Clinical pediatrics
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Clinical pediatrics · Nov 1990
Once-daily intramuscular ceftriaxone in the outpatient treatment of severe community-acquired pneumonia in children.
Ceftriaxone, a broad spectrum third-generation cephalosporin with a half-life of six to eight hours, was evaluated prospectively in 147 children with severe community-acquired bacterial pneumonia during the period 11/15/88-5/15/89. Thirty-nine of the children had been unsuccessfully treated with vanous oral antibiotics prior to admission [corrected]. All the patients were initially hospitalized and started on once a day intramuscular ceftriaxone. ⋯ The other two remained febrile for more than seven days; their subsequent improvement was unrelated to the antibiotic therapy, suggesting a viral or mycoplasmal syndrome. Our data suggest that once daily intramuscular ceftriaxone can be successfully used for the outpatient treatment of most community-acquired severe bacterial pneumonias in children. In our opinion it represents the treatment of choice for patients who failed treatment with other antimicrobials and are clinically stable enough not to require hospitalization.
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Clinical pediatrics · Jun 1990
Case ReportsProlonged headache after lumbar puncture. Successful treatment with an epidural blood patch in a 12-year-old boy.
A case is presented of a 12-year-old boy with a post-lumbar puncture headache of 6 weeks duration that was treated successfully with an epidural blood patch. Post-lumbar puncture headache in children is an uncommon event. ⋯ When a post-lumbar puncture headache occurs, conservative treatment with bedrest, hydration, analgesics, and psychologic support is usually all that is required. When a post-lumbar puncture headache lasts more than 1 week and other diagnoses have been excluded, an epidural blood patch performed by an experienced physician usually provides prompt and complete relief of symptoms with minimal risk.
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Clinical pediatrics · Feb 1990
Case Reports Comparative StudyNasal continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea in Hallermann-Streiff syndrome.
An 8-year-old girl with Hallermann-Streiff syndrome (oculomandibulofacial syndrome) was examined. She had a history of severe snoring, reported nocturnal apnea, excessive daytime hypersomnolence, nocturnal enuresis, and failure to thrive. Overnight polysomnography confirmed severe obstructive sleep apnea. Long-term nasal continuous positive airway pressure (CPAP) therapy completely relieved the obstructive sleep apnea and was associated with improved weight gain and growth.
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The authors reviewed the abuse reports submitted by the staff of The Children's Hospital, Columbus, Ohio, to determine the incidence and types of injuries inflicted to children's hands. The authors did not study hand injuries in children who were not reported as physically abused. The authors examined two time periods to ascertain changes injury severity. ⋯ A variety of instruments were used to injure these children. The hand is a delicate organ, and it is frequently the primary or incidental target of child abuse. Familiarity with the patterns and types of hand injury suffered in child abuse is essential for early recognition, reporting, and child protection.
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Clinical pediatrics · Jan 1990
ReviewPostoperative analgesia. Use of intrathecal morphine in children.
The identification of opiate receptors in the spinal cord gave rise to the suggestion that the use of intrathecal and epidural narcotics may provide effective and safe postoperative analgesia. The authors retrospectively reviewed the records of ten children who received intrathecal morphine as part of their anesthetic care over the last 2 years. Preservative-free morphine (Duramorph) in a dose of 0.02 mg/kg was administered to all patients in the lumbar intrathecal space before the start of the surgical procedure. ⋯ As with narcotics administered by any route, intrathecal morphine can cause respiratory depression, and such depression may be delayed for up to 24 hours after the dose. Therefore, the postoperative respiratory status of these children should be monitored for 24 hours after the dose, preferably in an intensive care unit. With this caveat, the use of intrathecal morphine provides safe and effective postoperative analgesia in children undergoing major surgery.