Current opinion in pediatrics
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Oral trauma continues to be a common pediatric emergency, accounting for 150 emergency room dental consultations per year at Children's Hospital in Boston. Children between the ages of 18 months and 2.5 years and between 8 and 11 years are most at risk. ⋯ The use of a doxycycline immersion prior to reimplantation by the dentist may be helpful in preventing external root resorption. As always, the best therapy against dentofacial trauma is the pediatrician's support of preventive measures.
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The adult (acute) respiratory distress syndrome is a significant cause of morbidity in children. The mortality rates remain elevated, greater than 50%, and even greater than 80% in patients with underlying malignancies. The therapeutic interventions remain mainly supportive. ⋯ High-frequency oscillatory ventilation and tracheal insufflation are not yet used extensively, although they should contribute to less aggressive ventilation. Surfactant replacement, nitric oxide inhalation, and partial liquid ventilation seem to be promising technologies, but controlled clinical studies are necessary before their wide-spread use. Extracorporeal membrane oxygenation remains the alternative technology in case of failure of conventional support.
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Bronchoscopic examination may be indicated to evaluate various parts of the airway including the larynx, the subglottic region, or the more peripheral aspects of the tracheobronchial tree. The chances of a successful examination may be increased by the appropriate use of sedation. ⋯ The essentials of the preoperative examination, requirements for intraoperative monitoring, and postoperative recovery are discussed. The various agents and techniques available for deep sedation and general anesthesia are reviewed.
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Pneumonia is a common serious illness in children with acute episodes of fever and in children with more prolonged episodes of fever, termed fevers of unknown origin. Recent studies have demonstrated that the clinical evaluation, including observation, history, and the physical examination, is highly sensitive in identifying children with acute episodes of fever who have pneumonia. The sensitivity of the clinical evaluation for pneumonia has been demonstrated for febrile infants younger than 90 days of age as well as older children. In children with fever of unknown origin, the chest roentgenogram is considered part of the diagnostic evaluation, but further research may define specific indications for its use based on observation, history, and physical examination.
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There is an increasing focus on the recognition, assessment, and management of pain in children. Children undergo many painful procedures in different clinical environments and are frequently undertreated for their pain. The pediatrician should be familiar with general concepts about the perception of pain in children. ⋯ There has been an increase in the development of topical anesthetics as well as modifying injectable local anesthetic to decrease the pain of local infiltration. Nonpharmacologic methods of pain management are being tested, developed, and used alone or as adjuncts to pharmacologic therapy for children undergoing painful procedures. It is imperative that clinicians keep themselves informed about new advances pertaining to pain treatment and incorporate them into their practices.