Current opinion in pediatrics
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Curr. Opin. Pediatr. · Apr 2005
ReviewAn update of N-acetylcysteine treatment for acute acetaminophen toxicity in children.
Acetaminophen poisoning accounts for a disproportionate percentage of all toxic ingestions, and can be life-threatening. This article reviews the mechanism and presentation of acetaminophen toxicity, as well as its treatment, including current thinking and treatment recommendations. ⋯ Acetaminophen can lead to irreversible liver damage and even death in acute overdose. Outcome is related to the swiftness in which the antidote (N-acetylcysteine) is provided. In the United States, there are now available both the oral and intravenous forms of N-acetylcysteine, and pros and cons exist for each. With brisk and adequate treatment using either route, recovery can be complete, and liver function can be restored.
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Curr. Opin. Pediatr. · Apr 2005
ReviewEthical dilemmas in the care of the most premature infants: the waters are murkier than ever.
Summarize the literature relevant to ethical issues surrounding decisions to provide intensive care to extremely premature newborns. ⋯ In Miller v HCA, the Millers sued the Hospital Corporation of America for resuscitating their approximately 23-week gestation daughter against their wishes. The baby survived with severe neurodevelopmental disabilities. They were awarded $59.9 million in a jury trial. However, the judgment was reversed by the court of appeals, which ruled that parents have no right to withhold urgently needed life-sustaining medical treatment from children with non-terminal impairments, deformities, or disabilities, regardless of their severity. The Supreme Court of Texas upheld that ruling, but reasoned that parents have no right to refuse resuscitation of extremely premature infants prior to birth because they cannot be fully evaluated until birth; therefore, decisions before birth could not be fully informed. Robertson (Hasting Center Report 2004) supports precluding parental refusal of resuscitation before birth. He argues that parents have a right to withhold or withdraw medical treatment from a non-terminally ill child, but only if the child will lack capacity for symbolic interaction. Such severe limitation of quality of life concerns in decision making for extremely premature newborns is inconsistent with current published guidelines, the positions of noted bioethicists, and the practice of many neonatologists. Further, the additional information attained by initiating intensive care in the most premature infants does not justify doing so without parental consent.
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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.