Showing papers by "Children's Memorial Hospital published in 1994"

The Clinical and Genetic Spectrum of the Holt-Oram Syndrome (Heart-Hand Syndrome)

Abstract: Background The Holt-Oram syndrome is an autosomal dominant condition characterized by skeletal abnormalities that are frequently accompanied by congenital cardiac defects. The cause of these disparate clinical features is unknown. To identify the chromosomal location of the Holt-Oram syndrome gene, we performed clinical and genetic studies. Methods Two large families with the Holt-Oram syndrome were evaluated by radiography of the hands, electrocardiography, and transthoracic echocardiography. Genetic-linkage analyses were performed with polymorphic DNA loci dispersed throughout the genome to identify a locus that was inherited with the Holt-Oram syndrome in family members. Results A total of 19 members of Family A had Holt-Oram syndrome with mild-to-moderate skeletal deformities, including triphalangeal thumbs and carpal-bone dysmorphism. All affected members of Family A had moderate-to-severe congenital cardiac abnormalities, such as ventricular or atrial septal defects or atrioventricular-canal defects...

Radiofrequency Catheter Ablation for Tachyarrhythmias in Children and Adolescents

Abstract: Background Although radiofrequency catheter ablation has been used extensively to treat refractory supraventricular tachycardia in adults, few data are available on its safety and efficacy in children and adolescents. We reviewed registry data obtained from 24 centers to evaluate the indications, early results, complications, and short-term follow-up data in young patients who underwent this procedure. Methods Standardized data were submitted for 652 patients who underwent 725 procedures between January 1, 1991, and September 1, 1992. The mean length of follow-up was 13.5 months. Results The median age of the patients was 13.5 years, and 84 percent of them had structurally normal hearts. The initial success rates for ablation of atrioventricular accessory pathways (508 of 615 procedures) and atrioventricular-node reentry (63 of 76 procedures) were both 83 percent. Greater institutional experience in performing ablation in children and location of the accessory pathway in the left free wall correlated with...

Pediatric Cardiac Surgery

Abstract: This text, now in its second edition, contains up-to-date details of recent advances in paediatric cardiac surgery, including improved coverage of myocardial protection, operations, thoracic transplantation, intraoperative echocardiography and transcatheter therapeutic interventions. The chapters in the book discuss embryology, circulatory physiology, diagnostic evaluation, interventional cardiology, anaesthetic management, perioperative care and the role of the nurse practitioner. The remainder is devoted to individual chapters covering all current procedures, including heart, heart-lung and lung transplantation. New to this edition are sections on: cardiac transplantation for infants with hypoplastic left heart syndrome; the fenestrated Fontan procedure; one-stage repair of interrupted aortic arch with ventricular septal defect; the arterial switch operation; and approach to neonates with pulmonary stenosis/atresia with intact ventricular septum.

Prevalence of Low Birth Weight among Hispanic Infants with United States-born and Foreign-born Mothers: The Effect of Urban Poverty

Abstract: Although Hispanics are a poorly educated and medically underserved minority, the incidence of low birth weight (less than 2,500 g) Hispanic infants is similar to that of non-Hispanic whites. The authors used 1982-1983 Illinois vital records and 1980 US census income data to determine the contribution of maternal nativity and place of residence to this epidemiologic paradox. The proportion of low birth weight Hispanic (n = 22,892) infants ranged from 4.3% for Mexicans to 9.1% for Puerto Ricans. Maternal age, education, trimester of prenatal care initiation, and place of residence were associated with the prevalence of low birth weight infants among Puerto Rican but not foreign-born Mexican or Central-South American mothers. In very low-income (less than $10,000/year) census tracts, Mexican and other Hispanic infants with US-born mothers had low birth weight rates of 14 and 15%, respectively. In contrast, Mexican and other Hispanic infants with foreign-born mothers who resided in these areas had low birth weight rates of 3 and 7%, respectively. In a logistic model that included only impoverished infants, the adjusted odds ratio of low birth weight for those with US-born mothers equalled 6.3 (95 percent confidence interval 2.3-16.9). The authors conclude that urban poverty is negatively associated with Hispanic birth weight only when the mother is Puerto Rican or a US-born member of another subgroup.

