Acta paediatrica
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To evaluate whether paediatric randomized clinical trials (RCTs) adopt recent guidance on Data Monitoring Committees (DMCs), interim analysis and early termination. ⋯ Few paediatric trials report on DMCs' roles, interim analysis or early stopping. Heterogeneous practices and apparent shortcomings jeopardize the validity of trial results. Easily accessible guidelines for the design, conduct and reporting of paediatric DMCs are needed.
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Neonatal hypoxic-ischaemic encephalopathy (HIE), if severe, may involve cerebral vasoparalysis. In HIE, Pourcelot's cerebral vascular resistance index (RI) below 0.55 (by Doppler ultrasound) from published literature at normothermia predicted poor outcome with a positive predictive value (PPV) of 84%. The aim of this study was to re-assess RI as a predictor of outcome in HIE during hypothermia. ⋯ Low RI is significantly less predictive of poor outcome during hypothermia than normothermia. The lower PPV may be because hypothermia affects cerebral vasculature or protects the brain solely at a molecular and cellular level. Infants, who would have been predicted from their RI to have poorer outcome at normothermia, have better outcome when cooled.
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Successful transplantation has lead to increasing need for donated organs from children; however, contemporaneously decreased brain-death rates means optimization of donation processes is crucial. Although excellent palliative care and organ donation are compatible, discrepancies exist both between and within European countries in abilities to offer families donation opportunities. Change will require address of legal, ethical and cultural barriers, and this review aims to explore such changes pertinent to both dead and living organ donation. ⋯ We argue that across Europe it is surely time for legal, ethical and cultural change to facilitate parents, families and of course children in having the choice of donation.
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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.