Minerva pediatrica
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Early recognition of shock is the key to successful resuscitation in critically ill children. Often, shock results in or co-exists with myo-cardial dysfunction or acute lung injury. Recognition and appropriate management of these insults is crucial for successful outcomes. ⋯ Management of co-morbidities such as asthma and seizures should be implemented simultaneously. Inotropes, respiratory support, antibiotics and steroids may also be needed during the management of shock. While the management of shock can be protocol based, the treatment needs to be individualized depending on the suspected etiology and therapeutic response.
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The natural history of allergic disease and its potential for prevention merit close examination because of the explosive worldwide increase in the prevalence and morbidity of atopic disorders. In infants from ''high-risk'' families (i.e. those with one or two parents and/or a sibling with food allergy, eczema, asthma or allergic rhinitis) food allergen avoidance has been advocated as means of preventing the development of atopic disease. ⋯ When breast-feeding is not possible or supplemental feeding is needed, infants from atopic families should be given a hydrolyzed infant formula for the first 6 month of life. High-risk infants without a history of eczema in a primary relative will receive the protective effect from the less expensive partial hydrolyzed formula (p-HF); whereas those infants who have first-degree relatives with eczema should receive the extensively hydrolyzed formula (e-HF).
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Respiratory failure is common in the preterm infant. Support of the infant with oxygen, positive pressure, and assisted ventilation are among the commonest interventions required in neonatal care. This article is an overview of many features of respiratory care of the preterm infant, including the goals of therapy, continuous positive airways pressure (CPAP), non-invasive ventilation, various modes of ''conventional'' ventilation, high frequency ventilation and inhaled nitric oxide use. ⋯ Many prospective trials have been performed which, in general, have failed to demonstrate a significant additional benefit of any newer mode of ventilation over conventional time-cycled pressure limited ventilation. Many of the currently available modes of respiratory support have never been subjected to adequate study. Newer modes of respiratory support including such innovations as volume targeted ventilation, pressure support ventilation, and inhaled nitric oxide use in the preterm, require further investigation prior to their adoption for routine clinical use.
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A large proportion of premature infants presents with acute respiratory failure after birth and require mechanical ventilatory support. In addition to conventional mechanical ventilation, an increasing number of these infants are currently supported by newer modes including synchronized, volume targeted and noninvasive mechanical ventilation. While these new modes have improved weaning from mechanical ventilation they have not had a consistent impact on respiratory outcome or other morbidities. This is a review of the different modes of invasive and noninvasive mechanical ventilation used to support premature infants with respiratory failure.
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Mechanical ventilation, while accepted as standard therapy for critically ill infants and children with respiratory failure, has significant morbidity and mortality. While recent emphasis on low tidal volume ventilation and low airway pressures may result in decreased lung stretch and limit lung disease, adjunctive therapies have been tried to reduce the stressors of mechanical ventilation. Therapies included inhaled nitric oxide, heliox and surfactant. ⋯ However, our understanding of their role is hindered by studies with small numbers of patients and its use in diseases with varied pulmonary pathology. Studies have shown potential for benefit of inhaled nitric oxide in newborns with hypoxemic respiratory failure and pulmonary hypertension, surfactant in respiratory distress syndrome in preterm neonates and heliox in severe upper airway obstruction. However, the use in other respiratory conditions has led to mixed results and hence paucity of firm recommendations.