The Journal of pediatrics
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The Journal of pediatrics · Aug 1995
ReviewNew concepts in the treatment of children with acute respiratory distress syndrome.
Recent advances in mechanical ventilation, accompanied with a better understanding of the pathophysiology of ARDS, have resulted in a brighter outlook for the child who acquires this still dreaded disease. A greater understanding of the pathophysiology of ARDS has led to a heightened awareness that the care of these patients should be more than just supportive. The potential for exacerbation of lung injury by mechanical ventilation is real. ⋯ Centers with experience using ECMO in the setting of pediatric ARDS have better results than those where ECMO is infrequently used for this purpose. It is imperative that future studies of both mechanical ventilation and ECMO describe ventilation strategy and prospectively identify protocols or algorithms for ventilator management. Coupled with severity scores, ventilator techniques and ECMO can then be systematically compared in children with ARDS.
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The Journal of pediatrics · Aug 1995
Pitfalls in newborn hemoglobinopathy screening: failure to detect beta(+)-thalassemia.
Although universal newborn screening can reliably identify all infants with sickle cell hemoglobinopathies, the initial screening result must not be considered the definitive diagnosis. We describe 23 infants whose screening phenotype was FS or FC but whose true phenotype included hemoglobin A, establishing a definitive diagnosis of hemoglobin S or hemoglobin C in combination with beta(+)-thalassemia. Higher than expected hemoglobin concentrations or lower than expected mean erythrocyte volumes should suggest concurrent beta(+)-thalassemia.
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The Journal of pediatrics · Jun 1995
Randomized Controlled Trial Comparative Study Clinical TrialA randomized trial comparing the efficacy of epinephrine with salbutamol in the treatment of acute bronchiolitis.
This randomized, double-blind trial compared the efficacy of nebulized epinephrine with salbutamol in the treatment of infants with acute bronchiolitis. The mean percent oxygen saturation at 60 minutes was significantly higher in the epinephrine group. Thirty-three percent of the patients in epinephrine group were admitted to the hospital compared with 81% of the salbutamol group (p = 0.003). We conclude that nebulized epinephrine is more efficacious than salbutamol for infants with acute bronchiolitis seen in an emergency department.
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The Journal of pediatrics · Jun 1995
Clinical TrialRisk of recurrent stroke in patients with sickle cell disease treated with erythrocyte transfusions.
To determine the effect of a transfusion program on risk of stroke recurrence in children with sickle cell disease. ⋯ We conclude that maintenance of hemoglobin S at a level less than 30% appears to be effective in reducing the rate of recurrent infarction but does not prevent transient neurologic events. Transient neurologic events are common but do not appear to be related to recurrent stroke.
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The Journal of pediatrics · Jun 1995
Coagulation factor deficiencies during initiation of extracorporeal membrane oxygenation.
We examined the hypothesis that critically ill patients receiving extracorporeal membrane oxygenation (ECMO) have reduced clotting factor levels, which may contribute to the risk of hemorrhagic complications. ⋯ Severe coagulation factor deficiencies are often present in patients requiring ECMO, and coagulation factors provided through the circuit prime are insufficient to ensure correction of these deficiencies. Deficiency of multiple coagulation factors may contribute to the risk of intracranial hemorrhage during ECMO; the practice of excluding factor-containing solutions from the circuit prime should be examined prospectively.