Current opinion in pediatrics
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Curr. Opin. Pediatr. · Feb 2011
ReviewPrevention of central line associated bloodstream infections in critical care units.
Central line associated bloodstream infections (CLABSIs) are a common source of morbidity and mortality in neonatal and pediatric intensive care units. Successful preventive strategies have recently been reported which have resulted in significant reductions in CLABSIs and their associated adverse outcomes. ⋯ CLABSIs remain a significant problem in neonatal and pediatric critical care units, but implementation of catheter care bundles can significantly reduce rates of these infections. The safety and efficacy of chlorhexidine gluconate, silver alginate, and antibiotic-coated catheters need to be assessed via large, multicenter trials. Creation of collaborative networks may facilitate this goal.
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Bronchiolitis impacts millions of infants worldwide. Although several therapeutic options stem from highly plausible theoretical rationales for success and some may even offer modest short-term symptom relief, none has been conclusively shown to alter the course of the disease or its major outcomes. However, several recent papers shed light on which treatments show promising preliminary evidence and offer insight into future research endeavors on this topic. This review will summarize bronchiolitis therapy in view of this recent evidence. ⋯ Because bronchiolitis is a highly heterogeneous entity, future research challenges should include detailed characterization of infants most likely to benefit from given interventions. In the meantime, stick with the good old time-honored supportive route!
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Child maltreatment remains a prevalent problem for which notable best practices such as home visitation can be effective; however, most eligible families do not receive these beneficial services. Additionally, there are other promising prevention interventions to effectively address child maltreatment. This review focuses on the recent advances and strategies for child maltreatment prevention. ⋯ Effective child maltreatment prevention efforts exist; however, not all programs provide the same effectiveness, or target the same maltreatment issues. Pediatricians are in a key position to offer support to families in their own practice, as well as to direct families to the appropriate resources available.
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Severely injured children have a decreased incidence and different pattern of multiple organ failure when compared with adults. This article reviews recent advances in understanding the mechanisms leading to this discrepancy. ⋯ The inflammatory response to injury in children is functionally and mechanistically unique, as suggested by age-related differences in the incidence and pattern of systemic inflammation and multiple organ failure after major trauma. We review the current clinical and basic science literature related to postinjury inflammation in childhood, focusing on the developmental biology of innate immunity and the implications of a maturing immune system for trauma-related interventions and outcomes.
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Curr. Opin. Pediatr. · Jun 2010
ReviewCommunity-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin infections.
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has become increasingly important as a cause of skin and soft tissue infections (SSTIs), particularly abscesses, in patients seen in the emergency department setting. The antibiotic sensitivity profile of Staphylococcus aureus isolates from SSTIs has changed over time in many geographic locations. Whether antibiotics are needed in the management of skin abscesses, and, if so, when, is controversial. ⋯ CA-MRSA has become an important cause of SSTIs. Current data suggest that most abscesses can be treated successfully with incision and drainage alone. Antibiotic choice is more crucial for management of cellulitis and should be guided by the prevalence of CA-MRSA in the community and its antibiotic susceptibility profile.