From Staff Reports

Flu Shot Safe for Children

No evidence of serious adverse events within 2 weeks of vaccination appeared in a population-based study of 251,600 children, mean age 10 years, who received the trivalent inactivated influenza vaccine, said Eric K. France, M.D., of Kaiser Permanente Colorado, Denver, and his colleagues. The study spanned four flu seasons and two half-seasons between 1993 and 1999 (Arch. Pediatr. Adolesc. Med. 2004;158:1031–6). In a primary analysis, only one case of uncomplicated diabetes mellitus was positively associated with vaccination. Subanalysis revealed one case each of impetigo, atopic dermatitis, and a renal and ureteral disorder not otherwise specified. Overall, vaccinated children were significantly less likely to visit a doctor for an illness during the postvaccination period, compared with a control period. Reasons for this may include the fact that children are more likely to be vaccinated when they are healthy and that children are less likely to visit a doctor for low-grade fever, limb soreness, and irritability during the postvaccination period, because parents expect these symptoms after vaccination.

Hepatitis B Incidence Declines

Incidence of acute hepatitis B declined by 89% among U.S. children aged 19 years and younger between 1990 and 2002, according to data collected by the Centers for Disease Control and Prevention (MMWR 2004;53:1015–8). A total of 13,829 cases were reported during this period. Overall, incidence per 100,000 children declined by 92% among Asian/Pacific Islanders, 88% among whites, 88% among blacks, and 84% among American Indians/Native Alaskans. The greatest declines coincided with greater hepatitis B vaccination rates in children aged 19–35 months, which increased from 16% in 1992 to 90% in 2002, and in adolescents aged 13–15 years, which increased from almost 0% in 1992 to 67% in 2002.

Iron Deficiency's Role in ADHD

Children with attention-deficit hyperactivity disorder had significantly lower levels of iron, compared with controls in a study of 53 children aged 4–14 years, said Eric Konofal, M.D., of Hôpitaux de Paris, and his colleagues.

The mean serum iron level was 23 ng/mL in the children with ADHD, compared with 44 ng/mL in the controls. In addition, 42 (84%) of the ADHD children had iron levels considered abnormally low—below 30 ng/mL—compared with 5 (18%) of the 27 controls (Arch. Pediatr. Adolesc. Med. 2004;158:1113–5). Low levels of iron may hamper the development of the central nervous system and consequently contribute to the likelihood of behavioral disorders, so children with ADHD might benefit from iron supplements.

Neighborhoods and Violent Girls

Adolescent girls who mature early and live in economically disadvantaged neighborhoods committed three times as many violent acts as early maturers in less disadvantaged neighborhoods, said Dawn Obeidallah, Ph.D., of Harvard Medical School, Boston, and her colleagues.

The investigators used census data to characterize neighborhoods in the Chicago area and interviewed 501 adolescent girls and their families twice during a 3-year period (J. Am. Acad. Child Adolesc. Psychiatry 2004;43:1460–8).

Overall, 121 girls had engaged in violent behavior at the time of the second interview: 18% of the early maturers, 48% of on-time maturers, and 33% of late maturers. Approximately 50% of the girls were Hispanic, 36% were black, and 14% were white, and 20% of early maturing black girls, 14% of early maturing Hispanic girls, and 7% of early maturing white girls had engaged in violence at the time of the second interview.

Infant Hypoglycemia

Significant risk factors for prolonged hypoglycemia in infants include gestational age, 1-minute Apgar scores, male sex, and weight in the lowest quartile.

Prolonged hypoglycemia was present in 55 of 594 (9%) small-for-gestational-age infants, Dr. Eugenia K. Pallotto said in a poster presented at the annual meeting of the Society for Perinatal and Pediatric Epidemiologic Research in Salt Lake City.

The infants were born between 1998 and 2001 and were in the 10th percentile or below for gestational age. Prolonged hypoglycemia was defined as blood sugar of 40 mg/dL or less occurring beyond 72 hours of life.

One-minute Apgar scores of less than 5, male gender, young gestational age, and birth weight in the lowest quartile of the study group were significantly associated with prolonged hypoglycemia, said Dr. Pallotto of the University of Missouri-Kansas City. Hypoglycemic episodes were longer among premature infants, compared with those born at term. Prospective monitoring of high-risk infants may improve glucose control and reduce unrecognized hypoglycemic episodes, she said.

