Outpatient management of young febrile infants with urinary tract infections.

Objective: Controversy exists regarding the disposition of young febrile infants who present to emergency departments (EDs) with urinary tract infections (UTIs). In a large multicenter cohort of such patients, we aimed to determine the variation in patient disposition and clinical factors independently associated with outpatient management.

Methods: Secondary analysis of a retrospective study of infants 29 to 60 days with fever (≥38.

Acute care costs in overweight children: a pediatric urban cohort study.

Background: Evidence indicates obese children have increased health care utilization. It is unknown if this is true within the emergency department (ED) setting. Our purpose is to determine if overweight children presenting for emergency care have increased resource utilization over normal weight peers.

A randomized controlled trial of cast versus splint for distal radial buckle fracture: an evaluation of satisfaction, convenience, and preference.

Objectives: Buckle fractures are inherently stable and at low risk for displacement. These advantages allow for treatment options that may create confusion for the practitioner. Accepted immobilization methods include circumferential cast, plaster or prefabricated splint, and soft bandaging.

Potential adverse effects of spinal immobilization in children.

Objective: The purpose of our study was to describe potential adverse effects associated with spinal immobilization following trauma among children.

Methods: We conducted a prospective cohort study of children presenting to the emergency department (ED) for evaluation following trauma over a 13-month period. Children were eligible if they underwent spinal immobilization prior to physician evaluation or if they met the American College of Surgeons (ACS) guidelines for spinal immobilization but were not immobilized.

Procedural sedation for diagnostic imaging in children by pediatric hospitalists using propofol: analysis of the nature, frequency, and predictors of adverse events and interventions.

Objective: To evaluate the nature, frequency, and predictors of adverse events during the use of propofol by pediatric hospitalists.

Study Design: We reviewed 1649 charts of patients sedated with propofol by pediatric hospitalists at St Louis Children's Hospital between January 2005 and September 2009.

Results: Hospitalists were able to complete 1633 of the 1649 sedations reviewed (99%).

Clinical outcomes after withdrawal of anti-tumor necrosis factor α therapy in patients with juvenile idiopathic arthritis: a twelve-year experience.

Objective: To estimate the length of time to disease flare and the likelihood of achieving clinical remission after discontinuation of treatment with tumor necrosis factor α (TNFα) blockers in patients with juvenile idiopathic arthritis (JIA).

Methods: We conducted a retrospective chart review in a cohort of patients with JIA treated with TNFα inhibitors between January 1, 1998 and November 1, 2009. Demographic information, laboratory data, and medication exposure were extracted using a standardized tool.

Lung transplantation in children with idiopathic pulmonary arterial hypertension: an 18-year experience.

Background: The natural history of idiopathic pulmonary arterial hypertension (IPAH) in patients of all ages is one of relentless progression. For those who fail medical therapy, lung transplantation remains the ultimate palliation. In the USA, IPAH is the second leading indication for lung transplantation in children and first for children 1 to 5 years of age.

Camp jump start: effects of a residential summer weight-loss camp for older children and adolescents.

Objective: Residential weight-loss camps offer an opportunity for overweight and obese children to lose weight in a medically safe, supervised, supportive environment. The purpose of this report is to describe short-term outcomes in 76 children participating in a 4- or 8-week residential weight-loss camp for children and adolescents.

Patients And Methods: The camp program enrolled obese 10- to 18-year-old adolescents.

Late onset hearing loss: a significant complication of cancer survivors treated with Cisplatin containing chemotherapy regimens.

Cisplatin is a known ototoxic agent and has been associated with late onset hearing loss (LOHL) in children beyond completion of treatment. We completed a retrospective review of 160 patients yielding 59 who received cisplatin and had sufficient data to determine the presence of LOHL. LOHL was defined as a significant change in hearing thresholds 6 months past the last cisplatin therapy.

Dismal lung transplant outcomes in children with tetralogy of Fallot with pulmonary atresia compared to Eisenmenger syndrome or pulmonary vein stenosis.

