Current opinion in pediatrics
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'Energy drinks', 'energy shots' and other energy products have exploded in popularity in the past several years; however, their use is not without risk. Caffeine is the main active ingredient in energy drinks, and excessive consumption may acutely cause caffeine intoxication, resulting in tachycardia, vomiting, cardiac arrhythmias, seizures, and death. The effects of chronic high-dose caffeine intake in children and adolescents are unknown. Caffeine may raise blood pressure, disrupt adolescent sleep patterns, exacerbate psychiatric disease, cause physiologic dependence, and increase the risk of subsequent addiction. ⋯ Although prior studies have examined the effects of caffeine in adolescents, energy drinks should be considered a novel exposure. The high doses of caffeine, often in combination with ingredients with unknown safety profiles, mandates urgent research on the safety of energy drink use in children and adolescents. Regulation of pediatric energy drink use may be a necessary step once the health effects are further characterized.
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Acute kidney injury (AKI) is associated with increased risk of morbidity and mortality in critically ill children and adults. Neonates remain an understudied group, although previous evidence suggests that this association holds true for them as well. ⋯ AKI is an independent risk factor for poor outcomes in critically ill neonates. Our ability to improve outcomes for these patients depends on heightened awareness of this issue both at the bedside as well as in research, commitment to using standardized AKI definitions in order to pool and compare data more effectively and improvement in our diagnostic methods with better AKI biomarkers so that we can identify AKI and intervene much earlier in the disease course.
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Antenatal magnesium sulfate may reduce the excessive rates of cerebral palsy in survivors of very preterm birth. ⋯ On the basis of these findings several countries have now released clinical practice guidelines recommending antenatal magnesium sulfate prior to very preterm birth.
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There has been a substantial increase in the number of studies of neonatal resuscitation and it is timely to review the accumulating evidence. ⋯ The International Liaison Committee on Resuscitation guidelines on the management of newborn infants were updated in 2010 and incorporate much of the newly available evidence. The use of intensive care techniques in the delivery room is promising but requires further evaluation. Monitoring techniques and interventions need to be adapted for use in developing countries.
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Curr. Opin. Pediatr. · Apr 2012
ReviewClinical implications of pharmacokinetics and pharmacodynamics of procedural sedation agents in children.
Procedural sedation has become the standard of care for managing pain and anxiety in children in the emergency department. ⋯ We review the pharmacokinetics and pharmacodynamics of the pediatric procedural sedation pharmacopeia from a clinical perspective with emphasis on the practical implications for drug titration and dosing.