Pediatrics
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Randomized Controlled Trial
A vancomycin-heparin lock solution for prevention of nosocomial bloodstream infection in critically ill neonates with peripherally inserted central venous catheters: a prospective, randomized trial.
Critically ill neonates are at high risk for vascular catheter-related bloodstream infection (CRBSI), most often caused by coagulase-negative staphylococci. Most CRBSIs with long-term devices derive from intraluminal contaminants. The objective of this study was to ascertain the safety and the efficacy of a vancomycin-heparin lock solution for prevention of CRBSI. ⋯ Prophylactic use of a vancomycin-heparin lock solution markedly reduced the incidence of CRBSI in high-risk neonates with long-term central catheters and did not promote vancomycin resistance but was associated with asymptomatic hypoglycemia. The use of an anti-infective lock solution for prevention of CRBSI with long-term intravascular devices has achieved proof of principle and warrants selective application in clinical practice.
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The purpose of this study was to examine the association between ambient air pollution and hospitalization for respiratory infections among children who were younger than 15 years in Toronto during a 4-year period (1998-2001). ⋯ Our study suggested a detrimental effect of relatively low levels of ambient particulate matter and gaseous pollutants, especially coarse particulate matter and NO2, on hospitalization for respiratory infections in children.
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Comparative Study
Ethnic differences in parent preference to be present for painful medical procedures.
To examine ethnic differences between white, black, and Hispanic (English-speaking and Spanish-speaking) parents in their desire to remain present during their children's painful medical procedures. ⋯ We found few ethnic differences in parents' desire to be present during their child's painful medical procedures. Overall, the vast majority of parents would prefer to remain present even for highly invasive procedures.
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Multicenter Study
Preterm infants with congenital heart disease and bronchopulmonary dysplasia: postoperative course and outcome after cardiac surgery.
Success in treatment of premature infants has resulted in increased numbers of neonates who have bronchopulmonary dysplasia (BPD) and require surgical palliation or repair of congenital heart disease (CHD). We sought to investigate the impact of BPD on children with CHD after heart surgery. ⋯ BPD has significant implications for children who have CHD and undergo cardiac surgery, leading to prolonged ICU and hospital stays, although most survivors are not O2 dependent. Postoperative mortality was highest among patients with univentricular hearts and severe BPD. Optimal timing of surgery and strategies to improve outcome remains to be delineated.
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The majority of deaths from unintentional injuries in children occur in the home environment, but there has not been a comprehensive analysis of residential deaths in the United States since 1985. The objective of this study was to determine the incidence and trends of deaths from injuries that occurred in the residential setting. ⋯ Despite a 22% decline since 1985, residential injuries remain a leading cause of death in US children and adolescents. Black children were 2 times more likely to die from residential injuries than white children.