Background: Certain congenital heart lesions in children can lead to irreversible lung disease thus making lung transplantation a therapeutic option. We retrospectively analyzed our experience with lung transplantation in 32 children with three distinct underlying congenital heart defects: (1) Eisenmenger syndrome (EIS); (2) tetralogy of Fallot with pulmonary atresia (PA); and (3) pulmonary vein stenosis (PVS).

Methods: Pediatric patients <18 years of age with either EIS (n = 7), PA (n = 8) or PVS (n = 17), who underwent lung or heart-lung transplantation, were analyzed.

Lower airway obstruction is associated with increased morbidity in children with sickle cell disease.

Rationale: The association between pulmonary function and morbidity in children with sickle cell disease (SCD) has not been previously evaluated. Our objective was to study the relationship between abnormalities in pulmonary function and morbidity as represented by the rate of hospitalizations for pain or acute chest syndrome (ACS) in children with SCD.

Methods: Results of pulmonary function tests obtained for clinical indications in children ages 6-18 years were classified as lower airway obstruction (forced expiratory volume in 1 sec/forced volume capacity <95% confidence interval adjusted for age, gender, race, and height), restriction (total lung capacity <80% predicted adjusted for gender, age, race, and height), and normal lung function.

Brain-derived neurotrophic factor in infants <32 weeks gestational age: correlation with antenatal factors and postnatal outcomes.

Neurotrophins (NTs) play important roles in brain growth and development. Cord blood (CB) brain-derived neurotrophic factor (BDNF) concentrations increase with gestational age but data regarding postnatal changes are limited. We measured BDNF concentrations after birth in 33 preterm infants <32-wk gestation.

Elevated urinary leukotriene E4 levels are associated with hospitalization for pain in children with sickle cell disease.

Cysteinyl leukotrienes (CsyLTs) are inflammatory mediators produced by white blood cells. Leukotriene LTE(4) is the stable metabolite of CsyLTs, which can be measured in urine. We tested two hypotheses among children with sickle cell disease (SCD): (1) baseline urinary LTE(4) levels are elevated in children with SCD when compared with controls; and (2) baseline LTE(4) levels are associated with an increased incidence rate of hospitalization for SCD-related pain.

Physician beliefs and practices regarding the use of hepatitis A vaccine.

Background: In 1999, the Centers for Disease Control and Prevention recommended routine vaccination of children against hepatitis A in states, counties, and communities with rates twice the national average or greater. Milwaukee is such a community.

Objectives: To assess physician knowledge, beliefs, and practices regarding hepatitis A disease and hepatitis A vaccine recommendations in Milwaukee.

Association of adrenal steroids with hypertension and the metabolic syndrome in blacks.

Blacks have a high prevalence of hypertension and adrenal cortical adenomas/hyperplasia. We evaluated the hypothesis that adrenal steroids are associated with hypertension and the metabolic syndrome in blacks. Ambulatory blood pressures, anthropometric measurements, and measurements of plasma renin activity (PRA), aldosterone, fasting lipids, glucose, and insulin were obtained in 397 subjects (46% hypertensive and 50% female) after discontinuing antihypertensive and lipid-lowering medications.

An exploratory study of the cognitive, academic, and behavioral functioning of pediatric cardiothoracic transplant recipients.

Context: Limited information is available regarding the cognitive, academic, and behavioral outcomes of pediatric cardiothoracic transplant recipients.

Objective: To examine the cognitive, behavioral, and academic functioning of a group of children who have received heart, heart/lung, or lung transplants.

Design, Participants, And Setting: An exploratory cross-sectional outcomes study of surviving pediatric cardiothoracic transplant recipients at a Midwestern pediatric hospital.

Perceptions of inner city parents about early behavioral and violence prevention counseling.

Objectives: (1) Identify how receptive inner city parents of young children are to routine anticipatory guidance about behavior at well child care visits. (2) Determine whether inner city parents correlate early behavior problems with a risk of later behavior problems. (3) Determine whether inner city parents believe that physician-provided anticipatory guidance about behavioral issues and violence prevention can help their child avoid future violence-related problems.