The impact of extracorporeal membrane oxygenation on survival in pediatric patients with acute respiratory failure

Abstract: Objective : Extracorporeal membrane oxygenation (ECMO) has been used with increasing frequency in the treatment of acute respiratory failure in pediatric patients. Our objective in this study was to test the hypothesis that ECMO improves outcome in pediatric patients with acute respiratory failure. Design : Multicenter, retrospective cohort analysis. Setting : Forty one pediatric intensive care units participated in the study under the auspices of the Pediatric Critical Care Study Group. Patients : All pediatric patients admitted to the participating institutions with acute respiratory failure during 1991 were included. Patients with congenital heart disease, contraindications to ECMO, or incomplete data were excluded, yielding a data set of 331 patients from 32 hospitals. Interventions : Conventional mechanical ventilation, high-frequency ventilation, and extracorporeal membrane oxygenation. Measurements and Main Results : Multivariate logistic regression analysis was used to identify factors associated with survival. In a second analysis, pairs of ECMO and non-ECMO patients, matched by severity of disease and respiratory diagnosis, were compared. The use of ECMO (p =.0082), but not the use of high-frequency ventilation, was associated with a reduction in mortality. Other factors independently associated with mortality included oxygenation index (p <.0001), Pediatric Risk of Mortality score (PRISM) (p <.0001) and the Paco 2 (p =.045). In 53 diagnosis- and risk-matched pairs, there was a significantly lower mortality rate (26.4% vs. 47.2% ; p <.01) in the ECMO-treated patients. When all patients were stratified into mortality risk quartiles on the basis of oxygenation index and PRISM score, the proportion of deaths among ECMO-treated patients in the 50% to 75% mortality risk quartile was less than half the proportion in the non-ECMO treated patients (28.6% vs. 71.4% ; p <.05). No effect was seen in the other quartiles. Conclusions : The use of ECMO was associated with an improved survival in pediatric patients with respiratory failure. The lack of association of outcome with treatment in the ECMO-capable hospital or with another tertiary technology (i.e., high-frequency ventilation) suggests that ECMO itself was responsible for the improved outcome. Further studies of this procedure are warranted but require broad-based multi-institutional participation to provide sufficient statistical power and sensitivity to demonstrate efficacy.

Forty-six years of patient ductus arteriosus division at Children's Memorial Hospital of Chicago. Standards for comparison.

Abstract: OBJECTIVE: The authors reviewed a large surgical experience (during five decades) with ligation and division of patent ductus arteriosus (PDA) in light of previously reported historical standards and present-day alternatives. SUMMARY BACKGROUND DATA: Ligation of PDA was first performed by Gross in 1938. Various surgical techniques used since then have included ligation and division, simple ligation, and hemaclip application. Recently introduced therapies include percutaneous transcatheter ductal closure devices (PTDC) and video-assisted thoracotomy (VAT). Percutaneous transcatheter ductal closure device protagonists cite surgical recurrence rates as high as 22% to justify continued application. METHODS: Between 1947 and 1993, 98.2% of 1108 patients (premature babies excluded) had interruption of PDA by ligation and division. Recent improvements have included muscle-sparing thoracotomy, minimal use of tube thoracostomy, and same-day surgery. RESULTS: Mortality was zero and morbidity (4.4%) has been low over time. Mean age at surgery has decreased from 5.9 +/- 3.3 years to 3.6 +/- 3.8 years (p < 0.001); patients requiring blood transfusion decreased from 34% to 4.6% (p < 0.001); and length of hospital stay (LOS) has decreased from 12.1 +/- 2.9 days to 3.8 +/- 2.1 days (p < 0.001). Length of stay for the last 27 patients was 2.8 +/- .8 days. Patient ductus arteriosus recurrence rate is zero with this technique. CONCLUSIONS: Recurrence rates for PTDC are high with as yet unknown consequences of large catheter vascular access, endocarditis, or left pulmonary artery stenosis. Video-assisted thoracotomy for PDA interruption has the potential for uncontrolled exsanguinating hemorrhage. Open thoracotomy for PDA ligation and division can be performed safely and without recurrence through a muscle-sparing incision with short LOS. All other therapeutic interventions must be compared to these standards.

