Current opinion in pediatrics
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Ethylene glycol is a serious toxin that children frequently ingest. Diagnosis and treatment of this poisoning are challenging and frequently involve the use of novel therapies. In the past year, fomepizole (4-methylpyrazole) has been approved for use as an antidote in the treatment of ethylene glycol poisoning in adults, and the first article reporting the use of fomepizole in a pediatric ethylene glycol exposure was published. As a result, the therapy of ethylene glycol poisoning in children is likely to change from the traditional approach of ethanol administration coupled with hemodialysis to the administration of fomepizole with or without hemodialysis.
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Curr. Opin. Pediatr. · Jun 1999
ReviewHypoxic-ischemic brain injury: advancements in the understanding of mechanisms and potential avenues for therapy.
Hypoxic-ischemic brain injury occurs frequently in infancy and childhood. Events such as perinatal asphyxia, near drowning, respiratory arrest, and near sudden infant death syndrome cause significant mortality and morbidity. Despite current critical care practices, the outcomes from such injuries may be life-long neurologic deficits. ⋯ The development of new therapies for hypoxic-ischemic brain injury depends on such understanding. To date, the results of preclinical therapeutic trials have not demonstrated a "magic bullet." Nevertheless, the understanding of injury mechanisms has uncovered potential avenues for new therapies, particularly combination therapies or single interventions that have multiple effects. Clinical trials, using these strategies, are planned or have been recently begun and offer hope for advancements in treatment.
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Pediatric interstitial lung disease comprises a diverse group of rare conditions characterized by an infiltrative process, abnormal gas exchange, and restrictive lung disease. Although the disorder is similar to its adult counterpart, its course is complicated by the continued need for lung growth and differentiation in infants and children. ⋯ Clinicians continue to define the various types of interstitial lung disease and to evaluate the roles of bronchoalveolar lavage, radiography, and biopsy in diagnosis. Together, investigators are working toward the development of specific, targeted therapy that will reduce the significant morbidity and mortality seen in pediatric interstitial lung disease.
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Over the last 10 years, there has been a fundamental change in physicians' attitudes toward analgesia and sedation in pediatrics. In this time, basic and clinical research have provided a wealth of information. ⋯ Fortunately, the attitude of physicians toward these matters has changed significantly and much more attention is now paid to the alleviation of pain and provision of adequate sedation. However, there remains, according to most estimates, incongruity between these advances and what is practiced clinically.
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Curr. Opin. Pediatr. · Jun 1999
ReviewHyperbaric oxygen therapy in childhood carbon monoxide poisoning.
Hyperbaric oxygen therapy is the administration of 100% oxygen at pressures two to three times ambient pressure, and it significantly increases dissolved oxygen content. Although it has been used successfully to treat decompression illness and arterial air embolism, its role in the treatment of carbon monoxide poisoning remains somewhat controversial. ⋯ This review focuses on the unique aspects of carbon monoxide poisoning and hyperbaric oxygen therapy in the fetus, the newborn, the infant, and the child. In addition, it discusses general indications for and special and practical considerations in the use of hyperbaric oxygen therapy in children.