Pediatrics
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Previous studies suggested that parents frequently do not adequately treat postoperative pain that is experienced at home. Reasons for these parental practices have not been extensively studied. Aims of this study were to examine parental postoperative pain assessment and management practices at home as well potential attitudinal barriers to such pain practices. ⋯ Parents detected pain in their children yet provided few doses of analgesics. Parents may benefit from interventions that provide them with information that addresses individual barriers regarding assessing and treating pain.
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Here we describe a case of propofol-related infusion syndrome (PRIS) in a child with malignant refractory status epilepticus treated with partial-exchange blood transfusion (PEBT), an innovative method of resuscitation that has the potential to reduce the mortality rate associated with this syndrome. Our patient is a 4-year-old boy with malignant status epilepticus associated with bacterial meningitis. Propofol was used because of persistent seizure activity refractory to adequate doses of phenytoin, phenobarbital, levetiracetam, and midazolam infusion at 0.7 mg/kg per hour. ⋯ PEBT corrected all the cardiac abnormalities and returned enough hemodynamic stability to permit continuous veno-venous hemodialysis for renal failure and removal of toxins. PEBT is a safe and innovative option for correcting the metabolic abnormalities that result in cardiac dysfunction, which is typically the most serious and usually terminal event in PRIS. When done with small aliquots, it avoids the severe hemodynamic instability that is usually a hindrance with hemodialysis, continuous veno-venous hemodialysis, and extracorporeal membrane oxygenation, which are other methods of supporting these children during the crisis that are mentioned in the literature.
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Outcomes of pediatric button battery ingestions have worsened substantially, predominantly related to the emergence of the 20-mm-diameter lithium cell as a common power source for household products. Button batteries lodged in the esophagus can cause severe tissue damage in just 2 hours, with delayed complications such as esophageal perforation, tracheoesophageal fistulas, exsanguination after fistulization into a major blood vessel, esophageal strictures, and vocal cord paralysis. Thirteen deaths have been reported. The objective of this study was to explore button battery ingestion scenarios to formulate prevention strategies. ⋯ Parents and child care providers should be taught to prevent battery ingestions. Because 61.8% of batteries that were ingested by children were obtained from products, manufacturers should redesign household products to secure the battery compartment, possibly requiring a tool to open it.
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Neonatal resuscitation guidelines recommend techniques to minimize heat loss in the delivery room. The use of humidified and heated gas is standard of care for preterm infants who need respiratory support in the NICU, but international resuscitation guidelines do not stipulate use of this therapy during stabilization at birth. We aimed to investigate the effect of humidified and heated gas on admission temperature in preterm infants who require respiratory support at birth. ⋯ The use of heated and humidified air during respiratory support in very preterm infants just after birth reduced the postnatal decrease in temperature. Heating and humidifying the gas during stabilization merits additional investigation.
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Recent cases suggest that severe and fatal button battery ingestions are increasing and current treatment may be inadequate. The objective of this study was to identify battery ingestion outcome predictors and trends, define the urgency of intervention, and refine treatment guidelines. ⋯ Revised treatment guidelines promote expedited removal from the esophagus, increase vigilance for delayed complications, and identify patients who require urgent radiographs.