Crohn's disease and cystic fibrosis

Abstract: Advances in investigative techniques have led to increasing reports of Crohn's disease in CF patients A retrospective review of the literature on IBD in CF showed findings characterized by ileocolitis with fistula formation; 83% required surgery A prospective survey of 11,321 CF patients attending 49 CF centers revealed 28 with IBD (25 Crohn's, three ulcerative colitis), ages 4-20 years, mean 156 years The prevalence rate of IBD (247/10(5)) was 7x controls and was accounted for by Crohn's disease (221/10(5)) which was 17x controls The mechanisms that predispose CF patients to Crohn's disease are discussed

Obesity in Preschool and School-age Children: Treatment Early and Often May Be Best

Abstract: Objective: To determine if timing and frequency of interventions affect the outcome of treatment of obesity in pediatric patients. Design: Retrospective chart review; comparison of subgroups defined by age and frequency of visits. Setting: A nutrition evaluation clinic, an outpatient referred care clinic at a metropolitan hospital. Participants: All 93 obese children, aged 1 to 10 years, seen within 1 year and with one or more subsequent visits in the next year. Obesity was defined as greater than 120% ideal body weight for height age (IBWH). Mean percent IBWH was 171% (median, 199%; range, 127% to 251%). Interventions: (1) Initial visit. Comprehensive history and physical examination, by physician, registered dietician, and licensed clinical social worker; design of individualized care plan, including prescribed frequency and size of meals and snacks; and type, frequency, and duration of exercise. (2) Subsequent visits (after 1 month, then with frequency tailored to need). Review of progress, adjustment of energy intake and expenditure; management of biopsychosocial obstacles to needed changes. Measurements/Main Results: Four patient groups were defined by two variables: age (preschool vs school-age children) and frequency of visits in 1 year (two to three vs four or more). Groups were compared on change in mean percent IBWH and on mean change in percent IBWH. All groups showed significant change in percent IBWH ( P ≤.040 for school-age children, P ≤.012 for preschool children). For all visits, the mean change was more than twice as great for preschool as for school-age children (4.7±5.4 vs 1.9±4.8, P =.027). Conclusions: (1) The most successful treatment of preadolescent obesity may be in preschool children with frequent visits. (2) A randomized trial is warranted to test this possibility. (3) Many of the techniques used to treat early obesity can be adapted for prevention and intervention in early obesity during the preschool years, and this is the preferred approach. (Arch Pediatr Adolesc Med. 1994;148:1257-1261)

Sequence and rate of bone marrow conversion in the femora of children as seen on MR imaging: are accepted standards accurate?

Abstract: The purpose of this study was to reassess the normal sequence and rate of marrow conversion in the femora of children as depicted on MR imaging.We retrospectively analyzed 81 T1-weighted MR images of the femur for the appearance and distribution of hematopoietic (red) and fatty (yellow) marrow. Eighty-one children 2 days to 15 years old with no known bone marrow abnormalities were divided into four age groups. The signal intensity and homogeneity of the marrow in the proximal epiphysis, proximal metaphysis, diaphysis, distal metaphysis, distal epiphysis, and greater trochanter were compared with the signal intensity and homogeneity of surrounding muscle and fat and graded by two observers. In select cases, region-of-interest measurements of marrow, subcutaneous fat, and muscle were obtained to validate the visual grading system.Conversion of hematopoietic to fatty marrow in the femur followed a well-defined sequence, occurring first in the proximal and distal epiphyses, followed by the diaphysis, distal m...

Increased risk of craniosynostosis with maternal cigarette smoking during pregnancy

Abstract: We analyzed data from a population-based case control study to determine whether maternal prenatal smoking or alcohol drinking might increase the risk of craniosynostosis. Between 1986 and 1989, the Colorado Craniosynostosis Registry ascertained 233 children whose diagnoses were confirmed by an independent radiologist. Of the 212 (91%) cases who participated 86 had lambdoid, 69 had sagittal, 25 had coronal, 18 had metopic, and 14 had multiple suture synostosis. Random sampling of birth certificate records yielded 367 eligible controls, of whom 291 (79%) participated. Study staff interviewed case and control mothers between 1989 and 1991 for prenatal smoking and alcohol drinking. We used Mantel-Haenszel and polychotomous logistic regression techniques to estimate the relative odds of craniosynostosis for smoking and drinking in all cases and in relevant case subgroups. Smoking was associated with a relative odds of craniosynostosis of 1.7 (95% confidence interval, 1.2-2.6). For smoking of more than one pack per day, the relative odds were 3.5 (1.5-8.4) for all types of synostosis combined, and 5.6 (2.1-15.3) for coronal synostosis. No strong or significant association was noted for drinking. Maternal prenatal smoking may increase the risk of craniosynostosis in this population.

