Pediatrics international : official journal of the Japan Pediatric Society
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Many drugs used for neonates are unlicensed or off-label. An increased risk of medication errors and unexpected adverse drug reactions is associated with their use. This risk is even higher in preterm newborns, because of their physiological immaturity and the exposure to many different medicines. The objective of this study was to evaluate the use of unlicensed or off-label drugs in eight tertiary-level neonatal intensive care units (NICU) from two different southern Italian regions. ⋯ The use of unlicensed or off-label drugs use is common practice in NICU, with wide variation in local policies and newborn characteristics. Well-designed and -conducted pharmaceutical studies in newborns are needed to increase the number of licensed drugs, thereby reducing any risk for patients due to over- or under-treatment, and also legal issues for clinicians.
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Case Reports
Neonatal case of classic maple syrup urine disease: usefulness of (1) H-MRS in early diagnosis.
We describe a male neonate with classic maple syrup urine disease (MSUD) in metabolic crisis. On day 7 of life, he was referred to hospital because of coma and metabolic acidosis with maple syrup odor. On day 4 after admission, brain magnetic resonance imaging findings were consistent with encephalopathy due to MSUD. ⋯ The diagnosis of MSUD was confirmed on low branched-chain α-keto acid dehydrogenase complex activity in lymphocyte. (1) H-MR spectra were obtained in 10 min, while it took at least several days to obtain the results of other diagnostic examinations. In convalescence, the peak at 0.9 p.p.m. decreased. The large methyl resonance peak at 0.9 p.p.m. in brain (1) H-MRS would be one of the earliest clues to the diagnosis of classic MSUD in the neonatal period, especially in metabolic crisis.
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The aim of this study was to investigate the integration of ultrasound (US) findings with Alvarado score in diagnosing or excluding acute appendicitis. ⋯ In the case of non-visualization of the appendix without a high Alvarado score, appendicitis can be safely ruled out.
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The aim of this study was to assess correlations between demographic, clinical and laboratory characteristics and the risk of serious bacterial infection (SBI) in febrile <90-day-old infants. ⋯ Of the clinical and laboratory variables selected for evaluation, qualitative CRP was the strongest independent predictor for diagnosing SBI and a significantly better diagnostic marker than clinical characteristics, ANC and white blood cell count.
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Comparative Study
Use of non-invasive total hemoglobin measurement as a screening tool for anemia in children.
Universal screening for anemia is important in children, but invasive blood sampling is required. A new device (Radical-7® Pulse CO-Oximeter™, Masimo, Irvine, CA, USA) now enables non-invasive hemoglobin concentration (SpHb) measurement to be done, but the usefulness of this device for anemia screening in children is unclear. The objective of this study was to compare SpHb with complete blood count (CBC) using a hematology analyzer (Microsemi® LC-667CRP; Fukuda Denshi, Tokyo, Japan). ⋯ The correlation of Radical-7® and Microsemi® was 0.602 (P < 0.0001). On Bland-Altman comparison, bias was -0.6 ± 1.1 g/dL. Even though further improvement is required, Radical-7® offers many possibilities in the context of primary screening.