Current opinion in pediatrics
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Curr. Opin. Pediatr. · Apr 2013
ReviewOptimal oxygen saturations in preterm infants: a moving target.
New evidence is emerging to address the continued uncertainty regarding the optimal range to target oxygen saturation levels in preterm infants. ⋯ Defining and maintaining optimal oxygen saturations in preterm infants remains a challenge for clinicians caring for preterm infants. However, ongoing investigative collaborations may soon provide guidance.
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Curr. Opin. Pediatr. · Apr 2013
ReviewTiming of umbilical cord clamping after birth for optimizing placental transfusion.
A brief delay in clamping the umbilical cord after birth offers health benefits to the newborn, with no adverse effects to the mother or her infant. Yet, in most obstetric practice, the cord is clamped soon after birth. A summary of the current evidence on delayed cord clamping and some reasons for the disconnect between the evidence and practice are discussed here, along with the recommendations from professional organizations and societies about this practice. ⋯ Many professional organizations, societies, and experts recommend at least a 30-s delay before clamping the umbilical cord, especially after preterm births. The value of this practice for term births in resource-rich settings has not been evaluated.
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Curr. Opin. Pediatr. · Feb 2013
ReviewPerinatal management of infant tumors and the promise of fetal surgery.
This review outlines the current approaches to prenatal imaging, differential diagnosis, antenatal natural history, and the available treatment options for the most commonly prenatally diagnosed malignant tumors. ⋯ Diagnosis of a fetal tumor should prompt referral to a specialized center. Further understanding of these rare patients will require multicenter collaboration.
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Intravenous immunoglobulin (IVIG) and aspirin is the standard initial therapy in the treatment of Kawasaki disease. Some patients have persistent or recrudescent fever despite this therapy. Although there is no conclusive body of evidence defining the best second and third-line therapies for Kawasaki patients, there have been several recent studies published describing the results of these therapies. ⋯ Although most practitioners in the USA use IVIG as a second-line therapy for those Kawasaki disease patients who have persistent or recrudescent fever, promising new therapies are under study. Infliximab and steroids are currently the two agents that have been most studied. However, larger studies and studies in genetically diverse populations are needed.
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Curr. Opin. Pediatr. · Dec 2012
ReviewSubacute concussion-related symptoms and postconcussion syndrome in pediatrics.
Millions of youth sustain concussion each year; although most fully recover following an isolated concussion, a significant minority develop prolonged symptoms and disability following concussion. This article reviews recent data regarding the epidemiology of postconcussion syndrome (PCS) and recommendations for the evaluation and management of postconcussive symptoms in pediatrics. ⋯ Although a minority of concussed youth develop prolonged PCS, those who are affected can develop significant disability. Prolonged postconcussive symptoms are likely due to interactions between the biological injury, pre-existing risk factors and psychosocial issues. Further research is essential to improve outcomes for this vulnerable population.