Pediatrics
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Comparative Study Clinical Trial Controlled Clinical Trial
Effects of volume-guaranteed synchronized intermittent mandatory ventilation in preterm infants recovering from respiratory failure.
Volume guarantee (synchronized intermittent mandatory ventilation [SIMV]+VG) is a novel mode of SIMV for automatic adjustment of the peak inspiratory pressure to ensure a minimum set mechanical tidal volume (V(T mech)). The objective of this study was to compare the effects of SIMV+VG with conventional SIMV on ventilation and gas exchange in a group of very low birth weight infants recovering from acute respiratory failure. ⋯ The short-term use of SIMV+VG resulted in automatic weaning of the mechanical support and enhancement of the spontaneous respiratory effort while maintaining gas exchange relatively unchanged in comparison to conventional SIMV.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of oral versus normal and high-dose rectal acetaminophen in the treatment of febrile children.
To compare the defervescent effect of high-dose rectal suppository acetaminophen with the recommended oral and rectal dosages and to evaluate acceptability of rectal acetaminophen. ⋯ There was no difference between the temperature decrement in patients treated with 15 mg/kg oral acetaminophen and the same or double dose rectally. Thus, there seems to be no evidence to support the use of higher doses of rectal acetaminophen for the treatment of fever in children. The rectal route proved to be as acceptable as the oral among parents.
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Comparative Study
Survival in early- and late-term infants with congenital diaphragmatic hernia treated with extracorporeal membrane oxygenation.
Congenital diaphragmatic hernia (CDH) is a malformation of the diaphragm that allows bowel to enter the thoracic cavity, resulting in pulmonary hypoplasia and pulmonary hypertension. Approximately 50% of CDH patients are treated with extracorporeal membrane oxygenation (ECMO). The optimal gestational age for delivery of term infants with CDH at high risk for requiring ECMO is not known. The goal of this study was to compare survival of infants with CDH receiving ECMO born early term (38 0/7-39 6/7 weeks' gestation) with those born late term (40 0/7-41 6/7 weeks' gestation). Changes in survival rates of term infants and the factors associated with these changes were assessed over the 25 years that ECMO has been available. ⋯ Among term infants with CDH receiving ECMO, late-term delivery compared with early-term delivery is associated with improved survival, shorter ECMO duration, shorter hospital length of stay, and fewer complications on ECMO. These data suggest that, at least for the approximately 50% of CDH patients treated with ECMO, outcomes for infants with CDH may be improved by delay of elective delivery until 40 completed weeks of gestation.
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To determine the baseline injury rate for children ages 7 to 13 participating in community organized baseball, softball, soccer, and football. ⋯ Given the classification of football as a collision sport, the high number of exposures per player, the FITS score, and the percentage of injuries considered serious, youth football should be a priority for injury studies. Health professionals should establish uniform medical coverage policies for football even at this age level. RECOMMENDATIONS FOR MODIFICATIONS: Injury surveillance for youth sports is gaining momentum as an important step toward formulating injury prevention methods. However, establishing patterns of injuries, taking preventive measures, and evaluating equipment and coaching modifications may take years. In addition to the objective findings of this study, our direct observations of community sports through 2 seasons showed areas where immediate modifications could reduce injury risk. The first recommendation is that youth sports leagues provide and require first aid training for coaches. Training could be done by sports medicine professionals and include recognition and immediate response to head, neck, and spine injuries, as well as heat-related illnesses. The second recommendation is that youth sports leagues have clear, enforceable return to play guidelines for concussions, neck and back injuries, fractures, and dislocations. The third recommendation is that baseball and softball leagues consider the injury prevention potential of face guards on batting helmets.
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Comparative Study
Does parenchymal brain injury affect biobehavioral pain responses in very low birth weight infants at 32 weeks' postconceptional age?
Children with neurologic impairments have shown diminished pain response compared with control subjects; however, it remains unclear what mechanisms underlie this response or when it develops. If this were also true with premature infants who undergo neonatal intensive care, then infants with parenchymal brain injury (PBI) would be at increased risk of underrecognition and undertreatment of procedural pain. The purpose of this study was to determine whether infants with PBI display altered responses to acute procedural pain at 32 weeks' postconceptional age (PCA), compared with control subjects. ⋯ Contrary to expectations, we did not find any evidence of an altered pain response pattern in infants with proven brain injury in the neonatal period. Although most infants with PBI developed cerebral palsy, these findings suggest that cerebral injury predominantly to the central white matter leaves brainstem responses intact in the neonatal period. Furthermore, it seems that the injured brain of the preterm infant has not yet expressed the identifiable differences in pain display and the functional impairment observed at later ages.