Pediatrics
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Coagulopathy is a potential complication of head trauma that may be attributable to parenchymal brain damage. The objectives of this study were to assess the frequency of coagulation defects in pediatric abusive head trauma and to analyze their relationship to parenchymal brain damage. ⋯ PT prolongation and activated coagulation are common complications of pediatric abusive head trauma. In the presence of parenchymal brain damage, it is highly unlikely that these coagulation abnormalities reflect a preexisting hemorrhagic diathesis. These conclusions have diagnostic, prognostic, and legal significance.
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Comment Clinical Trial
Efficacy and safety of intravenous midazolam and ketamine as sedation for therapeutic and diagnostic procedures in children.
We have used the combination of midazolam, a short-acting benzodiazepine, and ketamine, a "dissociative anesthetic," to provide conscious sedation for invasive or lengthy procedures. ⋯ This sedative regimen of intravenous midazolam and ketamine was found to be safe and effective. Its use has greatly reduced patient and parent anxiety for diagnostic and therapeutic procedures.
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Randomized Controlled Trial Clinical Trial
Have Medicaid reimbursements been a credible measure of the cost of pediatric care?
Despite uncertain validity as a measure of cost, Medicaid reimbursements may be used to compare the costs of different pediatric interventions. We explored the credibility of Medicaid reimbursements as a measure of the costs of inpatient care associated with two different approaches to follow-up care for high-risk indigent infants. ⋯ Without proper validation, reimbursements from Medicaid (or any program that replaces it) should not be assumed to provide an unbiased or acceptably accurate measure of the relative or absolute cost of pediatric health care interventions.
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Multicenter Study Clinical Trial
Does ribavirin impact on the hospital course of children with respiratory syncytial virus (RSV) infection? An analysis using the pediatric investigators collaborative network on infections in Canada (PICNIC) RSV database.
To determine the relationship between receipt of aerosolized ribavirin and the hospital course of high-risk infants and children with respiratory syncytial virus (RSV) lower respiratory infection (LRI). ⋯ These data raise further doubts about the clinical effectiveness of ribavirin in infants and children with risk factors for severe disease. Selection bias, with ribavirin used for sicker children, may have influenced outcome. Nevertheless the long durations of hospitalization, ICU, ventilation, and oxygen supplementation in nonventilated ribavirin recipients stress the need for further randomized trials to assess its efficacy.
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Comparative Study
High-dose epinephrine is not superior to standard-dose epinephrine in pediatric in-hospital cardiopulmonary arrest.
To compare the efficacy of high-dose epinephrine (HDE) with that of standard-dose epinephrine (SDE) for resuscitation from in-hospital pediatric cardiopulmonary arrest (CPA). ⋯ In this study, the use of HDE did not improve the rates of ROSC, short-term survival, or long-term survival after pediatric in-hospital CPA, nor did it improve overall outcome scores. Given the conflicting evidence surrounding possible detrimental effects of HDE use, a large, blinded, prospective trial of HDE use in this setting is necessary to clarify the appropriate role for HDE in pediatric resuscitation.