Current opinion in pediatrics
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Curr. Opin. Pediatr. · Jun 2000
ReviewPeriodic fever, aphthous stomatitis, pharyngitis, adenitis: a clinical review of a new syndrome.
Periodic fevers (fevers that occur predictably at fixed intervals) are unusual in infants and children. The classic periodic fever syndrome is cyclic neutropenia (neutropenia followed by infections and fever that recur every 21 days). A new periodic fever syndrome PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis) has been characterized over the past decade. ⋯ An episode of PFAPA can be aborted with one or two small doses of prednisone. The episodes of PFAPA may last for years and the patient is well between episodes. The cause of PFAPA is unknown and there are no reported sequelae.
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Of utmost importance in the practice of neurological critical care is the treatment of cerebral edema, when possible, and the control of life-threatening seizures. In this regard, severe traumatic head injury and refractory status epilepticus are useful clinical therapeutic paradigms. Evidence-based treatment established for these conditions has, by necessity, a wider application to other much less frequent causes of coma and acute neurological illness managed in the intensive therapy unit. Therefore, this review of pediatric neurocritical care literature in 1999 highlights central clinical reports of the medical management of severe traumatic brain injury, the benzodiazepines used in the treatment of status epilepticus, and the emerging or recently appreciated encephalopathies occurring in children.
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Sleep-disordered breathing, particularly the obstructive sleep apnea syndrome, is common during childhood. Complications include neurocognitive deficits, growth failure, and pulmonary hypertension. ⋯ Polysomnography is invaluable for the evaluation of sleep-disordered breathing. Advances in diagnosis and management can alleviate much of the morbidity previously associated with sleep-related respiratory disorders.
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Curr. Opin. Pediatr. · Apr 2000
ReviewCerebral hypothermia for prevention of brain injury following perinatal asphyxia.
The possibility that hypothermia has a therapeutic role during or after resuscitation from severe perinatal asphyxia has been a longstanding focus of research. Early studies using short periods of cooling had limited and contradictory results. ⋯ These encouraging results must be balanced against the well-known adverse systemic effects of hypothermia. Randomized clinical trials are in progress to test the safety and efficacy of cerebral hypothermia.
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Perinatal brachial plexus palsy (PBPP) has been traditionally classified into three types: upper plexus palsy (Erb's) affecting the C5, C6, and +/- C7 nerve roots, lower plexus palsy (Klumpke's) affecting the C8 and T1 nerve roots, and total plexus palsy. Although most cases will resolve spontaneously, the natural history of the remaining cases is influenced by contractures of uninvolved muscle groups and subluxation or dislocation of the shoulder and elbow. Microsurgical nerve repair has demonstrated to provide improved outcomes compared to conservative treatment, while advancements in secondary reconstruction have offered significant improvements in the performance of activities of daily living for older children with unresolved plexus palsy.