Archives of disease in childhood
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Multicenter Study
Pain and behaviour changes in children following surgery.
To quantify postoperative pain and problematic behaviour (PB) in children at home following day-case (same day admission and discharge) or inpatient (≥1 night in hospital) surgery, to identify factors associated with PB at 2 and 4 weeks after discharge and to determine whether pain is associated with PB after adjustment for other factors. ⋯ There was a high incidence of pain and PB persisting for several weeks after surgery in this cohort of children. Previous painful medical experiences and anxiety were important modifiable factors that require further attention from healthcare providers and researchers to potentially improve health and social outcomes for children after surgery.
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Complex regional pain syndrome type 1 (CRPS-1) is a clinical syndrome that affects one or more extremities and is characterised by persistent pain disproportionate to any inciting event, and at least one sign of autonomic dysfunction in the affected limb(s). The pathogenesis of this syndrome is poorly understood, but its onset is often precipitated by a physical injury, such as minor trauma, fracture, infection or a surgical procedure. ⋯ Here we present a case series of CRPS-1 following immunisation in adolescents, with either diphtheria-tetanus-acellular pertussis (1 case), or human papillomavirus vaccines (4 cases). Enhanced awareness of this syndrome and its potential to occur following immunisation in the paediatric population is vital to the prompt and effective management of this condition.
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Review Meta Analysis
Meta-analysis of bacterial meningitis score validation studies.
The Bacterial Meningitis Score, a derived and validated clinical decision rule, identifies children with cerebrospinal fluid (CSF) pleocytosis who are at very low risk of bacterial meningitis. Low-risk features include the following: negative CSF Gram stain, CSF absolute neutrophil count (ANC) <1000 cells/μl, CSF protein <80 mg/dl, peripheral blood ANC <10 000 cells/μl and no seizure at or prior to initial presentation. The study objective of the present work was to calculate the performance of the Bacterial Meningitis Score by performing a meta-analysis of all published validation studies. ⋯ The Bacterial Meningitis Score is a highly accurate clinical scoring system that could be used to assist clinical decision making for the management of children with CSF pleocytosis.
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Bronchiolitis is a common, self-limiting, seasonal viral respiratory tract infection in infancy accounting for the majority of hospital admissions in this age group. Supportive care is the mainstay of treatment, concentrating on fluid replacement, gentle suctioning of nasal secretions, prone position (if in hospital), oxygen therapy and respiratory support if necessary. ⋯ The combination of oral dexamethasone with nebulised epinephrine potentially decreases the need for hospitalisation, while nebulised 3% hypertonic saline mixed with a bronchodilator decreases the length of hospitalisation. Although both stratagems appear safe and well tolerated, their role in clinical practice remains unclear.