A phase II study of carboplatin in children with recurrent or progressive solid tumors. A report from the childrens cancer group

Abstract: Background. Carboplatin is an analogue of cisplatin with less nonhematologic toxicity than the parent compound. It has been demonstrated previously to have activity against a spectrum of pediatric brain tumors. This Phase II study was undertaken to assess the activity of carboplatin in children with various solid tumors. Methods. Between October 1985 and March 1988, the Childrens Cancer Group entered 117 patients with drug-resistant, recurrent lymphomas and solid tumors, excluding primary central nervous system tumors, into a Phase II trial of carboplatin given intravenously at a dosage of 560 mg/m2 over 1 hour every 4 weeks. Results. A complete response was seen in 1 of 15 evaluable patients with Ewing's sarcoma. Partial responses were seen in 2 of 17 evaluable patients with neuroblastoma, 1 of 16 with soft tissue sarcoma, 2 of 5 with Wilms' tumor, and 1 with an endodermal sinus tumor of the testis. Objective responses were not seen in patients with malignant lymphoma, osteosarcoma, or hepatoma. Four of 7 patients who responded to carboplatin had previously received cisplatin. Sixty-two percent of patients had a platelet count nadir of less than 50,000/mm3, and 41% had an absolute neutrophil count nadir of less than 1,000/mm3. Ototoxicity, nephrotoxicity, hypomagnesemia, hypertransaminasemia, and nausea and vomiting each were seen in fewer than 10% of patients. Conclusions. Carboplatin has some activity against Wilms' tumor, Ewing's sarcoma, neuroblastoma, soft tis-sue sarcoma, and endodermal sinus tumor of the testis. Activity was not demonstrated against osteosarcoma, malignant lymphoma, hepatoma, and miscellaneous other tumors. Myelosuppression was seen commonly, and non-hematologic toxicity was infrequent. Cancer 1994; 73:1297-301.

The biological effects of antisense N-myc expression in human neuroblastoma.

Abstract: Although N-myc amplification and overexpression are believed to play an important role in determining the clinical behavior of neuroblastoma (NB), the exact function of N-myc in NB cell growth and differentiation remains unknown To better understand the function of N-myc, an established human NB cell line was transfected with N-myc antisense (AS) complementary DNA in an effort to down-regulate N-myc gene expression Five clones expressing AS N-myc RNA have been maintained in culture for over 2 years Compared to control cells, a 30-69% decrease in the quantity of N-myc protein was demonstrated by Western blot analysis in 4 of the 5 AS clones All 5 of the AS clones exhibited a 50-75% decrease in colony formation in soft agar assays compared to control cells In addition, all 5 AS clones expressed a 32-kilobase protein kinase C-alpha transcript, whereas this message was not detected by Northern blot analysis in any of the control clones These results suggest that N-myc may play an important role in NB cell growth and that antisense N-myc expression is associated with an induction of protein kinase C-alpha RNA expression Further characterization of the AS clones may provide insight into the function of N-myc and may thus lead to a better understanding of the role that N-myc plays in determining the clinical behavior of this childhood neoplasm

Platelet-activating factor, tumor necrosis factor, hypoxia and necrotizing enterocolitis

Abstract: The pathogenesis of necrotizing enterocolitis (NEC) is poorly understood. We have established several animal models of NEC by using a combination of various stimuli and stress, including endotoxin, PAF, TNF, and hypoxia. We discuss the mechanism of their actions and the possible roles of these factors in the pathogenesis of human NEC.

Anesthetic management of children with intracardiac extension of abdominal tumors

Abstract: ome abdominal tumors have a marked propensity for intraluminal venous extension. NephroS blastoma (Wilms’ tumor) is the second most common solid abdominal tumor of childhood and presents with renal vein and inferior vena cava (IVC) invasion in approximately 10% of cases (11, though extension into the heart is rare. We describe two cases of intracardiac extension of a nephroblastoma and a case of intracardiac extension of a hepatic neuroendocrine tumor. These tumors presented several anesthetic and surgical challenges and were resected with the use of cardiopulmonary bypass (CPB).