Flu Shot Safe for Children

No evidence of serious adverse events within 2 weeks of vaccination appeared in a population-based study of 251,600 children, mean age 10 years, who received the trivalent inactivated influenza vaccine, said Eric K. France, M.D., of Kaiser Permanente Colorado, Denver, and his colleagues. The study spanned four flu seasons and two half-seasons between 1993 and 1999 (Arch. Pediatr. Adolesc. Med. 2004;158:1031–6). In a primary analysis, only one case of uncomplicated diabetes mellitus was positively associated with vaccination. Subanalysis revealed one case each of impetigo, atopic dermatitis, and a renal and ureteral disorder not otherwise specified. Overall, vaccinated children were significantly less likely to visit a doctor for an illness during the postvaccination period, compared with a control period. Reasons for this may include the fact that children are more likely to be vaccinated when they are healthy and that children are less likely to visit a doctor for low-grade fever, limb soreness, and irritability during the postvaccination period, because parents expect these symptoms after vaccination.

Hepatitis B Incidence Declines

Incidence of acute hepatitis B declined by 89% among U.S. children aged 19 years and younger between 1990 and 2002, according to data collected by the Centers for Disease Control and Prevention (MMWR 2004;53:1015–8). A total of 13,829 cases were reported during this period. Overall, incidence per 100,000 children declined by 92% among Asian/Pacific Islanders, 88% among whites, 88% among blacks, and 84% among American Indians/Native Alaskans. The greatest declines coincided with greater hepatitis B vaccination rates in children aged 19–35 months, which increased from 16% in 1992 to 90% in 2002, and in adolescents aged 13–15 years, which increased from almost 0% in 1992 to 67% in 2002.

Iron Deficiency's Role in ADHD

Children with attention-deficit hyperactivity disorder had significantly lower levels of iron, compared with controls in a study of 53 children aged 4–14 years, said Eric Konofal, M.D., of Hôpitaux de Paris, and his colleagues.

The mean serum iron level was 23 ng/mL in the children with ADHD, compared with 44 ng/mL in the controls. In addition, 42 (84%) of the ADHD children had iron levels considered abnormally low—below 30 ng/mL—compared with 5 (18%) of the 27 controls (Arch. Pediatr. Adolesc. Med. 2004;158:1113–5). Low levels of iron may hamper the development of the central nervous system and consequently contribute to the likelihood of behavioral disorders, so children with ADHD might benefit from iron supplements.

Neighborhoods and Violent Girls

Adolescent girls who mature early and live in economically disadvantaged neighborhoods committed three times as many violent acts as early maturers in less disadvantaged neighborhoods, said Dawn Obeidallah, Ph.D., of Harvard Medical School, Boston, and her colleagues.

The investigators used census data to characterize neighborhoods in the Chicago area and interviewed 501 adolescent girls and their families twice during a 3-year period (J. Am. Acad. Child Adolesc. Psychiatry 2004;43:1460–8).

Overall, 121 girls had engaged in violent behavior at the time of the second interview: 18% of the early maturers, 48% of on-time maturers, and 33% of late maturers. Approximately 50% of the girls were Hispanic, 36% were black, and 14% were white, and 20% of early maturing black girls, 14% of early maturing Hispanic girls, and 7% of early maturing white girls had engaged in violence at the time of the second interview.

Infant Hypoglycemia

Significant risk factors for prolonged hypoglycemia in infants include gestational age, 1-minute Apgar scores, male sex, and weight in the lowest quartile.

Prolonged hypoglycemia was present in 55 of 594 (9%) small-for-gestational-age infants, Dr. Eugenia K. Pallotto said in a poster presented at the annual meeting of the Society for Perinatal and Pediatric Epidemiologic Research in Salt Lake City.

The infants were born between 1998 and 2001 and were in the 10th percentile or below for gestational age. Prolonged hypoglycemia was defined as blood sugar of 40 mg/dL or less occurring beyond 72 hours of life.

One-minute Apgar scores of less than 5, male gender, young gestational age, and birth weight in the lowest quartile of the study group were significantly associated with prolonged hypoglycemia, said Dr. Pallotto of the University of Missouri-Kansas City. Hypoglycemic episodes were longer among premature infants, compared with those born at term. Prospective monitoring of high-risk infants may improve glucose control and reduce unrecognized hypoglycemic episodes, she said.

