The Journal of pediatrics
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The Journal of pediatrics · May 1994
Randomized Controlled Trial Comparative Study Clinical TrialEfficacy of the Flutter device for airway mucus clearance in patients with cystic fibrosis.
The Flutter is a handheld device designed to facilitate clearance of mucus in hypersecretory lung disorders. Exhalation through the Flutter results in oscillations of expiratory pressure and airflow, which vibrate the airway walls (loosening mucus), decrease the collapsibility of the airways, and accelerate airflow, facilitating movement of mucus up the airways. We studied 18 patients with cystic fibrosis and mild to moderate lung disease to determine the efficacy of the Flutter in clearing mucus from the airways. ⋯ The Flutter is simple to use, inexpensive, and fully portable, and once the patient and family are instructed in its use, it does not require the assistance of a caregiver. For hospitalized patients, elimination of the need for a therapist could reduce health care costs. Long-term studies of the use of the Flutter seem justified to determine its effects on pulmonary function and outcome.
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The Journal of pediatrics · May 1994
Review Case ReportsChoreoathetosis after surgery for congenital heart disease.
Choreoathetosis developed in three patients after cardiopulmonary bypass with hypothermia. None had significant hypotension or hypoxemia; all had hypocapnia and respiratory alkalosis during the rewarming period. We postulate that hypocapnia-induced cerebral vasoconstriction may have contributed to ischemic damage in focal central nervous system areas.
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The Journal of pediatrics · May 1994
Flow limitation during tidal expiration in symptom-free infants and the subsequent development of asthma.
During a longitudinal study of lung function and airway responsiveness in a cohort of healthy infants, we identified a subgroup of symptom-free infants at the age of 1 month with flow limitation during tidal expiration. We report a 2-year follow-up of 252 infants who were first studied at 1 month of age. Maximal flow at functional residual capacity (VmaxFRC) was measured from a forced expiratory flow-volume curve by the rapid thoracic compression technique. ⋯ At 6 and 12 months of age, although no longer flow limited, these infants still had significantly reduced lung function and increased airway responsiveness. Flow limitation in early life was also significantly associated with the development of physician-diagnosed asthma by the age of 2 years (odds ratio, 7.4; 95% confidence interval, 1.4 to 35.2). Infants with abnormal lung function soon after birth may have a genetic predisposition to asthma or other airway abnormalities that predict the risk of subsequent lower respiratory tract illness.
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The Journal of pediatrics · Apr 1994
Meta AnalysisRisk factors for seizure recurrence in children with febrile seizures: a pooled analysis of individual patient data from five studies.
To reassess the relations between postulated risk factors and seizure recurrence after a first febrile seizure (FS), the individual data from five follow-up studies that used similar definitions of FSs and risk factors were pooled and reanalyzed. The risk of frequent recurrent seizures and of the occurrence of complex seizures in previously healthy, untreated children was studied. Seizure recurrence hazard was described as a function of the child's attained age. ⋯ Young age at onset (< 12 months), a family history of unprovoked seizures, and a partial initial FS were all associated with an increased risk of complex seizures. A higher recurrence rate in clinic-based studies compared with population-based studies could not be explained by a difference in the presence of the risk factors studied. Thus other factors must influence seizure recurrence after an initial FS.