Articles: child.
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J. Cardiothorac. Vasc. Anesth. · Dec 2024
Review Meta AnalysisLocal Adverse Events Associated with Peripheral Vasoactive Infusion in Children: A Systematic Review with Meta-analysis.
Prior meta-analysis suggested a low incidence of local adverse events after infusion of vasoactive agents via a peripheral venous catheter in children. However, the number of included patients was relatively low, and the vasoactive agents used were mostly dopamine. We performed an updated systematic review with meta-analysis using databases of MEDLINE (via PubMed) and Cochrane Central Register of Controlled Trials to explore the safety of infusing vasoactive agents, including epinephrine and norepinephrine, through peripheral venous catheters or intraosseous access in critically ill children. ⋯ The pooled incidence rates of local adverse events associated with infusion of vasoactive agents through peripheral venous catheters or intraosseous access, peripheral venous catheters only, and intraosseous access only were 2.1% (95% confidence interval [CI]: 0.8%-3.9%), 2.3% (95% CI: 1.0%-4.0%), and 1.1% (95% CI: 0.0%-9.8%), respectively. Based on the findings of this meta-analysis, the incidence rate of local adverse events associated with peripheral vasoactive infusion appears to be low. Peripheral infusion of vasoactive agents, including epinephrine and norepinephrine, can be considered when necessary.
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Observational Study
Region-specific changes in brain glutamate and gamma-aminobutyric acid across the migraine attack in children and adolescents.
In patients with migraine, an excitation-inhibition imbalance that fluctuates relative to attack onset has been proposed to contribute to the underlying pathophysiology of migraine, but this has yet to be explored in children and adolescents. This prospective, observational, cohort study examined glutamate and gamma-aminobutyric acid (GABA) levels across the phases of a migraine attack and interictally in children and adolescents using magnetic resonance spectroscopy. Macromolecule-suppressed GABA (sensorimotor cortex and thalamus) and glutamate (occipital cortex, sensorimotor cortex, and thalamus) were measured in children and adolescents (10-17 years) with a migraine diagnosis with or without aura 4 times over 2 weeks. ⋯ In the 24 hours post headache onset, sensorimotor glutamate continued to decrease. Our results suggest changes in glutamate and GABA that are consistent with the thalamocortical dysrhythmia hypothesis. These findings provide insight into developmental migraine pathophysiology and may open future avenues for treatment targets specific to children and adolescents.
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Practice Guideline
Clinical guideline highlight for the hospitalist: Diagnosis and management of acute bacterial arthritis in children.
Clinical Practice Guideline by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA): 2023 Guideline on Diagnosis and Management of Acute Bacterial Arthritis RELEASE DATE: January 1, 2024 PRIOR VERSION(S): n/a DEVELOPER: Pediatric Infectious Diseases Society (PIDS), Infectious Diseases Society of America (IDSA) FUNDING SOURCE: PIDS and IDSA TARGET POPULATION: Children with suspected or confirmed acute bacterial arthritis.
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Eur J Trauma Emerg Surg · Dec 2024
Is cross-sectional imaging necessary for fractures of the distal lower leg in children and adolescents: results of a nationwide survey.
In childhood and adolescence, cross-sectional imaging, most commonly computed tomography (CT), is often performed for advanced diagnosis of joint injuries of the distal lower leg and upper ankle. Due to radiation exposure, the need for CT remains controversial, as these injuries follow stereotypies and usually have a similar course. Alternatively, the performance of magnetic resonance imaging (MRI) is also discussed. Since radiation sensitivity at this young age is much higher than in adults, an effort must be to minimize radiation exposure according to as low as reasonably achievable (ALARA) principles. The aim of this survey is to evaluate the current procedure in Germany in the diagnosis of pediatric injuries of the distal lower leg and upper ankle. ⋯ The survey showed that the conventional X-ray is still the gold standard. Interestingly, more than half of the respondents regularly use the Ottawa Ankle Rules, and diagnostics using ultrasound are also used by almost a quarter. Awareness of radiation protection in children exists, although a quarter of all participants do not know the extent to which their radiology department has a specific pediatric protocol for CT imaging. Cross-sectional imaging is performed on a regular basis. Regarding the actual extent of imaging, there is a clear divergence between theory and practice.
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Observational studies have linked low vitamin D (VD) levels to increased asthma attacks in children. Subsequent meta-analyses of adults and children revealed that VD treatment might benefit asthmatic patients by reducing the incidence of exacerbations. Therefore, this review aims to analyze the effects of VD supplementation in reducing asthma exacerbations in children. ⋯ Vitamin D supplementation can lower the occurrence of exacerbations in children with asthma, along with the improvement of FEV1.