Search for Highly Conserved Viral and Bacterial Nucleic Acid Sequences Corresponding to an Etiologic Agent of Kawasaki Disease

Abstract: The use of conventional methods to detect a possible infectious cause of Kawasaki disease (KD) has been unsuccessful. Using the polymerase chain reaction and DNA hybridization techniques, we have sought evidence that a known or new herpesvirus, parvovirus, or bacterial pathogen is related etiologically to KD. Peripheral blood DNA from acute KD patients was subjected to amplification and dot-blot hybridization to detect the presence of herpesvirus DNA, and acute KD peripheral blood and serum DNA were subjected to dot-blot hybridization for the presence of parvoviral DNA. All samples were negative for both herpesvirus and parvovirus DNA. In addition, we analyzed buffy-coat white blood cell DNA, synovial fluid DNA, and frozen autopsy and formalin-fixed, paraffin-embedded myocardial tissue DNA from KD, patients for the presence of highly conserved bacterial 16S ribosomal RNA gene sequences with the polymerase chain reaction, and all were negative. These results argue against a direct pathogenic role for herpesviruses, parvoviruses, and bacteria in KD. This approach to the detection of highly conserved genomic sequences among broad groups of microorganisms can be adapted for the detection of other groups of microorganisms and may yet prove useful in the search for an etiologic agent of KD.

Comparison of a rigid laryngoscope with the ultrathin fibreoptic laryngoscope for tracheal intubation in infants

Abstract: The flexible ultrathin fibreoptic laryngoscope allows placement of endotracheal tubes as small as 2.5 mm internal diameter. The purpose of this study was to document the safety and efficacy of intubation using an ultrathin fibreoptic laryngoscope. Proved safety and efficacy would justify the routine use of fibreoptic laryngoscopy in normal infants to maintain skills needed for management of the difficult infant airway. In this prospective study, 40 infants < 24 mo of age scheduled for elective surgery were randomly divided into two equal groups. After inhalation induction of anaesthesia, in 20 infants the trachea was intubated using direct rigid laryngoscopy, and in 20 using the ultrathin fibreoptic laryngoscope (size 1.8 mm OD) Olympus LFP. Time to successful intubation was recorded, as well as blood pressure, heart rate, end-tidal CO2 and oxygen saturation. Airway trauma in the operating room, the post-anaesthesia care unit, and on the first postoperative day was recorded. The intubation times using rigid laryngoscopy were less than those using fibreoptic laryngoscopy (13.6 +/- 0.9 sec (mean +/- SEM) vs 22.8 +/- 1.7 sec; P < 0.01). Oxygen saturation and end-tidal CO2 readings were not different between the two groups. After intubation, blood pressure and heart rate increased equally in both groups, returning to normal within one to two minutes. There was no difference in the airway trauma between groups. We conclude that the ultrathin fibreoptic laryngoscope is a safe and effective method for tracheal intubation in infants and may be used routinely in order to maintain fibreoptic airway skills.

MR of pediatric intracranial meningiomas.

Abstract: PURPOSE To assess MR and pathologic characteristics of childhood intracranial meningiomas, comparing the radiographic findings with those observed in adult intracranial meningiomas. METHODS Clinical records, MR and CT scans, and histology of eight children with intracranial meningiomas presenting for a period of 7.5 years were retrospectively reviewed. RESULTS Boys equaled girls but predominated from ages 4 to 11 years. The ages ranged from 4 to 18 years. Two patients had radiation-induced meningiomas. Two children had multiple lesions; neither had neurofibromatosis. All solitary lesions were supratentorial. Other characteristics included: dural-based attachment (n = 6); large size (> 5 cm) (n = 4); cystic components (n = 3); and intraventricular location (n = 1). Histologic subtypes were: meningothelial (n = 4); transitional (n = 3); and fibroblastic (n = 1). Preoperative diagnoses of meningiomas were made in six cases based on overall imaging characteristics. CONCLUSIONS Diagnosis of childhood intracranial meningiomas does not differ from that of adults radiographically, with the exception of larger tumor sizes.

Platelet-activating factor and endotoxin induce tumour necrosis factor gene expression in rat intestine and liver.

Abstract: We have shown previously that endotoxin, tumour necrosis factor (TNF) and platelet-activating factor (PAF) are important in the pathogenesis of bowel injury, and that endotoxin and TNF induce PAF formation in bowel tissue. In the present study we investigated the effects of endotoxin and PAF on TNF gene expression. Adult rats were injected with endotoxin (2 mg/kg), PAF (1 microgram/kg) or endotoxin plus PAF, and were killed after 30 min. Endotoxin had little systemic effect. PAF induced transient hypotension and mild bowel injury. Endotoxin plus PAF caused profound shock, severe haemoconcentration, leukopenia and intestinal necrosis. Sham-operated rats had barely detectable TNF mRNA in the liver or intestine. Endotoxin or PAF induced a marked increase in TNF mRNA, especially in the distal ileum and in the liver, but much less in the jejunum. Endotoxin plus PAF did not further increase TNF mRNA, probably due to development of tissue injury. Serum TNF levels in animals treated with endotoxin, PAF and endotoxin plus PAF were elevated. Endotoxin induces TNF gene expression probably via both PAF-dependent and PAF-independent pathways, since TNF mRNA formation was only partially blocked by PAF antagonist.

