The Journal of pediatrics
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The Journal of pediatrics · Sep 2014
Five-year follow-up of effects of neonatal intensive care and morphine infusion during mechanical ventilation on diurnal cortisol rhythm.
To test the hypothesis that the diurnal cortisol secretion rhythm of children who as neonates had been hospitalized differs from that of children without a history of neonatal hospital admission and that this rhythm differs between these hospitalized children treated with either continuous morphine infusion or placebo. ⋯ The finding that former trial participants had greater cortisol levels at 5 years of age supports the concept of long-lasting programming of the hypothalamic-pituitary-adrenal axis. Morphine infusion in the neonatal period did not alter cortisol secretion at 5 years of age.
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The Journal of pediatrics · Sep 2014
Comparative Study Observational StudyA fixed-dose ketamine protocol for adolescent sedations in a pediatric emergency department.
To assess provider and patient satisfaction with a fixed-dose ketamine protocol for procedural sedation of adolescent subjects. We further compared data for normal weight (body mass index [BMI] ≤ 25 kg/m(2)) vs overweight/obese subjects (BMI >25 kg/m(2)). ⋯ The fixed-dose ketamine protocol resulted in an adequate level of sedation and high provider/patient satisfaction for the majority of patients regardless of weight or BMI status.
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The Journal of pediatrics · Sep 2014
Epigenetic variation in the mu-opioid receptor gene in infants with neonatal abstinence syndrome.
Neonatal abstinence syndrome (NAS) from in utero opioid exposure is highly variable with genetic factors appearing to play an important role. Epigenetic changes in cytosine:guanine (CpG) dinucleotide methylation can occur after drug exposure and may help to explain NAS variability. We correlated DNA methylation levels in the mu-opioid receptor (OPRM1) promoter in opioid-exposed infants with NAS outcomes. ⋯ Increased methylation within the OPRM1 promoter is associated with worse NAS outcomes, consistent with gene silencing.
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The Journal of pediatrics · Sep 2014
Thrombopoietic agents for the treatment of persistent and chronic immune thrombocytopenia in children.
To determine the safety, tolerability, or efficacy of 2 licensed thrombopoietic agents in children with persistent and chronic immune thrombocytopenia (ITP). ⋯ Retrospective analysis of off-study use of TPO agents in children with mainly chronic ITP showed increases in platelet counts in more than 4 of 5 children. The long-term use of TPO agents, up to 53 months, without tachyphylaxis supports their efficacy. These agents appear safe, effective, and tolerable in children with chronic ITP.
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To assess digital access and mobile health in urban pediatric clinics by measuring demographics of smartphone ownership, primary uses of mobile devices by teens vs parents/caregivers, and interest levels in using smartphone health apps. ⋯ The prevalence of smartphone and app use in urban pediatric populations is high. With increased interest in mobile health, smartphones are an attractive modality for patient education, disease management, and streamlining health care communication in diverse settings, thus "mobilizing" the medical home. Further research is needed so that pediatricians can promote evidence-based apps, thus enabling patients to take ownership of their health.