Flu Shot Safe for Children

No evidence of serious adverse events within 2 weeks of vaccination appeared in a population-based study of 251,600 children, mean age 10 years, who received the trivalent inactivated influenza vaccine, said Eric K. France, M.D., of Kaiser Permanente Colorado, Denver, and his colleagues. The study spanned four flu seasons and two half-seasons between 1993 and 1999 (Arch. Pediatr. Adolesc. Med. 2004;158:1031–6). In a primary analysis, only one case of uncomplicated diabetes mellitus was positively associated with vaccination. Subanalysis revealed one case each of impetigo, atopic dermatitis, and a renal and ureteral disorder not otherwise specified. Overall, vaccinated children were significantly less likely to visit a doctor for an illness during the postvaccination period, compared with a control period. Reasons for this may include the fact that children are more likely to be vaccinated when they are healthy and that children are less likely to visit a doctor for low-grade fever, limb soreness, and irritability during the postvaccination period, because parents expect these symptoms after vaccination.

Hepatitis B Incidence Declines

Incidence of acute hepatitis B declined by 89% among U.S. children aged 19 years and younger between 1990 and 2002, according to data collected by the Centers for Disease Control and Prevention (MMWR 2004;53:1015–8). A total of 13,829 cases were reported during this period. Overall, incidence per 100,000 children declined by 92% among Asian/Pacific Islanders, 88% among whites, 88% among blacks, and 84% among American Indians/Native Alaskans. The greatest declines coincided with greater hepatitis B vaccination rates in children aged 19–35 months, which increased from 16% in 1992 to 90% in 2002, and in adolescents aged 13–15 years, which increased from almost 0% in 1992 to 67% in 2002.

Iron Deficiency's Role in ADHD

Children with attention-deficit hyperactivity disorder had significantly lower levels of iron, compared with controls in a study of 53 children aged 4–14 years, said Eric Konofal, M.D., of Hôpitaux de Paris, and his colleagues.

The mean serum iron level was 23 ng/mL in the children with ADHD, compared with 44 ng/mL in the controls. In addition, 42 (84%) of the ADHD children had iron levels considered abnormally low—below 30 ng/mL—compared with 5 (18%) of the 27 controls (Arch. Pediatr. Adolesc. Med. 2004;158:1113–5). Low levels of iron may hamper the development of the central nervous system and consequently contribute to the likelihood of behavioral disorders, so children with ADHD might benefit from iron supplements.

Neighborhoods and Violent Girls

Adolescent girls who mature early and live in economically disadvantaged neighborhoods committed three times as many violent acts as early maturers in less disadvantaged neighborhoods, said Dawn Obeidallah, Ph.D., of Harvard Medical School, Boston, and her colleagues.

The investigators used census data to characterize neighborhoods in the Chicago area and interviewed 501 adolescent girls and their families twice during a 3-year period (J. Am. Acad. Child Adolesc. Psychiatry 2004;43:1460–8).

Overall, 121 girls had engaged in violent behavior at the time of the second interview: 18% of the early maturers, 48% of on-time maturers, and 33% of late maturers. Approximately 50% of the girls were Hispanic, 36% were black, and 14% were white, and 20% of early maturing black girls, 14% of early maturing Hispanic girls, and 7% of early maturing white girls had engaged in violence at the time of the second interview.

Infant Hypoglycemia

Significant risk factors for prolonged hypoglycemia in infants include gestational age, 1-minute Apgar scores, male sex, and weight in the lowest quartile.

Prolonged hypoglycemia was present in 55 of 594 (9%) small-for-gestational-age infants, Dr. Eugenia K. Pallotto said in a poster presented at the annual meeting of the Society for Perinatal and Pediatric Epidemiologic Research in Salt Lake City.

The infants were born between 1998 and 2001 and were in the 10th percentile or below for gestational age. Prolonged hypoglycemia was defined as blood sugar of 40 mg/dL or less occurring beyond 72 hours of life.

One-minute Apgar scores of less than 5, male gender, young gestational age, and birth weight in the lowest quartile of the study group were significantly associated with prolonged hypoglycemia, said Dr. Pallotto of the University of Missouri-Kansas City. Hypoglycemic episodes were longer among premature infants, compared with those born at term. Prospective monitoring of high-risk infants may improve glucose control and reduce unrecognized hypoglycemic episodes, she said.

