Archives of disease in childhood
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Paediatric intensive care (PIC) services have been centralised to a significant extent in Britain in the past two decades. As part of centralisation, PIC retrieval teams were developed to transport critically ill children from district general hospitals to regional paediatric intensive care units. This review aims to summarise the current state of retrieval in Britain, with reference to the past and possible directions for the future. While significant progress has been achieved, and PIC retrieval has now become a clinical service in its own right, the coming years present unique opportunities as well as challenges for the specialty.
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Encephalitis is an uncommon but potentially devastating neurological syndrome with different aetiologies including direct central nervous system infection with different agents (most commonly viral) and those mediated by the immune system. Whilst there have been several recent publications and guidelines on the management of bacterial central nervous system infections in adults and children, viral infections have been relatively neglected. ⋯ For these reasons, we have reviewed the literature on encephalitis and have formulated a suggested management strategy for children with suspected, clinically diagnosed and proven encephalitis. We have excluded neonates, as encephalitis in this age group has different clinical features and is beyond the scope of this review.
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Multicenter Study
Higher rates of behavioural and emotional problems at preschool age in children born moderately preterm.
To compare preschool children born moderately preterm (MP; 32-35 weeks' gestation) and children born at term (38-41 weeks' gestation) regarding the occurrence of behavioural and emotional problems, overall, for separate types of problems and by gender. ⋯ Moderate preterm birth affects all domains of behavioural and emotional problems, particularly for girls. MP children should be targeted for the prevention of mental health problems as they have a great impact on developmental and social competencies at school and in the community.
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Bradycardia occurs during the intubation of some critically ill children as a result of vagal stimulation due to hypoxia and/or laryngeal stimulation; such 'stable' bradycardia is accompanied by selective vasoconstriction. Some induction drugs also induce bradycardia which may be accompanied by vasodilatation which is also a feature of certain pathologies, which influence the progression to 'unstable' bradycardia, which does not respond to re-oxygenation and a pause in laryngoscopy. ⋯ As such, there is insufficient evidence to support a recommendation for the indiscriminate use of atropine for intubation during critical care illness, including simple neonatal respiratory distress. Atropine is appropriate during septic or late stage hypovolaemic shock where abnormal vasomotor tone and bradycardia may potentially set up a negative feedback loop of cardiac hypo-oxygenation and hypoperfusion and during premedication when using suxamethonium.
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To investigate the association between the degree of patient dehydration on presentation with diabetic ketoacidosis (DKA) and clinical and laboratory parameters obtained on admission. ⋯ The magnitude of dehydration in DKA is not reflected by either clinical or biochemical parameters. These findings need confirmation in larger studies.