Acta paediatrica
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Randomized Controlled Trial Multicenter Study Comparative Study
Hypotonic versus isotonic maintenance fluids in critically ill children: a multicenter prospective randomized study.
Study the influence of hypotonic (HT) and isotonic (IT) maintenance fluids in the incidence of dysnatraemias in critically ill children. ⋯ Hypotonic maintenance fluids increase the incidence of hyponatraemia because they decrease blood sodium levels in normonatraemic patients. IT maintenance fluids do not increase the incidence of dysnatraemias and should be considered as the standard maintenance fluids.
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Practice Guideline
New guidelines for newborn resuscitation--a critical evaluation.
The 2010 International Liaison Committee on Resuscitation guidelines for newborn resuscitation represent important progress. The criteria for assessment are simplified based on heart rate and respiration only and there is no timing of stages after the first 60 sec. Instead of giving supplemental oxygen, the guidelines state that 'it is best to start with air'. However, the optimal oxygen concentration later in the process and for premature babies is not yet clear. A description of an adequate heart rate response is not given, and the cut-off of 100 bpm may be arbitrary. There are still no clear recommendations regarding ventilation, inspiratory time, use of positive end expiratory pressure or continuous positive airway pressure. The guidelines do not mention which paCO2 level might be optimal. As colour pink assessment and routine suctioning of airways are not recommended anymore, there is an urgent need to obtain international consensus and create a new and revised Apgar score without these two variables. ⋯ In spite of improved guidelines for newborn resuscitation, there is still a number of unanswered questions and a need for more delivery room studies.
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Case Reports
Anaphylactic reactions to measles-mumps-rubella vaccine in three children with allergies to hen's egg and cow's milk.
Allergies to hen's egg and cow's milk are the most frequent food allergies in infancy and childhood. Current guidelines recommend safe administration of measles-mumps-rubella (MMR) vaccine in egg allergic patients. ⋯ Therefore, we recommend that all children not only those who were sensitized to foods should receive the MMR vaccination in a setting that is equipped to deal with anaphylactic reactions. As stated by WHO in immunization safety surveillance, 'Each vaccinator must have an emergency kit with adrenaline, and be familiar with its dosage and administration'.