Pediatric blood & cancer
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Thromboembolism in children is typically treated with unfractionated heparin (UH) or low molecular weight heparin (LMWH). Both rely on antithrombin (AT) for their action. In addition, heparin-induced thrombocytopenia (HIT) is a potentially serious complication of heparin use in children. Bivalirudin or other direct thrombin inhibitors may be a useful alternative to heparins in treating thrombosis in children. ⋯ Bivalirudin was effective and well-tolerated in these patients. Further studies should be conducted to better define safety and efficacy of bivalirudin in pediatric patients.
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Pediatric blood & cancer · Nov 2008
The morbidity and mortality of pediatric oncology patients presenting to the intensive care unit with septic shock.
Children with an underlying diagnosis of malignancy are at high risk for developing serious infections. Previous studies, although very limited in number, suggest a particularly poor outcome for these patients if admitted to an intensive care unit with septic shock. ⋯ This review found that the survival of oncology patients admitted to the PICU with septic shock was not significantly different from control patients, and was significantly higher than previous reports. Aggressive management of these children is warranted as their long term prognosis may be much more favorable than originally thought.
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Pediatric blood & cancer · Nov 2008
Randomized Controlled TrialPediatric oncology sedation trial (POST): A double-blind randomized study.
There is limited evidence to support the use of an anti-emetic with the administration of intra-thecal chemotherapy. Nor is there adequate clarity on analgesic strategies for children with cancer undergoing painful procedures. ⋯ This study provides evidence that the addition of an analgesic (fentanyl) and an anti-emetic (ondansetron) to the combination of a sedative (midazolam) and an anesthetic (propofol) is of measurable benefit in children who undergo procedures that are painful and risk the consequence of nausea and vomiting.
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Pediatric blood & cancer · Sep 2008
Day hospital versus inpatient management of uncomplicated vaso-occlusive crises in children with sickle cell disease.
Day hospital (DH) management for patients with sickle cell disease (SCD) experiencing uncomplicated vaso-occlusive pain crises has been utilized as an alternative care delivery system to inpatient hospitalization. The objective of this study was to determine whether DH management results in shorter length of stay compared to inpatient care. ⋯ We conclude that a dedicated DH facility has the potential to provide efficient and timely management of uncomplicated VOCs through reduction of length of stay. This delivery care system may be particularly relevant for children who are significantly impacted by inpatient hospitalization.