Pediatrics
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Review Practice Guideline
A practice pathway for the identification, evaluation, and management of insomnia in children and adolescents with autism spectrum disorders.
This report describes the development of a practice pathway for the identification, evaluation, and management of insomnia in children and adolescents who have autism spectrum disorders (ASDs). ⋯ The insomnia practice pathway may help health care providers to identify and manage insomnia symptoms in children and adolescents who have ASD. It may also provide a framework to evaluate the impact of contributing factors on insomnia and to test the effectiveness of nonpharmacologic and pharmacologic treatment strategies for the nighttime symptoms and daytime functioning and quality of life in ASD.
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Multicenter Study
Variation in occult injury screening for children with suspected abuse in selected US children's hospitals.
To describe variation across selected US children's hospitals in screening for occult fractures in children <2 years old diagnosed with physical abuse and in infants <1 year old who have injuries associated with a high likelihood of physical abuse. ⋯ The observed variation in screening for occult fractures in young victims of physical abuse and infants who have injuries associated with a high likelihood of abuse underscores opportunities to improve the quality of care provided to this vulnerable population.
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Randomized Controlled Trial
Metformin's effect on first-year weight gain: a follow-up study.
The impact of metformin medication in pregnant women with polycystic ovary syndrome on weight gain during pregnancy and after delivery and the impact on growth of the offspring are essentially unexplored. ⋯ Women randomized to metformin were heavier in the first trimester, gained less weight in pregnancy, and lost less weight in the first year postpartum compared with women randomized to placebo. Children exposed to metformin weighed more at 1 year of age.
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Control of pain and stress for children is a vital component of emergency medical care. Timely administration of analgesia affects the entire emergency medical experience and can have a lasting effect on a child's and family's reaction to current and future medical care. A systematic approach to pain management and anxiolysis, including staff education and protocol development, can provide comfort to children in the emergency setting and improve staff and family satisfaction.
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Procalcitonin (PCT) has been introduced in many European protocols for the management of febrile children. Its value among young, well-appearing infants, however, is not completely defined. Our objective was to assess its performance in diagnosing serious bacterial infections and specifically invasive bacterial infections (IBIs) in well-appearing infants aged <3 months with fever without source (FWS). ⋯ Among well-appearing young infants with FWS, PCT performs better than CRP in identifying patients with IBIs and seems to be the best marker for ruling out IBIs. Among patients with normal urine dipstick results and fever of recent onset, PCT remains the most accurate blood test.