Current opinion in pediatrics
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To review the principles of prescribing intravenous fluids (IVFs) to the acutely ill child and of adjusting sodium composition and fluid rate to prevent disorders in serum sodium or volume status from occurring. ⋯ Hypotonic fluids should not be administered routinely in children due to the risk of hospital-acquired hyponatremia. 0.9% NaCl is the preferred IVF for the vast majority of hospitalized children.
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Curr. Opin. Pediatr. · Apr 2011
ReviewEvaluation and management of critically ill children with acute kidney injury.
This review will highlight recent studies on the diagnosis of acute kidney injury (AKI), review the differential diagnosis, highlight the importance of cumulative fluid overload and provide key management strategies for the pediatric patient with AKI. ⋯ Categorical definitions of AKI have shown that higher AKI portends poor outcomes even with adjustment for severity of illness and other confounders. Cumulative fluid overload independently predicts poor outcomes. Strategies to prevent and/or treat fluid overload are likely to improve outcomes.
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Curr. Opin. Pediatr. · Feb 2011
ReviewPrevention of central line associated bloodstream infections in critical care units.
Central line associated bloodstream infections (CLABSIs) are a common source of morbidity and mortality in neonatal and pediatric intensive care units. Successful preventive strategies have recently been reported which have resulted in significant reductions in CLABSIs and their associated adverse outcomes. ⋯ CLABSIs remain a significant problem in neonatal and pediatric critical care units, but implementation of catheter care bundles can significantly reduce rates of these infections. The safety and efficacy of chlorhexidine gluconate, silver alginate, and antibiotic-coated catheters need to be assessed via large, multicenter trials. Creation of collaborative networks may facilitate this goal.
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Bronchiolitis impacts millions of infants worldwide. Although several therapeutic options stem from highly plausible theoretical rationales for success and some may even offer modest short-term symptom relief, none has been conclusively shown to alter the course of the disease or its major outcomes. However, several recent papers shed light on which treatments show promising preliminary evidence and offer insight into future research endeavors on this topic. This review will summarize bronchiolitis therapy in view of this recent evidence. ⋯ Because bronchiolitis is a highly heterogeneous entity, future research challenges should include detailed characterization of infants most likely to benefit from given interventions. In the meantime, stick with the good old time-honored supportive route!