Pediatrics
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Randomized Controlled Trial Clinical Trial
Long-term safety and efficacy of risperidone for the treatment of disruptive behavior disorders in children with subaverage IQs.
The objective of this study was to investigate the long-term safety and efficacy of risperidone in disruptive behavior disorders in children with subaverage IQs. Disruptive behavior disorders were defined as oppositional defiant disorder, disruptive behavior disorder, and conduct disorder as per the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. ⋯ Risperidone, administered as an oral solution at a mean dose of 1.38 mg/d (range: 0.02-0.06 mg/kg/d) for 1 year, was well tolerated, safe, and showed maintenance of effect in the treatment of disruptive behavior disorders in children aged 5 to 12 years with subaverage IQs.
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To determine the construct, content, and convergent validity of 2 self-report pain scales for use in the untrained child in the emergency department (ED). ⋯ The CAS and the FPS exhibit construct, content, and convergent validity in the measurement of acute pain in children in the ED.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Routine sucrose analgesia during the first week of life in neonates younger than 31 weeks' postconceptional age.
To determine the efficacy of sucrose analgesia for procedural pain during the first week of life in preterm neonates in neonatal intensive care units on enhancing later clinical outcomes. ⋯ Repeated use of sucrose analgesia in infants <31 weeks' PCA may put infants at risk for poorer neurobehavioral development and physiologic outcomes. Additional study is needed to determine the most appropriate age and duration of sucrose analgesia in preterm infants.
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The objective of this study was to determine the rate, risk factors, and outcomes of nosocomial primary bloodstream infection in pediatric intensive care unit (PICU) patients. ⋯ Of 911 patients, 526 (58%) were male and 674 (74%) were white. Congenital heart disease (29%), lung disease (25%), and genetic syndrome (18%) were common. There were 65 episodes of primary bloodstream infection in 57 patients; 5 were polymicrobial and 7 patients had multiple bloodstream infections. Coagulase-negative Staphylococcus was the leading cause of bloodstream infection (n = 28), followed by Enterobacter cloacae (n = 8). The rate of bloodstream infection was 13.8 per 1000 central venous catheter days. In multiple logistic regression analysis, patients with bloodstream infection were more likely to have multiple central venous catheters (adjusted odds ratio [aOR]: 5.7; 95% confidence interval [CI]: 2.9-10.9), arterial catheters (aOR: 5.5; 95% CI: 1.8-16.3), invasive procedures performed in the PICU (aOR: 4.0; 95%CI: 2.0-7.8), and be transported out of the PICU (aOR: 3.4; 95% CI: 1.8-6.7) to the radiology or operating room suites. Severity of illness as measured by admission Pediatric Risk of Mortality score, underlying illnesses, and medications were not associated with increased risk of nosocomial bloodstream infection. Conclusions This study identified a high rate of bloodstream infection among St Louis Children's Hospital PICU patients. Risk factors for bloodstream infection were related more to process of care than to severity of illness. Additional research is needed to develop interventions to reduce nosocomial bloodstream infections in children.
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Child abuse (CA) can present with a spectrum of signs and symptoms. Apparent life-threatening events (ALTEs) may be a subtle presentation of CA. Retinal hemorrhages (RHs) are a well-described finding in some patients with CA. We hypothesized that screening children who present with a chief complaint of an ALTE for RH would detect an otherwise occult presentation of CA. ⋯ RH was detected in 1 (1.4%) of 73 patients in our population of infants with ALTEs and 1 of 3 patients who were victims of CA and presented with an ALTE. CA was detected in 2.3% of patients who presented with an ALTE. The diagnosis of CA should be seriously considered in patients who present with an ALTE. The evaluation of ALTEs should include funduscopic examination as ALTEs and RHs are associated with CA.