Pediatric pulmonology
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Pediatric pulmonology · Dec 1995
Randomized Controlled Trial Comparative Study Clinical TrialOral dexamethasone in the treatment of croup: 0.15 mg/kg versus 0.3 mg/kg versus 0.6 mg/kg.
The objective of this study was to compare the efficacy of a single dose of oral dexamethasone of varying sizes in 120 children hospitalized with croup in two sequential double blind, randomized, controlled clinical trials (Trials A and B). The study was conducted in the Emergency Department Observation Ward of a tertiary pediatric hospital. One hundred and twenty children (age range 6 to 160 months) hospitalized with croup participated. ⋯ Croup scores following treatment did not differ and were significantly lower than initial scores for all groups and in each trial. Other outcome measures were similar for the two groups in each trial, including need for nebulized adrenaline, numbers of patients admitted to intensive care, rate of return to medical care with reoccurrence of croup, and readmission to hospital with croup following discharge from hospital. We conclude that oral dexamethasone in a dose of 0.15 mg/kg is as effective as 0.3 or 0.6 mg/kg in relieving symptoms and results in a similar duration of hospitalization in children with croup.
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Pediatric pulmonology · Dec 1995
Randomized Controlled Trial Clinical TrialEffect of neck rotation on the timing and pattern of infant tidal breathing.
While neck flexion and extension are known to influence the patency of the upper airway, far less information is available regarding the effects of neck rotation. The effect of neck rotation on respiratory rate (RR), expiratory time (tE), and phase angle (phi) was assessed in 17 healthy infants aged between 1 and 4 months. An inclinometer was used to measure neck rotation and uncalibrated Respiratory inductive Plethysmography to measure the dependent variables while the infants were in natural, quiet sleep. ⋯ Consequently, these data, rather than those collected at 0 degree at the onset of quiet sleep, were used for comparisons with all subsequent positional changes. When comparing the positions whose order was randomized, neck rotation did not significantly affect RR (P = 0.445), tE (P = 0.272), or phi (P = 0.169). However, two infants demonstrated marked changes in respiratory pattern with decreases in RR and increases in tE at 90 degrees rotation, suggesting that some infants may be susceptible to obstruction in this position.
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Pediatric pulmonology · Dec 1995
Randomized Controlled Trial Comparative Study Clinical TrialOral and inhaled steroids in croup: a randomized, placebo-controlled trial.
It was the objective of this study to compare the efficacy of oral dexamethasone and inhaled budesonide in children hospitalized with croup, using a three-way, double blind, randomized, placebo-controlled clinical trial design. The trial was carried out in the Emergency Department Observation Ward of a tertiary pediatric hospital. The subjects for the study were 80 children (age range 5 to 158 months) who were hospitalized with croup. ⋯ The croup scores did not differ significantly in the 2 steroid treated groups. Six of the 30 children (20%) in the placebo group required adrenaline after the first hour compared to none of the 50 children in the steroid treated groups (P < 0.02). We conclude that oral dexamethasone and inhaled budesonide are both effective in reducing symptoms and duration of hospitalization in children with croup.
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Pediatric pulmonology · Dec 1995
Case ReportsVenous catheter thrombus formation and pulmonary embolism in children.
Central venous catheter (CVC)-related thrombus formation has been increasingly recognized as a complication in adults and somewhat less frequently in children and neonates. However, the association of CVC thrombus and pulmonary embolism (PE) has rarely been reported in infants or children, and the few existing reports primarily involve chronic, indwelling CVCs such as Broviac or Hickman catheters. During an 18-month-period of autopsy review, we found that 5 of our pediatric intensive care unit patients had autopsy-proven CVC thrombus and pulmonary embolism. ⋯ The diagnosis may have been missed because the symptoms of PE are the same as those of severe lung disease. We, therefore, advocate a heightened suspicion of CVC thrombus formation and PE in critically ill children with respiratory failure and temporary CVCs and recommend early diagnostic ultrasound to confirm the diagnosis. Once a CVC thrombus is found, subsequent pulmonary deterioration may necessitate evaluation for acute PE.