The Journal of pediatrics
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The Journal of pediatrics · Sep 2014
Multicenter StudyImpact of inpatient bronchiolitis clinical practice guideline implementation on testing and treatment.
To determine the association between institutional inpatient clinical practice guidelines (CPGs) for bronchiolitis and the use of diagnostic tests and treatments. ⋯ Most children's hospitals have an institutional bronchiolitis CPG in place. The content of these CPGs is largely uniform in practice recommendations against tests and treatments. The presence of institutional CPGs did not significantly reduce the ordering of tests and treatments. Online accessibility of a written CPG and prolonged duration of implementation reduce tests and treatments.
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The Journal of pediatrics · Sep 2014
Observational StudyPulse oximetry screening for critical congenital heart disease in planned out-of-hospital births.
To describe the use of pulse oximetry screening (POS) for critical congenital heart disease (CCHD). ⋯ This study provides information on the use of POS for CCHD in out-of-hospital births and shows that POS can be successfully implemented outside the hospital setting. Although the failure rate in this small sample was higher than reported in studies of hospital births, those babies failing the screening had significant disease processes that were identified more rapidly because of the screening.
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The Journal of pediatrics · Sep 2014
Editorial CommentKetamine dosing in adolescents: sizing up the problem.
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The Journal of pediatrics · Sep 2014
Randomized Controlled TrialCosts of bronchoalveolar lavage-directed therapy in the first 5 years of life for children with cystic fibrosis.
To determine whether bronchoalveolar lavage (BAL)-directed therapy for infants and young children with cystic fibrosis (CF), rather than standard therapy, was justified on the grounds of a decrease in average costs and whether the use of BAL reduced treatment costs associated with hospital admissions. ⋯ BAL-directed therapy did not result in either lower mean hospital admission costs or mean costs overall compared with managing patients with CF by a standard protocol based upon clinical features and oropharyngeal culture results alone. Following on our previous findings that BAL-directed treatment offers no clinical advantage over standard therapy at age 5 years, flexible bronchoscopy with BAL cannot be recommended for the routine management of preschool children with CF on the basis of overall cost savings.
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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.