Pediatrics
-
Treatment of dehydrating gastroenteritis, a major cause of morbidity in children, remains controversial. Practice parameters issued by the American Academy of Pediatrics (AAP) recommend oral rehydration therapy (ORT) as the preferred treatment for losses from both mild and moderate dehydration. The objective of this study was to test the hypothesis that awareness of the AAP practice parameters would be associated with a higher rate of use of ORT among emergency physicians. ⋯ This is the first national study to establish a relationship between awareness of the AAP practice parameters and physician practices in the treatment of dehydration. Emergency medicine physicians who were very familiar with the AAP parameters were significantly more likely to use ORT. These findings may have important implications for future efforts directed at increasing the rate of ORT use and for the evaluation of practice parameters in general.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Asthma morbidity after the short-term use of ibuprofen in children.
To test the hypothesis that short-term use of ibuprofen increases asthma morbidity in children. ⋯ Rather than supporting the hypothesis that ibuprofen increases asthma morbidity among children who are not known to be sensitive to aspirin or other nonsteroidal antiinflammatory drugs, these data suggest that compared with acetaminophen, ibuprofen may reduce such risks. Whether the observed difference in morbidity according to treatment group is attributable to increased risk after acetaminophen use or a decrease after ibuprofen cannot be determined. These data provide evidence of the relative safety of ibuprofen use in children with asthma.
-
Randomized Controlled Trial Clinical Trial
A randomized trial of moderately early low-dose dexamethasone therapy in very low birth weight infants: dynamic pulmonary mechanics, oxygenation, and ventilation.
Dexamethasone is used in very low birth weight (VLBW) ventilator-dependent infants to prevent or decrease the severity of chronic lung disease. We reported a significant increase in respiratory compliance during a 7-day weaning course of moderately early dexamethasone therapy (0.5 mg/kg/d) in VLBW infants, along with a shorter duration of mechanical ventilation and O2 supplementation. Although 0.5 mg/kg/d has been the most commonly used dose in preterm infants, the use of a lower dose of dexamethasone may reduce potential adverse effects of steroid therapy. Quantification of dynamic pulmonary mechanics in VLBW infants who receive low-dose dexamethasone has not been reported. The objective of this study was to compare the effect of 2 dose regimens of dexamethasone on dynamic pulmonary mechanics, mean airway pressure (MAP), and fractional inspired oxygen concentration (Fio2) in intubated VLBW infants who were at risk for chronic lung disease. ⋯ Our findings indicate that 1) comparable significant increases in Crs are present in the low-dose dexamethasone as well as the high-dose dexamethasone groups on days 2, 5, and 7 of steroid therapy; and 2) MAP and Fio2 are significantly decreased during dexamethasone therapy in both groups of infants. We conclude that low-dose and high-dose dexamethasone, as used in this study, have comparable beneficial effects on dynamic pulmonary mechanics and subsequently on oxygen requirement and applied ventilatory support in VLBW infants.
-
Multicenter Study Comparative Study
Treatment with highly active antiretroviral therapy in human immunodeficiency virus type 1-infected children is associated with a sustained effect on growth.
Growth failure is a common feature of children with human immunodeficiency virus type 1 (HIV-1) infection. Children who are treated with mono or dual nucleoside analogue reverse transcriptase inhibitor (NRTI) therapy show a temporary increase in weight gain and linear growth rate. In adults, protease-inhibitor-containing antiretroviral therapy is associated with a sustained weight gain and increased body mass index (BMI). Experience with protease inhibitors and growth in children is still limited. The data mainly deal with short-term effects on growth. ⋯ HAART has a positive influence effect on the growth of HIV-1-infected children. This effect is sustained for at least 96 weeks. Height and weight are favorably influenced in children in whom HAART leads to a reduction of the viral load of at least 1.5 log or to <500 copies/mL and to an increase in the CD4+ T-cell z score. In contrast to the increase of the BMI in adults on HAART, BMI did not increase in all children effectively treated with HAART. BMI increased more in children with an advanced stage of infection and a poor nutritional status at baseline. Data from pretreated and naive patients were difficult to interpret, because the baseline characteristics of these 2 groups differed too much.
-
Relatively little is known about the longer-term impact of traumatic brain injury (TBI) on children's daily functioning, especially the broader outcome domain referred to as health-related quality of life (HRQL). The objective of the present study was to examine the nature and predictors of HRQL outcomes in children with moderate to severe TBI an average of 4 years postinjury. ⋯ Findings underscore the importance of using comprehensive measures of HRQL, along with traditional indicators of functional outcomes, when evaluating the longer-term impact of injuries in children. Identification of predictors suggests the need for close monitoring and intervention of high-risk children.