The Journal of pediatrics
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Acute kidney injury (AKI) is a common consequence of perinatal asphyxia, occurring in up to 56% of these infants. A major difficulty in diagnosing this condition is the lack of a consensus definition of neonatal AKI, largely because of a dearth of specific measurable variables and biochemical markers. This review will discuss the current evidence regarding the epidemiology, investigation, and treatment of AKI in the asphyxiated neonate. Particular emphasis will be given to the investigation of renal function in the neonate and to potential biomarkers that may aid the clinician in the diagnosis of renal injury in this population.
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The Journal of pediatrics · Feb 2011
Comparative StudyInsurance-associated disparities in hospitalization outcomes of Michigan children.
To investigate whether children in Michigan with private insurance have better hospitalization-related outcomes than those with public or no insurance. ⋯ There are disparities in health outcomes and charges between Michigan children and newborns with public/no insurance and those with private health insurance, presenting a significant opportunity to improve the efficiency and efficacy of care.
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Neonatal asphyxia is associated with multi-organ hypoxia-ischemia and subsequent dysfunction. The cardiovascular system is frequently affected, causing signs of shock and complicating the neonatal circulatory transition. Hypothermia therapy can improve outcome from neonatal asphyxia without adversely affecting cardiovascular stability. Therapy directed at the cardiovascular system can improve short-term measures of systemic blood flow, but to date has not been demonstrated to improve long-term outcome.
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The Journal of pediatrics · Feb 2011
Comparative StudyAgreement between proxy and adolescent assessment of disability, pain, and well-being in juvenile idiopathic arthritis.
Adolescents with juvenile idiopathic arthritis have demonstrated substantial disagreement with their proxy's assessment of their disability, pain, and well-being. Our objective was to describe the clinical and psychological factors associated with discordance. ⋯ Proxy and adolescent reports of pain and well-being are more likely to disagree in those with severe disease. Adolescents who report depressive symptoms are also more likely to disagree with their proxy. The reasons for these are multifactorial, and considerations of both reports are important when assessing outcomes in juvenile idiopathic arthritis.
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The Journal of pediatrics · Feb 2011
Case ReportsCyclophosphamide for rapid-onset obesity, hypothalamic dysfunction, hypoventilation, and autonomic dysregulation syndrome.
Patients with rapid-onset obesity, hypothalamic dysfunction, hypoventilation, autonomic dysregulation, and neural crest tumor syndrome have poor long-term outcomes. We report a patient who was treated successfully with high-dose cyclophosphamide immunoablation. This experience offers a novel therapeutic approach and an indirect insight into the underlying pathogenesis of this syndrome.