Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie
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Intraosseous vascular access is a simple and very efficient technique for fluid and drug administration in any pediatric emergencies where the intravenous route is impossible or inadequate. Yet it remains unrecognized in France. ⋯ Provided that the technique is performed with careful asepsis, the risk of infectious complications is very low. However the intraosseous route must remain a transitory vascular access, and has to be stopped as soon as possible, its use never exceeding 24 hours.
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Children under 6 often show marked anxiety and physical pain during laceration repair. If locally infiltrated anesthetics usually give a good control of physical pain, they have no effect on anxiety and restlessness for which several medications are available for conscious sedation. Continuous nitrous oxide, intramuscular sedative "cocktail" with meperidine-promethazine-chlorpromazine or intravenous fentanyl have various inconveniences and therefore are not ideal for this purpose. By contrast, Midazolam, a short acting watersoluble benzodiazepine with anxiolitic, hypnotic and anterograde amnestic effect, appears to be a safe and effective treatment when given orally or intranasally for alleviating anxiety in under 6 year-old out-patient in emergency department; its rectal administration appears less effective and needs further studies before to be routinely used.
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Severe prolonged hypocalcemia may occur in neonates whose parathyroid hormone production has been blocked by maternal hyperparathyroidism. This report describes such a case. ⋯ Neonatal hypocalcemia always requires investigation of both the infant and mother. Measurements of vitamin D metabolites and intact PTH are required to recognize maternal hyperparathyroidism.