Pediatrics
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Randomized Controlled Trial Clinical Trial
Randomized, prospective study of low-dose versus high-dose inhaled nitric oxide in the neonate with hypoxic respiratory failure.
There is little information on the response to very low doses of inhaled nitric oxide (iNO) in hypoxic near-term infants. The potential toxicities of iNO are dose related; thus, the ability to use lower doses safely and effectively may be advantageous. We hypothesized that there is no difference in the acute improvement in oxygenation between treatment with inhaled nitric oxide at 1 to 2 parts per million (ppm) or 10 to 20 ppm. ⋯ We did not find any significant difference in response to low- versus high-dose iNO. An initial exposure to low-dose iNO does not compromise the response to higher doses if required and may result in less toxicity.
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Comparative Study
No evidence for a new variant of measles-mumps-rubella-induced autism.
A link has been postulated between measles-mumps-rubella (MMR) vaccine and a form of autism that is a combination of developmental regression and gastrointestinal symptoms that occur shortly after immunization. This hypothesis has involved 3 separate claims: 1) that there is new phenotype of autism involving regression and gastrointestinal symptoms, 2) that this new variant is responsible for the alleged rise of autism rates, and 3) that this phenotype is associated with biological findings suggestive of the persistence of measles infection. We tested the first of these claims. If this new "autistic enterocolitis" syndrome had some validity, then 1 or several of the following 6 predictions should be supported by empirical data: 1) childhood disintegrative disorder has become more frequent, 2) the mean age of first parental concern for autistic children who are exposed to MMR is closer to the mean immunization age than in children who are not exposed to MMR, 3) regression in the development of children with autism has become more common in MMR-vaccinated children, 4) the age of onset for autistic children with regression clusters around the MMR immunization date and is different from that of autistic children without regression, 5) children with regressive autism have distinct symptom and severity profiles, and 6) regressive autism is associated with gastrointestinal symptoms and/or inflammatory bowel disorder. ⋯ No evidence was found to support a distinct syndrome of MMR-induced autism or of "autistic enterocolitis." These results add to the recent accumulation of large-scale epidemiologic studies that all failed to support an association between MMR and autism at population level. When combined, the current findings do not argue for changes in current immunization programs and recommendations.
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Comparative Study
Association between sudden infant death syndrome and prone sleep position, bed sharing, and sleeping outside an infant crib in Alaska.
To determine the contribution of prone sleeping, bed sharing, and sleeping outside an infant crib to sudden infant death syndrome (SIDS). ⋯ Almost all SIDS deaths in Alaska occurred in association with prone sleeping, bed sharing, or sleeping outside a crib. In the absence of other risk factors, SIDS deaths associated with parental bed sharing were rare.
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Bicycling remains one of the most popular recreational sports among children in America and is the leading cause of recreational sports injuries treated in emergency departments. An estimated 23 000 children younger than 21 years sustained head injuries (excluding the face) while bicycling in 1998. ⋯ Recently, a group of national experts and government agencies renewed the call for all bicyclists to wear helmets. This policy statement describes the role of the pediatrician in helping attain universal helmet use among children and teens for each bicycle ride.