Long-Term Irritable Bowel Therapy

Alosetron provides significant long-term relief for women with symptoms of severe, chronic, diarrhea-predominant irritable bowel syndrome, reported William D. Chey, M.D., of the University of Michigan, Ann Arbor, and his associates.

Compared with 290 patients randomized to placebo, significantly more of 279 patients randomized to the selective 5-HT3-receptor antagonist alosetron (Lotronex) had adequate relief from irritable bowel syndrome (IBS) pain and discomfort (44% vs. 52%) and satisfactory urgency control rates (52% vs. 64%) after 48 weeks of treatment (Am. J. Gastroenterol. 2004;99:2195-203).

Significantly more alosetron patients reported adequate relief from IBS pain and discomfort as well as satisfactory urgency control rates regardless of whether they did or did not use rescue medication such as laxatives and antidiarrheals. But the two groups did not differ in rates of satisfactory control of stool frequency and consistency when rescue medications were used.

Constipation occurred significantly more often in alosetron (23%) than in placebo patients (5%), although in most cases it was a single episode that developed in the first month of treatment.

Endometritis and BV Linked

Bacterial vaginosis-associated organisms found frequently in women with pelvic inflammatory disease also were strongly associated with endometritis, Catherine L. Haggerty, Ph.D., of the University of Pittsburgh and her colleagues reported.

The investigators looked at the associations between endometritis and Neisseria gonorrhoeae, Chlamydia trachomatis, anaerobic bacteria, facultative bacteria, lactobacilli, and bacterial vaginosis (BV) in 278 women from the PID Evaluation and Clinical Health Study.

Those who had acute endometritis were more likely to be infected with C. trachomatis (odds ratio [OR] 16·2), N. gonorrhoeae (OR 11·6), diphtheroids (OR 5·0), black-pigmented gram-negative rods (OR 3·1), and anaerobic gram-positive cocci (OR 2·1), they reported (Clin. Infect. Dis. 2004:39;990-5).

The associations between acute endometritis and black-pigmented gram-negative rods, anaerobic gram-positive cocci, and BV remained significant after excluding the 41% of women who were infected with N. gonorrhoeae and/or C. trachomatis.

Treatment in most PID patients is directed at N. gonorrhoeae and C. trachomatis, but these account for fewer than half of all cases. The frequency of BV-associated organisms in PID patients suggests that treatment with a regimen containing metronidazole to improve anaerobic coverage is warranted, the investigators said.

HIV: What Women Don't Know

Many women aged 50 years and older lack appropriate knowledge about HIV transmission and prevention, according to findings published in the September issue of the Journal of the American Geriatrics Society. Nearly two-thirds of women incorrectly identified kissing as a mode of HIV transmission, 76% overestimated oral sex as a mode of HIV transmission, and only 13% identified condoms as effective in preventing HIV. The study was based on a survey of 514 women at a hospital in Atlanta (J. Am. Geriatr. Soc. 2004;52:1549-53).

“The problem is that they don't realize that they're at risk for this life-threatening disease,” said Lisa Bernstein, M.D., of Emory University, Atlanta, and one of the study's lead authors.

“Physicians have a tremendous role to play in educating patients—even those who are older than we normally think to be at risk.” Health care providers need to talk to their older female patients about HIV risk factors and the basics of HIV transmission and prevention, the authors concluded.

Elective Induction and C-Section Rate

Elective induction does not adversely affect the C-section rate or maternal fetal morbidity, said David J. Bonilla, M.D., and colleagues in a poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists' District VII in Washington.

They conducted a retrospective cohort study of 361 nulliparous patients between 37 and 41 weeks' gestation who had singleton pregnancies, with no medical indications for delivery.

Patients were divided into a spontaneous labor group and another group that had elective induction with a favorable cervix (Bishop score 5 or greater), according to the research team, headed by Dr. Bonilla of the Ochsner Clinic Foundation, New Orleans.

The C-section rate was 9·7% for 114 patients who had elective induction with a favorable cervix vs. a rate of 17·3% for 247 patients who had spontaneous labor. The induction group had a slightly higher rate of instrumental delivery, compared with the spontaneous labor group (31·88% vs. 22·6%).

There was a slight increase in admissions to the neonatal intensive care unit in the elective induction group, compared with the other group (1·45% vs. 3·23%), but it was not significant.

