Current opinion in pediatrics
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Despite increasing understanding of the cellular and molecular mechanisms that cause pathology in children who suffer traumatic brain injury, few advances have been made in developing new effective therapies for such injury. In the past, clinicians treated some neurologically injured patients with the sustained application of systemic hypothermia. This practice was largely abandoned when patients experienced complications; however, interest has been renewed in treatment with milder forms of hypothermia. ⋯ Promising results from two clinical trials are presented. Moreover, evidence is discussed in support of the notion that some children with traumatic brain injury, more so than adults, may benefit from hypothermic therapy. Lastly, putative mechanisms for the effects of hypothermia, including attenuation of injury caused by inflammation, excitotoxic amino acids, nitric oxide, and free radicals, are discussed.
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Lacerations account for a significant number of emergency department and urgent care clinic visits for pediatric patients. Children represent a unique challenge in repairing lacerations because of their developmental and behavioral characteristics, making rapidity, ease of performance, and minimal pain particularly desirable. ⋯ Topical administration of anesthetics such as tetracaine, adrenaline, and cocaine and lidocaine, epinephrine, and tetracaine offers the advantage of replacing lidocaine infiltration and provides an effective, safe, and painless alternative for local anesthesia. Finally, the introduction of cyanoacrylate tissues adhesives such as Histoacryl Blue (Trihawk International, Montreal, Canada) and Dermabond (Ethicon, Somerville, NJ) appear to be an ideal technique for laceration closure in children because they are easy and rapid to apply, are relatively painless, eliminate the need for suture removal, and provide an acceptable cosmetic result.
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Teen pregnancy is a multifaceted problem closely connected to economic, education, social, cultural, and political factors. Adolescents in the United States have the highest pregnancy rates in the Western world. ⋯ Prevention of teen pregnancy has become an important national agenda. The purpose of this paper is to provide a review of teen pregnancy prevention programs and strategies and to highlight some of the most promising interventions.
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The adult (acute) respiratory distress syndrome is a significant cause of morbidity in children. The mortality rates remain elevated, greater than 50%, and even greater than 80% in patients with underlying malignancies. The therapeutic interventions remain mainly supportive. ⋯ High-frequency oscillatory ventilation and tracheal insufflation are not yet used extensively, although they should contribute to less aggressive ventilation. Surfactant replacement, nitric oxide inhalation, and partial liquid ventilation seem to be promising technologies, but controlled clinical studies are necessary before their wide-spread use. Extracorporeal membrane oxygenation remains the alternative technology in case of failure of conventional support.
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Critically ill pediatric patients are frequently exposed to acute, established, and chronic pain as a result of their disease processes or intensive care therapies. Despite the availability of many drugs and techniques for providing analgesia, these painful conditions are not adequately treated in a large proportion of children. ⋯ We propose that adequate and early analgesic interventions will minimize patient's discomfort, maintain metabolic homeostasis, and improve a patient's tolerance of intensive care unit therapies and nursing interventions. Adequate analgesia can be provided to even the sickest child using the drugs, techniques, and novel approaches reviewed.