Current opinion in pediatrics
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Curr. Opin. Pediatr. · Apr 2009
ReviewRoom air or 100% oxygen for resuscitation of infants with perinatal depression.
The International Liaison Committee on Resuscitation (ILCOR) recommends initiating neonatal resuscitation with concentrations of oxygen between 21 and 100%. This wide range of oxygen concentrations recommended for resuscitation highlights the lack of evidence supporting either 21 or 100% O2. The purpose of this review is to analyze the efficacy of reoxygenation with 100% O2 or room air on rates of return of spontaneous circulation--the main goal of cardiopulmonary resuscitation. ⋯ Prior to a revision of current neonatal resuscitation guidelines it must be determined whether resuscitation initiated with room air results in the same rate of return of spontaneous circulation as resuscitation initiated with 100% oxygen.
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Curr. Opin. Pediatr. · Feb 2009
ReviewHuman papillomavirus vaccine: a paradigm shift for pediatricians.
Recommendations for human papillomavirus (HPV) vaccination during adolescence primarily for a disease, cancer, that occurs only during adulthood is a paradigm shift for pediatricians. Additional postlicensure data and guidelines about HPV biology and epidemiology, disease association, adverse effects, vaccination during pregnancy, and cost-benefit analyses are now available to inform pediatricians and guide HPV vaccination recommendations. ⋯ It is critical for pediatricians to thoroughly understand HPV biology and disease and champion HPV vaccination to prevent cervical, vulvar, and vaginal cancers, even though these benefits accrue during adulthood and will likely require 2-4 decades to realize the financial and public health benefits. Several new developments are expected in the near future, including licensure for use in boys and men and the approval of a second, bivalent HPV vaccine.
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Curr. Opin. Pediatr. · Feb 2009
ReviewPediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS): update.
To review recent developments related to the proposed entity Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococci (so-called 'PANDAS'). ⋯ Despite continued research in the field, the relationship between GAS and specific neuropsychiatric disorders (PANDAS) remains elusive. It is possible that GAS infection may be but one of the many stressors that can exacerbate tic/Tourette's or OCD in a subset of such patients.
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Although blood transfusion has been felt to be a beneficial therapy for sickle cell disease (SCD) since the 1950s, associated complications initially limited this therapy for these patients. With advances now reducing the side effects of transfusion and several landmark studies over the last decade clearly defining the efficacy for decreasing sickle cell morbidity, the indications for transfusion have increased. This review will discuss the indications, methods and goals of transfusion as well as complications and recent changes in transfusion therapy for SCD. ⋯ The increased use of transfusions may ultimately be balanced by hydroxyurea and other newer therapies developed as the complex pathophysiology of SCD is better understood; however, red cell transfusion is currently the most studied and accepted therapy for most acute and many chronic complications of SCD. Physicians caring for patients with sickle cell disease should be aware of the unique complications and transfusion requirements in this population.
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To enhance the ability of the practitioner to diagnose and manage children with parasomnias in the office setting. ⋯ Common childhood parasomnias such as hypnic starts, rhythmic movement disorder, sleep paralysis, confusional arousals, sleepwalking, sleep terrors, enuresis, and nightmares are discussed. These events may lead to significant concern and worry for the parents. Most parasomnias are recognizable by history alone, but some may require nocturnal polysomnography for accurate diagnosis and determining an underlying trigger factor. Findings on nocturnal polysomnography are described. Sleep terrors, confusional arousals and sleepwalking may mimic seizures; distinguishing seizures from parasomnias is discussed. There is a genetic predisposition to many childhood parasomnias. Management techniques, including behavioral therapy, are reviewed. Unfortunately, evidence-based recommendations are as yet unavailable. The management of sleep enuresis continues to remain a significant challenge.