Acta paediatrica
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Randomized Controlled Trial Comparative Study Clinical Trial
Nebulized budesonide versus oral steroid in severe exacerbations of childhood asthma.
The aim of this study was to assess whether nebulized budesonide may substitute for oral prednisolone in the management of children whose asthma is severe enough to warrant hospital admission, but who have no life threatening features. In a prospective, double-blind, randomized study nebulized budesonide (2 mg 8 hourly) was compared with oral prednisolone (2 mg/kg at entry and again at 24 h) in 46 children admitted to hospital with severe asthma exacerbations. ⋯ FEV1 improved significantly compared to baseline in patients who received nebulized budesonide compared to the prednislone group. The data show nebulized budesonide to be at least as effective as oral steroid in improving lung function and symptom severity in severe exacerbations of childhood asthma.
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Randomized Controlled Trial Comparative Study Clinical Trial
Efficacy of nebulized budesonide compared to oral prednisolone in acute bronchial asthma.
To evaluate the efficacy of nebulized budesonide compared to oral prednisolone early in the emergency room management of acute asthma, we conducted a double-blind, placebo-controlled trial. Eighty children, 2 years to 12 years of age, with acute moderate attacks of asthma, were randomized into two groups. ⋯ The proportion of patients who were fit for discharge at the end of 2 h after the third dose of nebulization was significantly higher in the budesonide group than in the prednisolone group (22/ 41, 54% vs 7/39, 18%, p < 0.001). The data suggest that a combination of nebulized salbutamol and budesonide should be preferred in the emergency room management of children with acute moderate to severe exacerbation of asthma and who are not on prior oral or inhaled steroid therapy.
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Randomized Controlled Trial Clinical Trial
Methaemoglobin formation after the use of EMLA cream in term neonates.
EMLA cream 5% (a eutectic mixture of lidocaine and prilocaine) is a topical anaesthetic that has become widely used to minimize pain from venipuncture in children. It has not, however, been recommended in neonates owing to the potential risk of methaemoglobinaemia induced by prilocaine. The aim of this study was to establish the safety of 1 g EMLA cream 5% used on intact skin in term neonates. ⋯ Following application of the cream, the mean metHb levels were 1.17% (range 0.50-2.53) in the EMLA group and 0.96% (range 0.50-1.53) in the placebo group. The metHb concentrations were significantly higher in the EMLA group in the intervals from 3.5 to 13 h after application than in the placebo group, but were well below potentially harmful levels. Based on these results, a 1-h application of 1 g EMLA cream is safe when used on the intact skin of term neonates below 3 months of age.
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Randomized Controlled Trial Clinical Trial
Alleviation of the pain of venepuncture in neonates.
A recent study has shown venepuncture to be more effective and less painful than heel-lancing when a single blood test is performed in neonates [Larsson, Pediatrics (in press)]. The aim of the present study was to investigate the value of EMLA applied on the dorsum of the hand when sampling blood in neonates. ⋯ In comparison with a placebo, EMLA significantly reduces the pain caused by venepuncture on the dorsum of the hand and does not complicate puncture of the vein.
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Randomized Controlled Trial Clinical Trial
Randomized, controlled, blinded trial of doxapram for extubation of the very low birthweight infant.
The objective of the study was to determine whether administering doxapram by infusion to the very low birthweight infant, prior to extubation during the first 3 weeks of life, would increase the incidence of successful extubation. The study patients, 56 infants of less than 1251 g birthweight and less than 30 weeks' gestation, were entered in the first 3 weeks of life when lung disease had started to improve. A randomized blinded trial was performed, with infants receiving 3.5 mg kg(-1) doxapram bolus, followed by an infusion at 1 mg kg(-1) h(-1), or placebo. ⋯ Fifteen infants in each group were successfully extubated before the 10th day of the study. In conclusion, when given in accordance with this protocol doxapram does not increase the likelihood of successful extubation in the very low birthweight infant. Increasing successful extubations in this group of infants will require other strategies.