Acta paediatrica
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To evaluate whether paediatric randomized clinical trials (RCTs) adopt recent guidance on Data Monitoring Committees (DMCs), interim analysis and early termination. ⋯ Few paediatric trials report on DMCs' roles, interim analysis or early stopping. Heterogeneous practices and apparent shortcomings jeopardize the validity of trial results. Easily accessible guidelines for the design, conduct and reporting of paediatric DMCs are needed.
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Neonatal hypoxic-ischaemic encephalopathy (HIE), if severe, may involve cerebral vasoparalysis. In HIE, Pourcelot's cerebral vascular resistance index (RI) below 0.55 (by Doppler ultrasound) from published literature at normothermia predicted poor outcome with a positive predictive value (PPV) of 84%. The aim of this study was to re-assess RI as a predictor of outcome in HIE during hypothermia. ⋯ Low RI is significantly less predictive of poor outcome during hypothermia than normothermia. The lower PPV may be because hypothermia affects cerebral vasculature or protects the brain solely at a molecular and cellular level. Infants, who would have been predicted from their RI to have poorer outcome at normothermia, have better outcome when cooled.
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Successful transplantation has lead to increasing need for donated organs from children; however, contemporaneously decreased brain-death rates means optimization of donation processes is crucial. Although excellent palliative care and organ donation are compatible, discrepancies exist both between and within European countries in abilities to offer families donation opportunities. Change will require address of legal, ethical and cultural barriers, and this review aims to explore such changes pertinent to both dead and living organ donation. ⋯ We argue that across Europe it is surely time for legal, ethical and cultural change to facilitate parents, families and of course children in having the choice of donation.
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Practice Guideline
New guidelines for newborn resuscitation--a critical evaluation.
The 2010 International Liaison Committee on Resuscitation guidelines for newborn resuscitation represent important progress. The criteria for assessment are simplified based on heart rate and respiration only and there is no timing of stages after the first 60 sec. Instead of giving supplemental oxygen, the guidelines state that 'it is best to start with air'. However, the optimal oxygen concentration later in the process and for premature babies is not yet clear. A description of an adequate heart rate response is not given, and the cut-off of 100 bpm may be arbitrary. There are still no clear recommendations regarding ventilation, inspiratory time, use of positive end expiratory pressure or continuous positive airway pressure. The guidelines do not mention which paCO2 level might be optimal. As colour pink assessment and routine suctioning of airways are not recommended anymore, there is an urgent need to obtain international consensus and create a new and revised Apgar score without these two variables. ⋯ In spite of improved guidelines for newborn resuscitation, there is still a number of unanswered questions and a need for more delivery room studies.