Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie
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Burn injury is considered by children as one of the most painful traumas (just after bone factures). Burn pain in children can and must be controlled as well as for adult patients, with almost identical techniques. ⋯ Due to very high levels of nociception, satisfactory management of procedural pain requires the use of opioid therapy. Non pharmacological methods are meaningless if pharmacological treatment is not optimal.
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Acute respiratory distress syndrome (ARDS) is a frequent condition in pediatric intensive care units. The mortality remains high despite advances in conventional mechanical ventilation and aetiological treatment. ⋯ Nevertheless the usefulness of extrapulmonary gas exchange remains much debated. New ventilatory strategies have been developed in order to reduce ventilator-induced lung injury and to improve systemic oxygenation but multicentric randomized clinical trials are needed before these strategies can be validated.
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Pulse oximetry has become the leading technique for monitoring hemoglobin oxygen saturation whenever a risk of hypoxia exists. It is based upon the principle of light absorbance of pulsatile arterial blood. Since it uses 2 wavelengths, it can only measure oxyhemoglobin and reduced hemoglobin. ⋯ Low tissue perfusion can also be responsible for inaccurate values. Nevertheless pulse oximetry is a reliable and easy-to-use technique in most of the clinical situations. This article reviews the physical basis, the reliability, the pediatric aspects, and the limitations of the technique.
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Recent research about nociceptive pathways in newborn infants have shown that, even very immature, preterm infants have all the anatomical and functional components required for the perception of painful stimuli. However, the perception of pain in preterm infants is thought to be slightly different from that of term infants: because of a lack of myelination of their sensitive fibers and a still immature cortical organization of the somatosensory system, painful stimuli are perceived more widespread and durable. ⋯ Finally, abnormal behavioural imprinting secondary to early painful stimuli is now suggested. Thus in contrast with the former misconception of "insensitivity towards pain", premature infants must be now considered as "hypersensitive" and vulnerable.