Current opinion in pediatrics
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Curr. Opin. Pediatr. · Feb 2005
ReviewFever in the new millennium: a review of recent studies of markers of serious bacterial infection in febrile children.
Evaluation of a febrile infant or child for serious bacterial infections (SBI) can be a challenging task; there is no single reliable predictor of SBI in infants. This review examines some of the recent work evaluating the usefulness of indicators for SBI, such as white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6). ⋯ Much progress has been made in recent years in finding more accurate indicators of SBI than WBC. However, while recent developments have given clinicians some new tools in evaluating febrile infants and children, it remains a formidable undertaking. In the especially vulnerable infant population, the holy grail of a single ideal SBI indicator remains elusive.
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Clinical research in children is increasing. Concerns have been raised about both the inclusion and the exclusion of children in such research. Corresponding to these concerns, issues in informed consent for pediatric trials have become more pressing. This review discusses informed consent in pediatric trials and characterizes the latest literature. ⋯ Lessons learned from recent studies regarding oversight of the consent process in pediatric clinical trials, the complex nature of assent, the impact of cultural variables, and more effective means of communicating what is involved in a clinical trial will shape future studies in consent and help to improve the process.
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To evaluate the increase in overuse injuries in the adolescent athlete, specifically sports-related injuries to the foot and ankle of the adolescent runner. Factors affecting these injuries include anatomic considerations, gender, rate of development, growth, training errors, shoe wear, and running surface. ⋯ Adolescent running injuries are common and becoming more frequent as trainers and athletes place increasing demands on the growing body. There is no evidence that this increased demand produces long-term adverse effects; however, a significant amount of time can be lost to injuries unless training patterns are constructed to allow for repair of the adolescent athlete.
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This review discusses recent literature that has focused on the epidemiology, clinical and laboratory evaluation and treatment of episodes of acute illnesses associated with fever and also of prolonged episodes of fever in children. ⋯ In the review period, there was a particular emphasis on invasive disease caused by S. pneumoniae and the impact of vaccination with conjugated pneumococcal vaccine, on the occurrence of serious bacterial infection in febrile infants with RSV infections, and on the broad spectrum of diagnoses in children with prolonged fever in varying geographic locales.
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Bronchiolitis is a very common and potentially serious respiratory disease of young children. To date, there is not a single, widely practiced, evidence-driven treatment approach. This review summarizes important recently published studies on the treatment of acute bronchiolitis for both outpatients and hospitalized children. ⋯ The routine and repetitive use of bronchodilators, epinephrine, or corticosteroids to treat bronchiolitis in the absence of demonstrated clinical benefits for individual patients is not justified.