Current opinion in pediatrics
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Curr. Opin. Pediatr. · Apr 2003
ReviewImmunotherapy in the prophylaxis and treatment of neonatal sepsis.
Neonatal sepsis is a significant cause of morbidity and mortality in the neonatal intensive care unit. The epidemiology of neonatal infections is complex; however, they are in large part secondary to developmentally immature host defense mechanisms. ⋯ In this paper, we have reviewed immunotherapies that modulate the immune system of the neonate, including: intravenous immunoglobulins, myeloid hematopoietic growth factors, and granulocyte transfusions. Future studies should focus on investigating other abnormalities of neonatal host defense and/or combined immunotherapy approaches in an attempt to circumvent the immaturity of host defense and potentially reduce both the incidence and severity of neonatal sepsis.
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Curr. Opin. Pediatr. · Apr 2003
ReviewNewer pharmacologic agents for procedural sedation of children in the emergency department-etomidate and propofol.
Procedural sedation for pediatric patients having painful or anxiety-producing procedures is a necessary but often a daunting task for emergency medicine providers. This article focuses on the two agents that have most recently been described for use in this population-etomidate and propofol. Etomidate is a nonbarbiturate sedative hypnotic agent with no analgesic properties. ⋯ Typically, it is administered as a bolus injection followed by an infusion. It has long been used for surgical procedures as well as in the intensive care unit setting, but little literature has supported its use in the pediatric emergency department. Recent studies appear to support propofol's use in this setting; however, a significant rate of side effects, including hypoxia, apnea, and decreased blood pressure, may limit its use.
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Curr. Opin. Pediatr. · Apr 2003
ReviewThe controversies surrounding oxygen therapy in neonatal intensive care units.
Despite the knowledge that excess amounts of oxygen in the blood (hyperoxia) can be damaging to preterm infants, there is a wide variation in approaches to oxygen therapy within neonatal intensive care units. This is predominantly determined by institutional or individual practices or preferences and might stem from a lack of understanding of the relative merits and demerits of the different techniques of oxygen monitoring in extremely preterm babies who are different from more mature babies. This article provides the physiological rationale and evidence from recent clinical studies suggesting that keeping the oxygen therapy to an "acceptable" minimum in premature babies does not do any harm and may be even advantageous.
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This section focuses on issues in infectious disease that are commonly encountered in pediatric office practices. Dr. McCarthy discusses recent literature regarding the evaluation and management of acute fevers without apparent source on clinical examination in infants and children and the evaluation of children with prolonged fevers of unknown origin. ⋯ Klig and Chen (pp 121-126) review recent literature about lower respiratory infection in children. This section focuses on febrile children in whom a source of fever is not readily apparent on clinical examination. This issue is discussed in several contexts: recent developments concerning the epidemiology, pathophysiology, diagnostic approach, and therapy of febrile illnesses; children from 3 to 36 months of age with fever; infants younger than 90 days of age with fever; and children of any age with prolonged fever, usually lasting more than 7 to 10 days, for whom a diagnosis has not been established.
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Curr. Opin. Pediatr. · Feb 2003
ReviewRecombinant human activated protein C for the treatment of severe sepsis: is there a role in pediatrics?
Sepsis with organ failure (severe sepsis) remains an important cause of morbidity and mortality among children. The clinical pathophysiology of severe sepsis reflects a coordinated activation of the innate immune response, including elaboration of proinflammatory cytokines and the induction of the extrinsic pathway of coagulation (sepsis-induced coagulopathy). These proinflammatory and procoagulant pathways are linked, and are similarly coregulated by a number of proteins and factors, including protein C. ⋯ This deficiency is associated with poor outcomes, including multiple organ failure and mortality. Recently, recombinant activated protein C was shown to reduce the mortality of adults with severe sepsis, and is now approved for such use in the United States and Europe. The rationale for pediatric applications of protein C and ongoing clinical trials in children are reviewed.