is responsive to light at very premature stages and that low-intensity lighting can regulate the developing clock. After birth, there is progressive maturation of the circadian system outputs, with pronounced rhythms in sleep-wake and hormone secretion generally developing after 2 months of age. Showing the importance of photic regulation of circadian phase in infants, exposure of premature infants to low-intensity cycled lighting results in the early establishment of rest-activity patterns that are in phase with the 24-hour light-dark cycle. With the continued elucidation of circadian system development and influences on human physiology and illness, it is anticipated that consideration of circadian biology will become an increasingly important component of neonatal care. Pediatrics 2003;112:373-381; circadian rhythms, infant, human, baboon, suprachiasmatic nuclei. [ABSTRACT FROM AUTHOR]

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. Pediatrics 2003;112:15-19; premature, osteopenia, exercise, quantitative ultrasound, speed of sound. [ABSTRACT FROM AUTHOR]

ABSTRACT. Objectives. "Wafting" oxygen is a possible strategy to deliver oxygen to a patient who may not tolerate delivery systems that involve contact on the face. We wished to assess the concentration of oxygen delivered to the patient with various methods of "wafting" oxygen. Design. Three methods of wafting oxygen were examined: an infant resuscitator bag, a standard pediatric Hudson RCI face mask, and a piece of standard green oxygen tubing. Contour lines for oxygen concentrations of 30% to 70% in 10% intervals were found with a Teledyne oxygen meter, at an oxygen flow rate of 5 L/min and 10 L/min. Experimental conditions simulated an infant in a cot in a pediatric ward. Results. The resuscitator bag can not be recommended for wafting oxygen delivery, as the flow-back valve may close and result in insignificant levels of oxygen delivery. Oxygen tubing gave a useable area too narrow for use with an active patient, with 30% oxygen concentration being available in an area with width of only 18 cm. This is, however, a suitable method in short-term attended administration, either during feeding, or in the situation of a neonatal resuscitation. The standard pediatric Hudson RCI face mask, at a flow rate of 10 L/min, delivers 30% oxygen to an area 35 cm wide and 32 cm from the top of the mask. At 10 L/min, 40% oxygen is delivered to an area 16 cm wide and 14 cm from the top of the mask. This is an area large enough to be usable in the infant who will not tolerate other methods of oxygen delivery. The contour lines are presented graphically. Conclusions. Although wafting can never replace conventional methods of oxygen delivery to children, if these have failed, a standard pediatric oxygen mask can give significant oxygen therapy without irritating the patient. Care should be taken to place the mask in the area described (ie, opposite the chest) to give the maximum benefit. Short-term administration can be appropriate with standard oxygen tubing aimed at the... [ABSTRACT FROM AUTHOR]

ABSTRACT. Objective. To evaluate an approach to the diagnosis and treatment of maple syrup disease (MSD). Methods. Family histories and molecular testing for the Y393N mutation of the E1α subunit of the branched-chain α-ketoacid dehydrogenase allow us to identify infants who were at high risk for MSD. Amino acid concentrations were measured in blood specimens from these at-risk infants between 12 and 24 hours of age. An additional 18 infants with MSD were diagnosed between 4 and 16 days of age because of metabolic illness. A treatment protocol for MSD was designed to 1) inhibit endogenous protein catabolism, 2) sustain protein synthesis, 3) prevent deficiencies of essential amino acids, and 4) maintain normal serum osmolarity. Our protocol emphasizes the enhancement of protein anabolism and dietary correction of imbalances in plasma amino acids rather than removal of leucine by dialysis or hemofiltration. During acute illnesses, the rate of decrease of the plasma leucine level was monitored as an index of net protein synthesis. The treatment protocol for acute illnesses included the use of mannitol, furosemide, and hypertonic saline to maintain or reestablish normal serum sodium and extracellular osmolarity and thereby prevent or reverse life-threatening cerebral edema. Similar principles were followed for both sick and well outpatient management, especially during the first year, when careful matching of branched-chain amino acid intake with rapidly changing growth rates was necessary. Branched-chain ketoacid excretion was monitored frequently at home and branched-chain amino acid levels were measured within the time of a routine clinic visit, allowing immediate diagnosis and treatment of metabolic derangements. Results. 1) Eighteen neonates with MSD were identified in the high-risk group (n = 39) between 12 and 24 hours of age using amino acid analysis of plasma or whole blood collected on filter paper. The molar ratio of leucine to alanine in... [ABSTRACT FROM AUTHOR]

Presents a study which examined the efficacy of the use of inhaled nitric oxide during interhospital transport of newborns with hypoxemic respiratory failure. Background of inhaled nitric oxide therapy; Methods used; Findings and discussion.

