Pediatrics
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Randomized Controlled Trial Clinical Trial
Prophylaxis against early adrenal insufficiency to prevent chronic lung disease in premature infants.
BACKGROUND. Many extremely low birth weight infants (<1000 g) show biochemical evidence of adrenal insufficiency in the first week of life, correlating with subsequent development of chronic lung disease (CLD). ⋯ First, early treatment with low-dose hydrocortisone in this population of extremely low birth weight infants increased the likelihood of survival without CLD. Second, the benefit was particularly apparent in infants with chorioamnionitis. Third, a larger multicenter trial is needed to verify the primary outcome and to better evaluate risks and benefits.
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This study examined the prevalence of gonorrhea in girls <12 years of age who presented with vaginitis and in whom sexual abuse was not suspected. ⋯ The prevalence of unsuspected GC infection was high and emphasizes the importance of culturing Tanner I girls for GC when they have a vaginal discharge along with routine bacterial cultures. Testing and/or treating for C albicans should be considered when there has been recent antibiotic use. Girls with vaginal complaints but without vaginal discharge may have a bacterial infection, but such diagnoses occur less frequently than with girls who have a discharge.
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Minor head trauma affecting children is a common reason for medical consultation and evaluation. In order to provide evidence on which to base a clinical practice guideline for the American Academy of Pediatrics, we undertook a systematic review of the literature on minor head trauma in children. ⋯ The literature on mild head trauma does not provide a sufficient scientific basis for evidence-based recommendations about most of the key issues in clinical management. More consistent definitions and multisite assessments are needed to clarify this field.
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Comparative Study
Looking beyond the physical injury: posttraumatic stress disorder in children and parents after pediatric traffic injury.
Traffic crashes are the leading health threat to children in the United States, resulting in nearly 1 million injuries annually. The psychological consequences of these injuries are primarily unknown. The aims of this study were to estimate the prevalence of posttraumatic stress disorder (PTSD) in traffic-injured children and their parents and to identify risk factors for PTSD development. ⋯ PTSD in children and their parents is a common, yet overlooked, consequence of pediatric traffic-related injury with prevalence rates similar to those found in children exposed to violence. Physicians managing the pediatric trauma patient, regardless of injury severity or whether the injury was intentional, should screen for PTSD and refer for treatment where appropriate.
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Comparative Study
Tumor necrosis factor-alpha, interleukin-1 beta, and interleukin-6 levels in febrile, young children with and without occult bacteremia.
To determine the utility of plasma levels of tumor necrosis factor-alpha (TNF), interleukin 1 beta (IL-1), and interleukin 6 (IL-6) in the prediction of occult bacteremia in febrile, young children. ⋯ In febrile children 0 to 36 months of age, IL-6 levels may be helpful in the prediction of occult bacteremia, but TNF and IL-1 levels are not. IL-6 levels alone or notably when combined with an ANC were more predictive of occult bacteremia than traditional tests and clinical criteria. The wide range in the IL-6 values for cases and controls detracts from the precision of the findings. The lack of rapid processing and clinical availability of IL-6 assays hampers its present application. However, despite these drawbacks and given the poor ability of traditional clinical and laboratory criteria to predict occult bacteremia, these results suggest a possible future role for IL-6 in predicting occult bacteremia when rapid assays become available.