Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie
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Asthma and chronic obstructive pulmonary disease are two distinct affections but two chronic inflammatory disorders. Respiratory symptoms are non-specific. ⋯ Airway remodeling in asthma can begin in childhood. If natural history is different, treatment strategies become similar.
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Paediatric intensive care and haematological units are ideal sites for the development of nosocomial infections. These infections remain a significant source of mortality and morbidity and increase length of stay and costs. Selective digestive decontamination (SDD) includes topical antibiotics during the entire intensive care unit (ICU) stay, parenteral antibiotic administered for three to five days, hand hygiene and surveillance cultures of throat and rectum. ⋯ Factors that predict facility, administration of i.v. antibiotics within the past 12 months, previous intensive care unit admission and hospitalization of a household contact within the past 12 months. As suggested by several authors, the term selective should mean selection of appropriate patient groups (those at high risk of nosocomial infection, e.g. patients mechanically ventilated for at least 48 hours) and units (excluding those where multiresistance is endemic). Obviously, surveillance of patient and unit bacterial ecology and improvement of antibiotic policy must be reinforced.
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Pain concerns more than 50% of the children cared in the emergency unit. After evaluation, it has to be cured with drugs adapted to its level and its origin. Residual pain needs therapeutic adjustment. ⋯ These drugs do not exist and every sedation procedure has a risk of hypoxemia. With the human and equipment's investment an emergency department should be able to ensure that procedures are performed in children under sedation with a standard of safety that is similar to general anaesthesia. The main drawback in a well-organised system should be a significant children's rate for which general anaesthesia is preferred.