American journal of diseases of children (1960)
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We reviewed our experience with home monitor observations of 83 preterm infants (postconceptional age, 36 to 44 weeks) who had persistent apnea, bradycardia, or cyanosis. Polygraphic recordings before discharge showed that 92% of these infants had cardiorespiratory abnormalities that included prolonged (greater than 20 s) apnea, excessive periodic breathing (greater than 15%), bradycardia (greater than 80 beats per minute), feeding hypoxemia, or elevated carbon dioxide values. ⋯ While polygraphic studies were helpful in documenting specific cardiorespiratory abnormalities, neither these abnormalities nor the clinical characteristics of the infants identified those infants experiencing subsequent home monitor alarms requiring parental intervention. Our data suggest that some preterm infants with persistent episodes of apnea, bradycardia, and cyanosis beyond 36 weeks of postconceptional age remain at risk for future serious episodes for several months.
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This study evaluates emergency room (ER) triage at a large urban children's hospital, in which patients are routinely referred outside of the institution for care. Seven hundred forty-eight children from 1 week to 17 years of age were enrolled in the study over a six-week period. Nearly two thirds (61%) of the patients were sent outside of the hospital for care; 31% of the patients were sent to community health centers, 17% were sent to private physicians' offices, 13% were sent home (self-care), and only 9% were treated in the ER. ⋯ The physician's diagnosis agreed with the triage nurse's diagnosis or was less serious than the nurse's diagnosis in 93.4% of patients. At two weeks after triage, nearly all patients had completely recovered, with no correlation of symptoms with level or site of care. This study indicates that nurse triage of pediatric walk-in patients, in which three of five patients are referred outside of the hospital for care, is a safe and effective alternative to care in the ER and, at the same time, serves to reinforce community health centers as the appropriate setting for primary care.
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Randomized Controlled Trial Comparative Study Clinical Trial
Outpatient oral rehydration in the United States.
Twenty-nine dehydrated, well-nourished infants, who were 3 to 24 months of age and had acute gastroenteritis, were enrolled in a prospective randomized study that compared the safety, efficacy, and costs of oral vs intravenous rehydration. The study was designed to assess the use of a holding room in the emergency room for the outpatient rehydration of dehydrated infants. The oral solution that was used contained 60 mEq/L of sodium, 20 mEq/L of potassium, 50 mEq/L of chloride, 30 mEq/L of citrate, 20 g/L of glucose, and 5 g/L of fructose. ⋯ Outpatient oral rehydration therapy was significantly less costly than inpatient intravenous therapy (+272.78 vs +2,299.50). Our results indicate that oral rehydration is a safe and cost-effective means of treating dehydrated children in an outpatient setting in the United States. The use of a holding room for observation in the emergency room can markedly decrease health care costs and unnecessary hospitalizations.
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Effectiveness of a protocol for intravenous (IV) access during pediatric resuscitation was prospectively evaluated to determine whether utilization of a specified sequence of measures would reduce IV access time compared with resuscitations deviating from the protocol. The protocol involved rapid sequential attempts at percutaneous femoral vein catheterization, saphenous vein cutdown, and intraosseous infusions if initial percutaneous peripheral IV insertion failed. ⋯ Even with incomplete compliance, 66% of resuscitations achieved IV access within the first five minutes. Our experience indicates that IV access during pediatric resuscitation should rarely be delayed beyond the fifth minute if all available IV techniques are used.
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Motor vehicle injuries are the leading causes of death and disability in childhood after age 1 year. Educational efforts by physicians and public policy have focused on the protection of motor vehicle occupants. However, fatal pedestrian injuries are more common than fatal occupant injuries in preschool and school-aged children. ⋯ Multidisciplinary accident investigation, which involves physicians, traffic engineers, psychologists, and social scientists, is most likely to provide the information needed to develop candidate educational and environmental strategies for study. Prevention of child pedestrian injury is a challenge that has not yet been addressed by pediatricians or policymakers. Pediatricians can promote and direct a national focus on this area that has been understudied by researchers, public health officials, and policymakers.