Clinical pediatrics
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Clinical pediatrics · Aug 1996
Case ReportsSlipping rib syndrome as a cause of chest pain in children.
Four patients with the slipping rib syndrome presenting as chest pain are described, and the appropriate literature is reviewed. In two of the patients the physicians caring for the children were initially concerned that a cardiac condition was the cause of the chest pain, and a cardiac evaluation was done. ⋯ It is suggested that slipping rib syndrome should be considered by physicians when evaluating children with a complaint of chest pain. The condition can be easily diagnosed on physical examination and therefore may save some patients from an unnecessary cardiac or gastroentestinal evaluation.
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Diabetic ketoacidosis (DKA), resulting from severe insulin deficiency, accounts for most hospitalization and is the most common cause of death, mostly due to cerebral edema, in pediatric diabetes. This article provides guidelines on management to restore perfusion, stop ongoing ketogenesis, correct electrolyte losses, and avoid hypokalemia and hypoglycemia and the circumstances that may contribute, in some instances, to cerebral edema (overhydration, rapid osmolar shifts, hypoxia). These guidelines emphasize the importance of monitoring glycemia, electrolytes, hydration, vital signs, and neurologic status in a setting where response can be rapid if necessary (e.g., mannitol for cerebral edema). Most important is the prevention of DKA in established patients by close supervision of those most likely to omit insulin, or during illness, and a high index of suspicion for diabetes to prevent deterioration to DKA in new patients, particularly those under age 5, who are at greatest risk of complications.
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Clinical pediatrics · May 1996
Weight gain: a possible factor in deciding timing for inguinal hernia repair in premature infants.
A retrospective study was done to determine whether improved weight gain follows inguinal hernia repair in the premature infant and whether the presence of an inguinal hernia is associated with comparatively poorer weight gain prior to repair. Demographic and growth data from 28 premature infants who had undergone hernia repair were compared with corresponding data from 25 matched "control" premature patients. ⋯ The differences found in Z scores between these two groups indicated that premature infants who have inguinal hernias seem to grow better after the hernia repair as compared with before the surgery. Despite issues related to group matching, the results of this study indicate that weight gain may be an additional factor to consider in determining the appropriate time to do surgical correction of a premature infant's inguinal hernia.
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Despite the availability of ECMO (extracorporeal membrane oxygenation) services for nearly a decade, the criteria for the institution of ECMO for pediatric respiratory failure are still not clearly defined. Therefore, a chart review was performed on children who were mechanically ventilated more than 48 hours in 1989-1990 in order to evaluate possible predictors of death from pediatric respiratory failure. Twenty-three children died as a consequence of respiratory failure. ⋯ After 4 days of mechanical ventilation, an alveolar-arterial oxygen gradient (AaDO2) greater than 400 torr (53.3 kPa) was a weak predictor of death due to respiratory failure, and yet an AaDO2 less than 400 torr (53.3 kPa) was a stronger predictor of survivability. Combination of variables did not yield a better predictor than any single variable. Early prediction of mortality from respiratory failure in this population was not found.
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Clinical pediatrics · Apr 1996
LetterRecommended Childhood Immunization Schedule--United States, January-June 1996.
In January 1995, the Recommended Childhood Immunization Schedule, developed by the Advisory Committee on Immunization Practices (ACIP) the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP), was published. This unified schedule represented the first such schedule developed through a collaborative process among the recommending groups, the pharmaceutical manufacturing industry, and the Food and Drug Administration. ⋯ Since publication of the schedule in 1995, Varicella Zoster Virus Vaccine (Var) has been licensed, and recommendations for adolescent hepatitis B vaccination have been developed. The following changes are incorporated into the Recommended Childhood Immunization Schedule.