Current opinion in pediatrics
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Curr. Opin. Pediatr. · Apr 2013
ReviewOptimal oxygen saturations in preterm infants: a moving target.
New evidence is emerging to address the continued uncertainty regarding the optimal range to target oxygen saturation levels in preterm infants. ⋯ Defining and maintaining optimal oxygen saturations in preterm infants remains a challenge for clinicians caring for preterm infants. However, ongoing investigative collaborations may soon provide guidance.
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Curr. Opin. Pediatr. · Apr 2013
ReviewDuration of empirical antibiotic therapy for infants suspected of early-onset sepsis.
Clinicians' adherence to the Centers for Disease Control guidelines to prevent group B Streptococcus (GBS) early-onset sepsis (EOS) has reduced GBS EOS. Although evidence-based testing and empirical antibiotic initiation are likely saving lives, clinicians have less compelling data to guide duration of empirically initiated antibiotics when cultures remain sterile and clinical signs resolve quickly. Our purpose is to review current opinions and evidence influencing clinicians' choices for duration of empirically initiated antibiotics in newborns with sterile cultures. ⋯ Every day clinicians caring for thousands of neonates in the United States stop antibiotics which were started empirically to treat EOS on the first postnatal day. Evidence is lacking to support a universal approach to decisions on duration of empirical antibiotics when cultures remain sterile. Reviewing predictive value relative to timing of laboratory testing can help clinicians develop locally appropriate antimicrobial duration decision-making guidelines.
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Intravenous immunoglobulin (IVIG) and aspirin is the standard initial therapy in the treatment of Kawasaki disease. Some patients have persistent or recrudescent fever despite this therapy. Although there is no conclusive body of evidence defining the best second and third-line therapies for Kawasaki patients, there have been several recent studies published describing the results of these therapies. ⋯ Although most practitioners in the USA use IVIG as a second-line therapy for those Kawasaki disease patients who have persistent or recrudescent fever, promising new therapies are under study. Infliximab and steroids are currently the two agents that have been most studied. However, larger studies and studies in genetically diverse populations are needed.
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Curr. Opin. Pediatr. · Feb 2013
ReviewPerinatal management of infant tumors and the promise of fetal surgery.
This review outlines the current approaches to prenatal imaging, differential diagnosis, antenatal natural history, and the available treatment options for the most commonly prenatally diagnosed malignant tumors. ⋯ Diagnosis of a fetal tumor should prompt referral to a specialized center. Further understanding of these rare patients will require multicenter collaboration.
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Curr. Opin. Pediatr. · Dec 2012
ReviewField-based measures of head impacts in high school football athletes.
Recent technological advances have allowed the in-vivo measurement of impacts sustained to the head during helmeted sports. These measurements are of interest to researchers and clinicians for their potential to understand both the underlying mechanics of concussive injuries and the potential for real-time injury diagnostics. Following an overview of impact biomechanics, this review will evaluate the following: in-vivo technology being used in American football players; impact frequencies and magnitudes; and the biomechanical threshold for concussion. ⋯ High school athletes sustain a significant number of head impacts each year. The impacts are similar in both volume and magnitude when compared with collegiate athletes. The magnitude of impact that results in concussion is also the same at both levels of play, although the collegiate athlete may have a higher injury tolerance.