Current opinion in pediatrics
-
In 1981, the Report of the Medical Consultants on the Diagnosis of Death established guidelines for the diagnosis of brain death and, in 1995, the American Academy of Neurology published practice parameters to standardize determination of brain death. In 1987, the American Academy of Pediatrics established guidelines for determining brain death in children. Despite the establishment of these guidelines, the declaration of "death" based on the cessation of brain function remains complex and controversial. In this review are discussed the current guiding principles and the controversies in the diagnosis of brain death in children.
-
Curr. Opin. Pediatr. · Jun 2003
ReviewFamily member presence in the pediatric emergency department.
Traditionally, family members were excluded from viewing invasive procedures and cardiopulmonary resuscitation in the pediatric emergency department. The concept of family-centered care in the emergency department has now become more widespread. Consequently, family member presence during routine invasive procedures such as venipuncture, intravenous cannulation, urethral catheterization, and lumbar puncture has become more accepted. ⋯ Variations in approval of witnessed resuscitation are influenced by occupation, level of training and experience, and prior exposure to family member presence practices. Although several organizations formally support family presence policies, citing benefits for grieving relatives, critics point to a lack of rigor in a large body of the research cited to underpin these endorsements. We review the literature from the perspective of pediatric emergency physicians, offer suggestions for family member presence, and provide directions for future study.
-
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.
-
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.
-
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.