Pediatric research
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Randomized Controlled Trial Multicenter Study Comparative Study
Effect of inborn vs. outborn delivery on neurodevelopmental outcomes in infants with hypoxic-ischemic encephalopathy: secondary analyses of the NICHD whole-body cooling trial.
The effect of birth location on hypothermia-related outcomes has not been rigorously examined in the literature. In this study, we determined whether birth location had an impact on the benefits of whole-body cooling to 33.5 °C for 72 h in term infants (n = 208) with hypoxic-ischemic encephalopathy (HIE) who participated in the Neonatal Research Network (NRN) randomized controlled trial. ⋯ Although limited by sample size and some differences in baseline characteristics, the study showed that birth location does not appear to modify the treatment effect of hypothermia after HIE.
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Randomized Controlled Trial Multicenter Study
Seven- to eight-year follow-up of the CoolCap trial of head cooling for neonatal encephalopathy.
We sought to determine whether 18- to 22-mo neurodevelopmental outcomes predicted functional outcomes at 7-8 y for survivors of the CoolCap study of therapeutic hypothermia for neonates with hypoxic-ischemic encephalopathy. ⋯ All surviving children who participated in the CoolCap study and were assessed at 18 mo were eligible for reassessment using the WeeFIM instrument that qualitatively measures self-care, mobility, and cognitive function. Center investigators obtained consent from the families for a certified researcher to administer the WeeFIM instrument by phone.
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Randomized Controlled Trial
Television viewing at mealtime reduces caloric compensation in peripubertal, but not postpubertal, girls.
The effect of television viewing (TVV) and pubertal status of 9- to 14-y-old girls on mealtime food intake (FI) after a premeal glucose drink was determined. On four separate mornings, girls randomly received equally sweetened drinks containing Sucralose (control) or glucose (1.0 g/kg body weight) in 250 mL of water 2 h after a standardized breakfast. FI from an ad libitum pizza meal was measured 30 min later with or without TVV. ⋯ In postpubertal girls (n = 8), glucose reduced FI by ~27% in both the no TVV and TVV conditions, but in peripubertal girls (n = 17), reduction in FI was 22% without TVV and only 1% while TVV. Appetite correlated with FI at 30 min only in postpubertal girls. TVV at mealtime reduced caloric compensation after consumption of the glucose drink in peripubertal, but not postpubertal, girls, with no effect on mealtime FI. (Clinical trial number NCT01025687.)
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Randomized Controlled Trial
Improved cerebral oxygen saturation and blood flow pulsatility with pulsatile perfusion during pediatric cardiopulmonary bypass.
Brain monitoring techniques near-infrared spectroscopy (NIRS) and transcranial Doppler (TCD) ultrasound were used in pediatric patients undergoing cardiopulmonary bypass for congenital heart defect (CHD) repair to analyze the effect of pulsatile or nonpulsatile flow on brain protection. Regional cerebral oxygen saturation (rSO2) and cerebrovascular pulsatility index (PI) were measured by NIRS and TCD, respectively, in 111 pediatric patients undergoing bypass for CHD repair randomized to pulsatile (n = 77) or nonpulsatile (n = 34) perfusion. ⋯ Patients undergoing pulsatile perfusion had numerically lower decreases in PI from baseline for the majority of time points compared with the nonpulsatile group, with significant ∼30% lower decreases between 5 and 40 min after crossclamp. Pulsatile flow has advantages over nonpulsatile flow as measured by NIRS and TCD, especially at advanced time points, which may improve postoperative neurodevelopmental outcomes.
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Randomized Controlled Trial
Effect of topical emollient treatment of preterm neonates in Bangladesh on invasion of pathogens into the bloodstream.
Topical emollient therapy may reduce the incidence of serious infections and mortality of preterm infants in developing countries. We tested whether emollient therapy reduced the burden of pathogens on skin and/or prevented bacterial translocation. Neonates <33 wk gestational age were randomized to treatment with sunflower seed oil (SSO) or Aquaphor or the untreated control group. ⋯ Skin condition scores at 3 d were better in patients treated with either emollient compared with untreated controls; however, skin flora was similar across the groups. The SSO group showed a 72% elevated odds of having a false-positive (FP) skin culture associated with a negative blood culture (i.e. skin flora blocked from entry into blood) compared with the control group. Topical therapy with SSO reduced the passage of pathogens from the skin surface into the bloodstream of preterm infants.