Archives of disease in childhood
-
Randomized Controlled Trial Clinical Trial
Intracranial hypertension in Africans with cerebral malaria.
The causes of death and neurological sequelae in African children with cerebral malaria are obscure. Intracranial pressure (ICP) was monitored and cerebral perfusion pressure (CPP) calculated in 23 Kenyan children with cerebral malaria. Four children had severe intracranial hypertension (ICP > 40 mm Hg, CPP < 40 mm Hg): two died, one with an ICP of 158 mm Hg and signs of transtentorial herniation, the other one with an ICP of 42 mm Hg and cardiorespiratory arrest. ⋯ Nine had intermediate intracranial hypertension (ICP > 20 mm Hg, CPP < 50 mm Hg) and 10 had mild intracranial hypertension (maximum ICP 10-20 mm Hg); all survived without severe sequelae. Mannitol controlled the ICP in children with intermediate intracranial hypertension, but it did not prevent the development of intractable intracranial hypertension in children with severe intracranial hypertension. Intracranial hypertension is a feature of Kenyan children with cerebral malaria and severe intracranial hypertension is associated with a poor outcome.
-
Randomized Controlled Trial Clinical Trial
Dexamethasone and bacterial meningitis in Pakistan.
The objective of this study was to assess, in a developing country setting, the effect of dexamethasone therapy on bacterial meningitis outcomes. A prospective double blind placebo controlled trial was conducted in 89 children aged from 2 months to 12 years suffering from bacterial meningitis. Neurological, developmental, and hearing assessments were conducted at one, four, and 12 months after discharge. ⋯ The presence of neurological sequelae and high cerebrospinal fluid protein independently predicted hearing loss. No beneficial effect of dexamethasone was observed on morbidity or mortality of this group of patients with bacterial meningitis. Dexamethasone is therefore not useful in developing countries as adjunctive treatment in patients seriously ill with bacterial meningitis, who present late for treatment and have been partially treated.
-
Randomized Controlled Trial Clinical Trial
Randomised comparison of ondansetron and metoclopramide plus dexamethasone for chemotherapy induced emesis.
The serotonin (5HT3) antagonist ondansetron was compared in a randomised study with metoclopramide and dexamethasone for the prevention of chemotherapy induced emesis. Thirty children aged 1-15 years with acute lymphoblastic leukaemia received 'intensification modules' according to the MRC United Kingdom acute lymphoblastic leukaemia regimen UKALL XI. This contains the moderately emetogenic drugs daunorubicin, etoposide, and cytarabine. ⋯ Fifteen children received intravenous metoclopramide every six hours for three days with a loading dose of dexamethasone, repeated every eight hours for three days intravenously or orally. Efficacy was assessed by a diary card documenting the incidence of nausea, retching, or vomiting. In the 24 hour period after starting chemotherapy, ondansetron was more effective, with a complete or major response rate of 93%, compared with 33% using metoclopramide/dexamethasone.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Equipping the community to measure children's height: the reliability of portable instruments.
To compare (1) the reliability of two expensive and two inexpensive measuring instruments, suitable for use in the community and (2) the reliability of experienced compared with inexperienced observers. ⋯ Inexpensive height measuring equipment, once accurately installed, is no less reliable than the most expensive. Inexperienced observers can, with care, measure as reliably as those with long experience. Every effort should be made, however, to ensure that the progress of individual children is monitored not only by the same observer, but on a long term basis.
-
Randomized Controlled Trial Clinical Trial
Nebulised racemic adrenaline in the treatment of acute bronchiolitis in infants and toddlers.
The effect of inhaled nebulised racemic adrenaline upon symptoms of acute bronchiolitis was investigated in 29 infants and toddlers aged 2-17.5 months by transcutaneous oxygen tension (TcPO2), oxygen saturation, transcutaneous carbon dioxide tension (TcPCO2), and clinical evaluation in a double blind placebo controlled study. Clinical score and TcPO2 improved significantly at 30, 45, and 60 minutes after inhalation of racemic adrenaline, with an increase in TcPO2 > or = 0.5 kPa in 72% of the children < 1 year of age. ⋯ No significant changes in heart rate or TcPCO2 were observed from before to after inhalation, but a small increase in mean systolic blood pressure was observed immediately and 45 minutes after racemic adrenaline inhalation. This study demonstrates that treatment with nebulised racemic adrenaline improved oxygenation and clinical signs in hospitalised children aged less than 18 months with bronchiolitis.