Journal of pediatric surgery
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Care of pediatric traumatic brain injury (TBI) has placed emphasis on maximizing cerebral perfusion to prevent ischemia and reperfusion injury. A subset of patients with TBI will continue to have refractory intracranial pressure (ICP) elevation despite aggressive therapy including ventriculostomy, pentobarbital coma, hypertonic saline, and diuretics. Decompressive craniectomy (DC) is a controversial treatment of severe TBI. It is our hypothesis that DC can enhance survival and minimize secondary brain injury in this patient subset. ⋯ Although this is a small sample, DC should be considered in patients with TBI with refractory elevated ICP. Long-term follow-up of this patient population should consist of neuropsychiatric evaluation in conjunction with measurement of social function.
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To design effective pediatric trauma care delivery systems, it is important to correlate site of care with corresponding outcomes. Using a multistate administrative database, we describe recent patient allocation and outcomes in pediatric injury. ⋯ Younger and more seriously injured children have improved outcomes in children's hospitals. Appropriate triage may improve outcomes in pediatric trauma.
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We studied the effects of total parenteral nutrition (TPN)-associated hyperglycemia on the clinical outcome in premature septic infants in the neonatal intensive care unit. ⋯ Hyperglycemia correlated with prolonged ventilator dependency and increased hospital length of stay in premature septic infants. Avoidance of excessive nutrient delivery and tight glycemic control during periods of acute metabolic stress may improve outcome in this patient population.
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Clinical Trial
Continuous noninvasive monitoring of cardiac performance and tissue perfusion in pediatric trauma patients.
The aim of this study was to assess the accuracy of a continuous survival probability prediction using noninvasive measures of cardiac performance and tissue perfusion in severely injured pediatric patients. ⋯ Thoracic bioimpedance and transcutaneous monitoring give critical real-time hemodynamic and tissue perfusion data that can provide early identification of pathologic flow patterns and accurately predict survival.
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Small children are vulnerable to serious accidents when a motor vehicle is placed in motion in a driveway. We describe a series of such accidents, consider the predisposing factors, and analyze the outcomes. ⋯ Driveway injuries are an underrecognized often severe form of auto-pedestrian accidents. To prevent these family tragedies, drivers of large vehicles with children younger than 12 years old should be extremely attentive and account for children outside the vehicle before moving.