European journal of pediatrics
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Our retrospective study presents and evaluates clinical ethics consultations (CECs) in pediatrics as a structure for implementing hospital-wide ethics. We performed a descriptive and statistical analysis of clinical ethics decision making and its implementation in pediatric CECs at Zurich University Children's Hospital. Ninety-five CECs were held over 5 years for 80 patients. ⋯ Patient autonomy was part of the ethical dilemma in only three CECs. The Zurich clinical ethics structure produced a 98 % intra-team consensus rate in 95 CECs and reduced initial team-parent dissensus from 21 to 10 %. Success depends closely on a standardized CEC protocol and an underlying institutional clinical ethics framework embodying a comprehensive set of transparently articulated values and opinions, with regular evaluation of decisions and their consequences for care teams and families.
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Review Meta Analysis
Risk factors for ventilator-associated pneumonia in the neonatal intensive care unit: a meta-analysis of observational studies.
Ventilator-associated pneumonia (VAP) is a common and serious problem among mechanically ventilated patients in intensive care units (ICU), especially for the newborn. However, limited literatures have been reviewed to synthesize the finding of previous papers to investigate the risk factors for VAP although it has been a serious complication of mechanical ventilation (MV) with a high morbidity and mortality in the newborn. We performed this meta-analysis to extend previous knowledge for developing VAP prevention strategies by identifying the potential risk factors related to VAP in the neonatal intensive care unit (NICU). The relevant literatures published up to July 2013 were searched in the databases of PubMed, Cochrane Central Register of Controlled Trials, Embase, and Web of Science. Three reviewers screened those literatures and extracted data according to the inclusion and exclusion criteria independently. A total of eight studies including 370 cases and 1,071 controls were identified. Ten risk factors were found to be related to neonatal VAP which were listed as follows in order by odds ratios (ORs): length of stay in NICU (OR 23.45), reintubation (OR 9.18), enteral feeding (OR 5.59), mechanical ventilation (OR 4.04), transfusion (OR 3.32), low birth weight (OR 3.16), premature infants (OR 2.66), parenteral nutrition (OR 2.30), bronchopulmonary dysplasia (OR 2.21), and tracheal intubation (OR 1.12). ⋯ We identified ten variables as independent risk factors for the development of VAP: length of stay in NICU, reintubation, enteral feeding, mechanical ventilation, transfusion, low birth weight, premature infants, parenteral nutrition, bronchopulmonary dysplasia, and tracheal intubation. Due to several limitations in the present study, further large and well-designed studies are needed to confirm the conclusion.
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This study was aimed to describe the epidemiology, clinical features, and prognosis of respiratory adenoviral infections among children in Suzhou, China. From 1 January 2006 to 31 December 2012, medical records of 474 hospitalized patients with respiratory adenovirus infection were reviewed retrospectively. From 2006 to 2012, the virus positive rate was 1.42, 0.82, 1.45, 1.54, 0.77, 1.63, and 0.78 %, respectively; there was no outbreak in Suzhou throughout the 7 years. Adenovirus was detected in almost every month of the year with a peak from March to August. The median age was 36 months (range, 2 days-13 years); 89 % of the infections were confined to children <7 years of age, positive rates in patients between 2 ∼ 7 years of age and patients >7 years of age were higher than that of patients <2 years of age (P < 0.002). Comparisons of the length of hospital stay using the log-rank test statistic demonstrated patients <2 years had a significantly longer length of hospital stay (P < 0.001). ⋯ The study demonstrates that respiratory adenovirus infection is an important cause of hospitalization in young children. Patients less than 2 years old were associated with prolonged hospitalization.
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Review Case Reports
Anterior cutaneous nerve entrapment syndrome (ACNES): the forgotten diagnosis.
The abdominal wall is an often overlooked source of pain in children with chronic abdominal pain. For example, abdominal wall pain can be caused by the abdominal cutaneous nerve entrapment syndrome (ACNES). ACNES occurs in children as well as adults. In pediatrics, this diagnosis is largely unknown. ACNES is characterized by a sharp stabbing pain which characteristically increases with the use of abdominal muscles (Carnett's sign). The pain is usually located in the lower right quadrant. Very often patient go through a long clinical track, sometimes leading to frequent hospitalizations and unnecessary examinations. In some cases, children even end up in the psychiatric circuit because of misunderstood pain symptoms. We describe three illustrative cases of abdominal pain in which eventually ACNES was diagnosed and successfully treated with infiltration of an anesthetic agent, and we also performed a literature search. ⋯ ACNES is a relatively unknown cause of abdominal pain in children. Diagnosis and treatment of ACNES are simply by local injection of anesthetics into the abdominal wall.
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Recombinant soluble human thrombomodulin (TM-α) has been shown to be useful in the treatment of disseminated intravascular coagulation (DIC) in a heparin-controlled study and has been available for clinical use in Japan since 2008. However, data on its use for neonatal DIC have not been reported from any clinical studies, so efficacy and safety were analyzed in 60 neonatal DIC patients identified in post-marketing surveillance. The DIC resolution rate as of the day after last administration of TM-α was 47.1 %, and the survival rate at 28 days after last administration was 76.7 %. Hemostatic test result profiles revealed decreased levels of fibrin/fibrinogen degradation products and increased platelet counts and antithrombin activity. Incidences of adverse drug reactions, bleeding-related adverse drug reactions, and bleeding-related adverse events were 6.7, 6.7, and 16.7 %, respectively, with no significant differences between neonatal, pediatric (excluding neonates), and adult DIC patients. ⋯ This surveillance provided real-world data on the safety and effectiveness of TM-alpha in the treatment of neonatal DIC in general practice settings.