Pediatrics
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Multicenter Study
Conflicts about end-of-life decisions in NICUs in the Netherlands.
To determine the frequency and background of conflicts about neonatal end-of-life (EoL) decisions. ⋯ The parents were involved in all EoL decision-making processes, and consensus was ultimately reached in all cases. Conflicts within the team occurred in 4% of the cases and between the team and the parents in 12% of the cases. The conflicts were resolved by postponing the EoL decision until consensus was achieved.
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Multicenter Study
Diagnostic value of immature neutrophils (bands) in the cerebrospinal fluid of children with cerebrospinal fluid pleocytosis.
We evaluated the diagnostic utility of the presence and number of cerebrospinal fluid (CSF) bands in distinguishing bacterial from aseptic meningitis among children with CSF pleocytosis. ⋯ In this multicenter study, neither the presence nor quantity of CSF bands independently predicted bacterial meningitis among children with CSF pleocytosis.
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Randomized Controlled Trial Multicenter Study
Clonidine as an adjunct therapy to opioids for neonatal abstinence syndrome: a randomized, controlled trial.
To determine if oral clonidine would reduce the duration of opioid detoxification for neonatal abstinence syndrome. ⋯ In this randomized, double-blind trial, adding clonidine to standard opioid therapy for detoxification from in utero exposure to methadone or heroin reduced the duration of pharmacotherapy for neonatal abstinence without causing short-term adverse cardiovascular outcomes. A larger trial is indicated to determine long-term safety.
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Multicenter Study Comparative Study
Child abuse training and knowledge: a national survey of emergency medicine, family medicine, and pediatric residents and program directors.
The objective of this study was to determine the level of knowledge, comfort, and training related to the medical management of child abuse among pediatrics, emergency medicine, and family medicine residents. ⋯ By analyzing the relationship between program characteristics and residents' child abuse knowledge, we found that pediatric programs provide far more training and resources for child abuse education than emergency medicine and family medicine programs. As leaders, pediatricians must establish the importance of this topic in the pediatric education of residents of all specialties.
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The diagnostic labeling of presumed nonbacterial lower respiratory tract infection is unclear. Our objective was to identify patterns of specific diagnoses and treatments that were given to children who presented with lower respiratory tract infection to US academic emergency departments. ⋯ For children who are age <2 years and present to an emergency department with lower respiratory tract infection symptoms, there is large variability in the assigned diagnosis. Children who present to emergency departments that more commonly diagnose lower respiratory tract infection as "asthma" are more likely to receive corticosteroids. As clinicians, we need to develop evidence- and outcome-based definitions for lower respiratory tract infections to guide diagnosis and treatment better.