Long-Term Irritable Bowel Therapy

Alosetron provides significant long-term relief for women with symptoms of severe, chronic, diarrhea-predominant irritable bowel syndrome, reported William D. Chey, M.D., of the University of Michigan, Ann Arbor, and his associates.

Compared with 290 patients randomized to placebo, significantly more of 279 patients randomized to the selective 5-HT3-receptor antagonist alosetron (Lotronex) had adequate relief from irritable bowel syndrome (IBS) pain and discomfort (44% vs. 52%) and satisfactory urgency control rates (52% vs. 64%) after 48 weeks of treatment (Am. J. Gastroenterol. 2004;99:2195-203).

Significantly more alosetron patients reported adequate relief from IBS pain and discomfort as well as satisfactory urgency control rates regardless of whether they did or did not use rescue medication such as laxatives and antidiarrheals. But the two groups did not differ in rates of satisfactory control of stool frequency and consistency when rescue medications were used.

Constipation occurred significantly more often in alosetron (23%) than in placebo patients (5%), although in most cases it was a single episode that developed in the first month of treatment.

Endometritis and BV Linked

Bacterial vaginosis-associated organisms found frequently in women with pelvic inflammatory disease also were strongly associated with endometritis, Catherine L. Haggerty, Ph.D., of the University of Pittsburgh and her colleagues reported.

The investigators looked at the associations between endometritis and Neisseria gonorrhoeae, Chlamydia trachomatis, anaerobic bacteria, facultative bacteria, lactobacilli, and bacterial vaginosis (BV) in 278 women from the PID Evaluation and Clinical Health Study.

Those who had acute endometritis were more likely to be infected with C. trachomatis (odds ratio [OR] 16·2), N. gonorrhoeae (OR 11·6), diphtheroids (OR 5·0), black-pigmented gram-negative rods (OR 3·1), and anaerobic gram-positive cocci (OR 2·1), they reported (Clin. Infect. Dis. 2004:39;990-5).

The associations between acute endometritis and black-pigmented gram-negative rods, anaerobic gram-positive cocci, and BV remained significant after excluding the 41% of women who were infected with N. gonorrhoeae and/or C. trachomatis.

Treatment in most PID patients is directed at N. gonorrhoeae and C. trachomatis, but these account for fewer than half of all cases. The frequency of BV-associated organisms in PID patients suggests that treatment with a regimen containing metronidazole to improve anaerobic coverage is warranted, the investigators said.

HIV: What Women Don't Know

Many women aged 50 years and older lack appropriate knowledge about HIV transmission and prevention, according to findings published in the September issue of the Journal of the American Geriatrics Society. Nearly two-thirds of women incorrectly identified kissing as a mode of HIV transmission, 76% overestimated oral sex as a mode of HIV transmission, and only 13% identified condoms as effective in preventing HIV. The study was based on a survey of 514 women at a hospital in Atlanta (J. Am. Geriatr. Soc. 2004;52:1549-53).

“The problem is that they don't realize that they're at risk for this life-threatening disease,” said Lisa Bernstein, M.D., of Emory University, Atlanta, and one of the study's lead authors.

“Physicians have a tremendous role to play in educating patients—even those who are older than we normally think to be at risk.” Health care providers need to talk to their older female patients about HIV risk factors and the basics of HIV transmission and prevention, the authors concluded.

Elective Induction and C-Section Rate

Elective induction does not adversely affect the C-section rate or maternal fetal morbidity, said David J. Bonilla, M.D., and colleagues in a poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists' District VII in Washington.

They conducted a retrospective cohort study of 361 nulliparous patients between 37 and 41 weeks' gestation who had singleton pregnancies, with no medical indications for delivery.

Patients were divided into a spontaneous labor group and another group that had elective induction with a favorable cervix (Bishop score 5 or greater), according to the research team, headed by Dr. Bonilla of the Ochsner Clinic Foundation, New Orleans.

The C-section rate was 9·7% for 114 patients who had elective induction with a favorable cervix vs. a rate of 17·3% for 247 patients who had spontaneous labor. The induction group had a slightly higher rate of instrumental delivery, compared with the spontaneous labor group (31·88% vs. 22·6%).

There was a slight increase in admissions to the neonatal intensive care unit in the elective induction group, compared with the other group (1·45% vs. 3·23%), but it was not significant.