Focuses on the effect of continuous intravenous infusion of fentanyl on urinary bladder retention. Side effects of fentanyl; Causes of urinary bladder retention; Impact of sedation on the neonate.

Discusses a study which evaluated the efficacy of gabapentin (GBP) in the treatment of neuropathic pain in children. Pharmacokinetic profile of GBP; Information on two opiate analgesics, morphine and fentanyl; Side effects of GBP therapy.

Conclusions. Despite current recommendations against use in adolescents less than 18 years old, creatine is being used by middle and high school athletes at all grade levels. The prevalence in grades 11 and 12 approaches levels reported among collegiate athletes. Until the safety of creatine can be established in adolescents, the use of this product should be discouraged. creatine, nutritional supplements, ergogenic aids, adolescent sports medicine, preparticipation examination. [ABSTRACT FROM AUTHOR]

Conclusions. The results are consistent with obesity's being an important contributing factor to the earlier onset of puberty in girls. Factors other than obesity, however, perhaps genetic and/or environmental ones, are needed to explain the higher prevalence of early puberty in black versus white girls. puberty, obesity, BMI, breast, pubic hair. [ABSTRACT FROM AUTHOR]

Conclusion. These results showed a benefit of supplementing formulas for premature infants with AA and DHA from either a fish/fungal or an egg-TG/fish source from the time of first enteral feeding to 12 months' CA. premature infants, docosahexaenoic acid, arachidonic acid, long-chain polyunsaturated fatty acids, infant formulas. [ABSTRACT FROM AUTHOR]

Conclusions. These findings do not support adding AA+DHA to formulas containing 10% energy as linoleic acid and 1% energy as alpha-linolenic acid to enhance growth, visual acuity, information processing, general development, language, or temperament in healthy, term infants during the first 14 months after birth. infant development, breast feeding, infant formula, long-chain polyunsaturated fatty acids, docosahexaenoic acid. [ABSTRACT FROM AUTHOR]

Conclusions. Serum M-CSF levels are significantly higher in neonates with sepsis. High serum M-CSF levels may have a possible role in the pathogenesis of thrombocytopenia in neonates with sepsis. macrophage--colony-stimulating factor, thrombocytopenia, monocyte, sepsis, neonate. [ABSTRACT FROM AUTHOR]

Conclusions. The majority of uncomplicated cases of AOM resolve spontaneously without apparent suppurative complications. Ampicillin or amoxicillin confers a limited therapeutic benefit. There is no evidence to support any particular antibiotic regimens as more effective at relieving symptoms. Certain antibiotics are more likely than others to cause diarrhea and other adverse events. otitis media, children, antibiotics. [ABSTRACT FROM AUTHOR]

Conclusions. This study targeted a large sample of racially and ethnically diverse low-income families, in whom both exposure and disease burden is likely to be significant. This is the first study to our knowledge that has been effective in reducing objective measures of passive smoke exposure in households with healthy children. These findings have important implications for pediatric health care providers, who play an important role in working with parents to protect children's health. Providers can help parents work toward reducing household passive smoke exposure using motivational strategies and providing a menu of approaches regardless of whether the parents are ready to quit. passive smoke, nicotine levels, low income families. [ABSTRACT FROM AUTHOR]

Conclusions. No adverse health or neurodevelopmental outcomes have been observed among infants treated with nitric oxide for PPHN. The parents of the critically ill infants enrolled in our clinical trial welcomed their child's inclusion and all expressed satisfaction with the care that their child received while at a tertiary care hospital. Enrollment in either arm of this randomized, controlled trial did not seem to affect parental satisfaction with the hospital care that their child received. nitric oxide, parental satisfaction, infant development follow-up, persistent pulmonary hypertension of the newborn, outcome studies. [ABSTRACT FROM AUTHOR]

Conclusions. We observed transient neurologic abnormalities in 5 of 6 infants readmitted to the hospital during the first week of life with marked hyperbilirubinemia. The abnormalities resolved following aggressive management using hydration, phototherapy, and exchange transfusion and may not correlate with long-term prognosis. Less aggressive therapy may be associated with residual neurologic abnormalities. We speculate that inadequate establishment of breastfeeding coupled with early discharge practices may play a role in the development of marked hyperbilirubinemia in these infants. bilirubin, brain injury, kernicterus. [ABSTRACT FROM AUTHOR]

Conclusions. Preterm infants with volume- and pressor-resistant hypotension respond to hydrocortisone with rapid normalization of the cardiovascular status and sustained decreases in volume and pressor requirement. blood pressure, dopamine, hydrocortisone, hypotension, preterm infant. [ABSTRACT FROM AUTHOR]