La Pediatria medica e chirurgica : Medical and surgical pediatrics
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Randomized Controlled Trial Comparative Study Clinical Trial
[Analgesic efficacy of ketorolac and fentanyl in pediatric intensive care].
To evaluate the efficacy of the two different drugs (Ketorolac and Fentanyl), used singularly or in association, in the management of postoperative pain in Picu. ⋯ Ketorolac presents a good efficient analgesia, particularly evident when administered in continuous intravenous infusion. However, the association of this NSAID with an opioid drug can be favourably proposed in postoperative pain therapy of moderate to severe grade, since the confirmed analgesic efficacy is not aggravated by important side effects.
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Comparative Study
[Resuscitation in the delivery room: experience in 3 Veneto Centers].
On the basis of the classical USA guidelines for neonatal resuscitation, we examined the personnel activity in delivery room in 3 Veneto's Centres of different level (level I, II, III). Totally, we studied 3492 neonates in the period January, 1-December, 31, 1994. Three hundred and seven (8.7%) of them needed resuscitation at birth; respectively 5.6%, 4.6% and 14.2% in the level I, II and III Centres. ⋯ Furthermore, the physicians of the 3 examined Institutions followed no protocol for neonatal resuscitation. The differences in neonatal resuscitation policy among the 3 studied Centres demonstrate the absence of a protocol and an educational program for the personnel. Theoretical and practical guidelines for correct neonatal resuscitation have to be implemented in our Region.
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The epidemiology of hepatitis A, a disease endemic in various countries, is in a state of continuous change. Adults are more exposed to infection and considering the frequent absence of immunity, in contrast to children in whom the disease is almost always asymptomatic, the disease is often serious and prolonged with a mortality of up to 2.5%. The mode of transmission of HAV is predominantly the fecal-oral route; the virus is isolated during the prodromic period of the disease from the feces, blood, bile and seminal fluid. ⋯ The protection of the vaccine begins 14 days after administration and lasts from one month to one year. Numerous studies have been conducted which have shown that the vaccine is effective when given in 2 doses and confers protection against HAV for at least one year. The results have shown that the vaccination causes seroconversion in approximately 100% of subjects, and does not cause serious side effects and the acceptance of the vaccination worldwide has been good.
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Advance in the science and technology of neonatal and pediatric critical care have resulted in improved outcome for high risk newborn and children. Effective interhospital transport programmes are necessary for the appropriate use of resources and has become an integral component of regionalized perinatal care. It is now well established that use of an organized neonatal and pediatric transport team results in a fall in mortality and morbidity of infant. ⋯ Training of personnel, selection of equipment, organization and communication between hospitals are critical elements of a successful transport system. We present an overview of the role, principles and operating procedures of such neonatal-pediatric transport team and the basis of clinical stabilization before and during transfer. We also discuss data of the first 17 month experience of the Neonatal-Pediatric Transport Service of the Department of Pediatrics, University of Padua.
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Extracorporeal membrane oxygenation (ECMO) has become a nearly standard treatment for neonates with refractory hypoxemic respiratory failure due to various disease. Even though in the non-neonatal age the experience is less extensive, an increased widespread interest on the possible applications in children with severe life-threatening respiratory or cardiovascular insufficiency is well documented in the literature. ⋯ At present, nonetheless, more than 10.000 newborns and 1.000 children with severe respiratory insufficiency at high mortality risk have received an ECMO treatment, with a survival rate of more than 80% and 50%, respectively. The initial results of our ECMO program for both neonatal and pediatric patients with refractory respiratory failure are encouraging, both in terms of mortality and morbidity, and they will be briefly discussed.