Long-Term Irritable Bowel Therapy

Alosetron provides significant long-term relief for women with symptoms of severe, chronic, diarrhea-predominant irritable bowel syndrome, reported William D. Chey, M.D., of the University of Michigan, Ann Arbor, and his associates.

Compared with 290 patients randomized to placebo, significantly more of 279 patients randomized to the selective 5-HT3-receptor antagonist alosetron (Lotronex) had adequate relief from irritable bowel syndrome (IBS) pain and discomfort (44% vs. 52%) and satisfactory urgency control rates (52% vs. 64%) after 48 weeks of treatment (Am. J. Gastroenterol. 2004;99:2195-203).

Significantly more alosetron patients reported adequate relief from IBS pain and discomfort as well as satisfactory urgency control rates regardless of whether they did or did not use rescue medication such as laxatives and antidiarrheals. But the two groups did not differ in rates of satisfactory control of stool frequency and consistency when rescue medications were used.

Constipation occurred significantly more often in alosetron (23%) than in placebo patients (5%), although in most cases it was a single episode that developed in the first month of treatment.

Endometritis and BV Linked

Bacterial vaginosis-associated organisms found frequently in women with pelvic inflammatory disease also were strongly associated with endometritis, Catherine L. Haggerty, Ph.D., of the University of Pittsburgh and her colleagues reported.

The investigators looked at the associations between endometritis and Neisseria gonorrhoeae, Chlamydia trachomatis, anaerobic bacteria, facultative bacteria, lactobacilli, and bacterial vaginosis (BV) in 278 women from the PID Evaluation and Clinical Health Study.

Those who had acute endometritis were more likely to be infected with C. trachomatis (odds ratio [OR] 16·2), N. gonorrhoeae (OR 11·6), diphtheroids (OR 5·0), black-pigmented gram-negative rods (OR 3·1), and anaerobic gram-positive cocci (OR 2·1), they reported (Clin. Infect. Dis. 2004:39;990-5).

The associations between acute endometritis and black-pigmented gram-negative rods, anaerobic gram-positive cocci, and BV remained significant after excluding the 41% of women who were infected with N. gonorrhoeae and/or C. trachomatis.

Treatment in most PID patients is directed at N. gonorrhoeae and C. trachomatis, but these account for fewer than half of all cases. The frequency of BV-associated organisms in PID patients suggests that treatment with a regimen containing metronidazole to improve anaerobic coverage is warranted, the investigators said.

HIV: What Women Don't Know

Many women aged 50 years and older lack appropriate knowledge about HIV transmission and prevention, according to findings published in the September issue of the Journal of the American Geriatrics Society. Nearly two-thirds of women incorrectly identified kissing as a mode of HIV transmission, 76% overestimated oral sex as a mode of HIV transmission, and only 13% identified condoms as effective in preventing HIV. The study was based on a survey of 514 women at a hospital in Atlanta (J. Am. Geriatr. Soc. 2004;52:1549-53).

“The problem is that they don't realize that they're at risk for this life-threatening disease,” said Lisa Bernstein, M.D., of Emory University, Atlanta, and one of the study's lead authors.

“Physicians have a tremendous role to play in educating patients—even those who are older than we normally think to be at risk.” Health care providers need to talk to their older female patients about HIV risk factors and the basics of HIV transmission and prevention, the authors concluded.

Elective Induction and C-Section Rate

Elective induction does not adversely affect the C-section rate or maternal fetal morbidity, said David J. Bonilla, M.D., and colleagues in a poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists' District VII in Washington.

They conducted a retrospective cohort study of 361 nulliparous patients between 37 and 41 weeks' gestation who had singleton pregnancies, with no medical indications for delivery.

Patients were divided into a spontaneous labor group and another group that had elective induction with a favorable cervix (Bishop score 5 or greater), according to the research team, headed by Dr. Bonilla of the Ochsner Clinic Foundation, New Orleans.

The C-section rate was 9·7% for 114 patients who had elective induction with a favorable cervix vs. a rate of 17·3% for 247 patients who had spontaneous labor. The induction group had a slightly higher rate of instrumental delivery, compared with the spontaneous labor group (31·88% vs. 22·6%).

There was a slight increase in admissions to the neonatal intensive care unit in the elective induction group, compared with the other group (1·45% vs. 3·23%), but it was not significant.