Archives of disease in childhood
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Comparative Study
Blood pressure in children aged 4-8 years: comparison of Omron HEM 711 and sphygmomanometer blood pressure measurements.
To collect normal data on blood pressure (BP) in healthy children aged 4-8 and to compare measurements of BP made in the same subjects with a sphygmomanometer and a portable automated oscillometric BP monitor (Omron HEM 711 with child cuff). ⋯ Children were equally distributed in their preference for BP device. There was a wide variation between the two methods of BP measurement, which suggests that comparison of automated BP measurements with normative data obtained by sphygmomanometer is not valid.
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Comparative Study Controlled Clinical Trial
Comparison of morphine concentration-time profiles following intravenous and intranasal diamorphine in children.
Current best practice for treating acute severe pain in children is to administer intravenous or intranasal opioid. Intranasal diamorphine offers less traumatic analgesia than the potentially difficult and distressing intravenous route. However, there has been no direct comparison of intranasal and intravenous diamorphine nor are there pharmacokinetic data for intranasal diamorphine in children. ⋯ Our evidence supports the wider use of diamorphine administration by nasal drops in children, as it shows that adequate plasma levels of morphine are usually achieved. However, we demonstrated significantly attenuated and delayed peak plasma morphine levels with lower levels at 1 h with intranasal compared with intravenous diamorphine.
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Controlled Clinical Trial
Intranasal diamorphine for acute sickle cell pain.
The painful crisis is the commonest acute presentation of sickle cell disease (SCD), yet effective pain control in hospital is often delayed, inadequate and dependent on injected opiates. Intranasal diamorphine (IND) has been used in paediatric emergency departments for management of acute pain associated with fractures, but the analgesic effect is short lived. We evaluated its efficacy and safety when given in combination with intravenous or oral morphine for rapid analgesia for children presenting to our emergency department with painful crisis of SCD. ⋯ There was a rapid improvement in pain score; the proportions in severe pain at t = 0, 15, 30 and 120 minutes in phase 1 were 78%, 11%, 0% and 11%, respectively; in phase 2, 77%, 30%, 15% and 0%, respectively. There were no serious side effects and questionnaire scores indicated that children found IND effective and acceptable. IND can be recommended for acute control of sickle pain in children presenting to hospital.
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There is limited knowledge of the accuracy of height and weight measurements from child health records, despite widespread use for research and clinical care. We assess the accuracy of such measurements, using research measurements as the gold standard. ⋯ Routinely collected child health record height/length and weight data are compatible with no systematic bias, at least in children over 8 months old, supporting their use in clinical practice and research.
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Each winter seasonal respiratory virus infections account for large variations in unplanned admission to UK paediatric intensive care units (PICU). The emergence of pandemic influenza A(H1N1) has been associated with a notable predominance in children and may be expected to have a significant impact on PICU provision. ⋯ Contingency measures for children needing paediatric intensive care are needed to absorb the likely increase in activity expected due to pandemic influenza this winter. Because of variations in provision by region, the role of paediatric retrieval services will be especially important.