Current opinion in pediatrics
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Curr. Opin. Pediatr. · Jun 2000
ReviewPediatric cardiac intensive care: current state of the art and beyond the millennium.
Pediatric cardiac intensive care has emerged as a distinct clinical entity to meet the unique needs of pediatric patients with congenital and acquired heart disease. This new subspecialty demands expertise and experience in the pediatric subspecialties of cardiology, intensive care, cardiac surgery, cardiac anesthesia, neonatology, and others. Ten recent developments will have an impact on pediatric cardiac intensive care for the coming decades: 1) emergence of new patient populations; 2) new clinical methodologies in the treatment of pulmonary hypertension; 3) innovations in techniques of respiratory support; 4) expanding research of single ventricle physiology; 5) advances in the treatment of heart failure; 6) improved noninvasive imaging; 7) new directions in interventional cardiac catheterization; 8) new techniques in pediatric cardiac surgery; 9) use of computer technology and intensive care monitoring; and 10) appreciation for global economics of intensive care. Finally, a multidisciplinary approach with a team esprit de corps remains vital to a successful pediatric cardiac intensive care program.
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Curr. Opin. Pediatr. · Jun 2000
ReviewPeriodic fever, aphthous stomatitis, pharyngitis, adenitis: a clinical review of a new syndrome.
Periodic fevers (fevers that occur predictably at fixed intervals) are unusual in infants and children. The classic periodic fever syndrome is cyclic neutropenia (neutropenia followed by infections and fever that recur every 21 days). A new periodic fever syndrome PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis) has been characterized over the past decade. ⋯ An episode of PFAPA can be aborted with one or two small doses of prednisone. The episodes of PFAPA may last for years and the patient is well between episodes. The cause of PFAPA is unknown and there are no reported sequelae.
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Sleep-disordered breathing, particularly the obstructive sleep apnea syndrome, is common during childhood. Complications include neurocognitive deficits, growth failure, and pulmonary hypertension. ⋯ Polysomnography is invaluable for the evaluation of sleep-disordered breathing. Advances in diagnosis and management can alleviate much of the morbidity previously associated with sleep-related respiratory disorders.
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Curr. Opin. Pediatr. · Jun 2000
ReviewProblems associated with intravenous fluid administration in children: do we have the right solutions?
Edema, both in its cellular and tissue form, is a frequent complication in critically ill patients. In health, a balance is struck between intracellular and extracellular osmotic forces and interstitial and intravascular oncotic forces, which in turn governs fluid distribution between the intracellular, extracellular and interstitial fluid compartments. The use of hypo- and hypernotic electrolyte solutions has major effects on brain cells, which can be detrimental or beneficial. The controversy over the use of colloids versus crystalloid solutions in critically ill patients remains unresolved.
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Of utmost importance in the practice of neurological critical care is the treatment of cerebral edema, when possible, and the control of life-threatening seizures. In this regard, severe traumatic head injury and refractory status epilepticus are useful clinical therapeutic paradigms. Evidence-based treatment established for these conditions has, by necessity, a wider application to other much less frequent causes of coma and acute neurological illness managed in the intensive therapy unit. Therefore, this review of pediatric neurocritical care literature in 1999 highlights central clinical reports of the medical management of severe traumatic brain injury, the benzodiazepines used in the treatment of status epilepticus, and the emerging or recently appreciated encephalopathies occurring in children.