The Journal of pediatrics
-
The Journal of pediatrics · Apr 1983
Randomized Controlled Trial Comparative Study Clinical TrialEffects of psychological preparation on children hospitalized for dental operations.
We studied the effect of preoperative preparation on stress reduction in children hospitalized for dental surgery under general anesthesia. Participants were 45 children, 3 and 4 years of age, with no previous hospital-surgery experience and no history of medical or psychological conditions requiring special care. Subjects were randomly assigned to one of three experimental groups: control, receiving no preoperative preparation; unrelated play therapy, receiving a preoperative play session unrelated to hospital or surgical procedures; and related play therapy, receiving a preoperative play session focusing on hospital and surgical procedures. ⋯ The related play therapy group was more cooperative and less upset than either the unrelated play therapy group or the control group across stress points. No significant heart rate differences were found among the three groups. The results suggest that play therapy related to hospital and surgical procedures can alleviate stress and anxiety in 3- and 4-year-old children.
-
The Journal of pediatrics · Jan 1983
Randomized Controlled Trial Comparative Study Clinical TrialOral antibiotic prophylaxis in patients with cancer: a double-blind randomized placebo-controlled trial.
In an attempt to reduce the incidence of fever and infection, we randomized patients with cancer to receive trimethoprim/sulfamethoxazole plus erythromycin (TMP/SMX + E) versus placebos after each cycle of chemotherapy (no crossover) and to continue until granulocytopenia (polymorphonuclear leukocytes less than 500/mm3) resolved or the patient became febrile. We evaluated 541 episodes (150 patients); 249 episodes (77 patients) with TMP/SMX + E and 292 episodes (73 patients) with placebos. The patients' median age was 17 years. ⋯ Patients with good or poor compliance showed no significant benefit from the TMP/SMX + E, and patients with excellent compliance did best, regardless of whether they were receiving antibiotics or placebos, suggesting that patient compliance is an important independent variable. The incidence of fever or infection was significantly lower for patients with leukemia with excellent compliance who received antibiotics (P = 0.037) than for patients with lymphomas or solid tumors. Oral antibiotic prophylaxis reduced the incidence of fever and infection in some granulocytopenic patients, but the benefit was limited and restricted to patients whose compliance was complete.
-
The Journal of pediatrics · Dec 1982
Comparative StudyMortality and morbidity in infants with intrauterine growth retardation.
This report is based on an analysis of the experience with all births in several urban and rural areas of the United States. All infants whose birth weight was in the lowest quartile for their week of gestation were designated as small for gestational age regardless of their birth weight or length of gestation; other infants were considered appropriate for gestation age. ⋯ In each weight group, the total proportion of infants who either died before one year of age or were handicapped at one year of age was similar for small-for-gestational age and appropriate-for-gestational age infants, but appropriate-for-gestational age infants were at greater risk of neonatal death and small-for-gestational age infants were at greater risk of problems manifested during the first year of life or at one year of age. As the findings are based on data obtained from entire populations (rather than from infants born in particular hospitals), they are likely to be generalizable.
-
The Journal of pediatrics · Nov 1982
Physiologic changes associated with ligation of the ductus arteriosus in preterm infants.
Cardiorespiratory and transcutaneous oxygen monitors were used on 13 preterm neonates to examine physiologic changes during ductus arteriosus ligation. Transcutaneous oxygen decreased 30 seconds after left lung deflation; all infants required increases in inspired oxygen and ventilation to correct abnormal values after the left lung was compressed. Transcutaneous oxygen decreased 30 seconds after ductus arteriosus ligation (mean delta tcPO2 = -17 mm Hg +/- 11.4) but increased 150 seconds after left lung inflation (mean delta tcPO2 = 46.9 mm Hg +/- 28.8). ⋯ Intraventricular hemorrhage was confirmed in two patients after surgery. Ligation of the ductus arteriosus results in an abrupt increase in blood pressure, which may be related to the pathogenesis of intraventricular hemorrhage. We suggest that the ductus arteriosus be closed gradually to allow a more gradual increase in blood pressure.