Compartment syndrome secondary to prolonged intraosseous infusion.

Abstract: Intraosseous infusions are a valuable means of establishing intravascular access in pediatric emergencies. We report a case of compartment syndrome from prolonged intraosseous infusion (53 hours). We postulate that chemical irritation from medications, infections, the tenuous nature of intraosseous infusions, and the use of infusion pumps may all play a role in the development of compartment syndrome. We recommend that, when possible, intraosseous lines be used only temporarily until more permanent vascular access is established, that lines that do not flow with gravity be removed, and that drugs known to cause chemical burns be used with caution. In addition, the use of x-ray and hourly measurement of leg circumference may help to determine whether a line is still in place. Also, given the changing circumstances and technology under which intraosseous infusions are used, new prospective studies of their complications are needed.

Malignant ureteral obstruction: treatment with metal stents--technique, results, and observations with percutaneous intraluminal US.

Abstract: PURPOSE: To test the technical feasibility and results of placement of metal stents into ureters obstructed by extensive tumor. MATERIALS AND METHODS: Six consecutive patients (two men and four women, aged 35-66 years and with incurable malignancies) underwent insertion of metallic endoprostheses in nine obstructed ureters through percutaneous tracts. RESULTS: Metal stents were inserted without technical difficulty in all obstructed ureters. The stents functioned well in four patients. In two patients, the metal were not tolerated and plastic double-J stents were placed through the metal stents; this permitted effective functioning and withdrawal of the protective external catheter. Intraluminal ultrasonography depicted stent clogging and debris, dimensions of stent opening, and tumor level. CONCLUSION: Insertion of metal stents in the ureter is technically straightforward and was well tolerated by patients. However, the efficacy is variable, and a greater beneficial effect than is achieved with plastic s...

Is there lead in the suburbs? Risk assessment in Chicago suburban pediatric practices. Pediatric Practice Research Group.

Abstract: OBJECTIVE This study was designed to determine: (1) the prevalence of elevated blood lead (BPb) levels (BPb > or = 10 micrograms/dL) in Chicago suburban children attending Pediatric Practice Research Group practices at 12 and 24 months of age, and (2) the efficacy of the Centers for Disease Control and Prevention (CDC) and Illinois lead exposure risk assessment questions. METHODS Parents bringing their 1- and 2-year-old children for health supervision visits at pediatric practices completed questionnaires. BPb levels were drawn on children. Both questionnaire and an analyzable BPb level were obtained on 1393 subjects (79.2%). RESULTS Only 2.1% of our sample had a venous BPb level > or = 10 micrograms/dL (0.48 mumol/L); no subjects had a level > or = 30 micrograms/dL (1.45 mumol/L). The CDC risk assessment questions had a sensitivity of .69 and specificity of .70. Due to the low prevalence of elevated BPb levels in this sample, CDC and Illinois screening strategies had high negative predictive values (.99) and low positive predictive values (.05 and .04, respectively). However, some of the subjects with BPb levels > or = 10 micrograms/dL were not at high risk by CDC and Illinois screening questions; 9 of 29 subjects with elevated lead levels (31%) did not respond affirmatively to any CDC risk assessment questions. The question best predicting an elevated BPb was the determination that the house the child lives in was built before 1960 (sensitivity = .83, specificity = .67). This question is not currently included in CDC or Illinois screening strategies. Screening based on the single question "Was your house built before 1960?" would have missed only five (17%) of the children with BPb levels > or = 10 micrograms/dL. Three of these five children were among the 17.1% of 1-year-olds and 26.3% of 2-year-olds in our sample who had moved. CONCLUSIONS In this sample, children living in houses built before 1960 should be considered at high risk for high-dose lead exposure. Due to the high mobility of our sample, phrasing the question to include lifetime exposure (ie, Has your child ever lived in a house built before 1960?) should also be considered. Selective BPb testing of high-risk children in low-prevalence suburban areas using this question would miss few children with elevated BPb. Useful risk assessment questions in other areas and other populations may differ.