Acta paediatrica
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Comparative Study
Acute and postoperative pain in children: a Swedish nationwide survey.
Many studies demonstrate inadequate pain treatment in children. The aim of this nationwide survey was to evaluate the prevalence of acute and postoperative pain in children; extent of, and reasons for, inadequate pain therapy; therapy methods; pain-management structure; and the need for education of healthcare professionals. Questionnaires concerning these points were sent to all departments in Sweden involved in the treatment of children. The response rate was 75% (299/ 395). Answers from physicians and nurses showed that, despite treatment, moderate to severe pain occurred in 23% of patients with postoperative pain and 31% of patients with pain of other origin. Postoperative pain seemed to be a greater problem in units where children were treated along with adults and in departments where fewer children were treated. According to 45% of physicians and nurses, treatment of pain could often or always be managed more efficiently. Pain assessments were performed regularly in 43% of all departments, but pain measurement was less frequent; 3% of the departments had no formal organization for pain management; and 15% never or infrequently used potent opioids. Educational needs were high. Insufficient pain treatment seemed to be mostly related to organizational aspects, such as inadequate prescriptions. Anxiety in children or parents also contributed to ineffective pain treatment. Swedish treatment practices for the management of pain in children roughly follow the published guidelines, but many improvements are still necessary. ⋯ Acute pain in children is still undertreated in Swedish hospitals. This seems to be related mainly to organizational aspects.
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To describe the neurobehavioral and developmental profile of very low birthweight (VLBW) preterm infants in early infancy. ⋯ Almost all VLBW infants showed non-optimal motor quality behavior at 6 mo and encountered far more problems with self-regulation compared with term infants.
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Pneumonia in childhood may be associated with surfactant dysfunction and severe acute respiratory distress syndrome (ARDS). The aim of this study was to investigate the effects of surfactant treatment on oxygenation in 8 infants (age range: 1 mo to 13 y) with severe respiratory failure owing to viral, bacterial or Pneumocystis Carinii pneumonia. ⋯ Surfactant dysfunction probably plays a role in the pathophysiology of severe paediatric ARDS triggered by pneumonia, as it was found that surfactant instillation rapidly improved gas exchange in the majority of the affected infants in our study. Larger randomized controlled studies are necessary to evaluate the effects of surfactant treatment on morbidity and mortality.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparing suprapubic urine aspiration under real-time ultrasound guidance with conventional blind aspiration.
To determine the optimal method of suprapubic aspiration (SPA), the success rates of real-time ultrasound-guided SPA were compared with those of conventional SPA, and factors associated with success were studied. Thirty infants were randomly allocated to group A (for real-time ultrasound-guided SPA) and 30 infants to group B (for blind SPA with a prehydration protocol). The results showed that the overall success rates for all attempts were similar (26/30 or 87% in group A vs 24/30 or 80% in group B, p > 0.05). The first attempts in both groups were equally successful (both 18/30 or 60%). In comparison with failed attempts, successful ultrasound SPA attempts were associated with a greater bladder depth (mean +/- SD: 28 +/- 11 vs 21 +/- 5 mm, p < 0.01), length (32 +/- 12 vs 23 +/- 9 mm, p < 0.05) and volume (17 +/- 13 vs 8 +/- 6 ml, p < 0.01), but similar width (33 +/- 9 vs 29 +/- 5 mm, p > 0.05). In blind SPA, successful attempts were associated with the presence of bladder dullness on percussion (odds ratio 29). ⋯ This study confirms that ultrasound-guided SPA has a high success rate. Blind SPA could also be equally successful with appropriate preparation. Ultrasound-guided SPA is recommended when the bladder depth exceeds 3 cm, or the bladder length exceeds 3.7 cm. If an ultrasound machine is not available, blind SPA may be an alternative, with attention being paid to prehydration and the demonstration of bladder dullness by percussion.