Pediatrics
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Comparative Study
Survival in early- and late-term infants with congenital diaphragmatic hernia treated with extracorporeal membrane oxygenation.
Congenital diaphragmatic hernia (CDH) is a malformation of the diaphragm that allows bowel to enter the thoracic cavity, resulting in pulmonary hypoplasia and pulmonary hypertension. Approximately 50% of CDH patients are treated with extracorporeal membrane oxygenation (ECMO). The optimal gestational age for delivery of term infants with CDH at high risk for requiring ECMO is not known. The goal of this study was to compare survival of infants with CDH receiving ECMO born early term (38 0/7-39 6/7 weeks' gestation) with those born late term (40 0/7-41 6/7 weeks' gestation). Changes in survival rates of term infants and the factors associated with these changes were assessed over the 25 years that ECMO has been available. ⋯ Among term infants with CDH receiving ECMO, late-term delivery compared with early-term delivery is associated with improved survival, shorter ECMO duration, shorter hospital length of stay, and fewer complications on ECMO. These data suggest that, at least for the approximately 50% of CDH patients treated with ECMO, outcomes for infants with CDH may be improved by delay of elective delivery until 40 completed weeks of gestation.
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To determine the baseline injury rate for children ages 7 to 13 participating in community organized baseball, softball, soccer, and football. ⋯ Given the classification of football as a collision sport, the high number of exposures per player, the FITS score, and the percentage of injuries considered serious, youth football should be a priority for injury studies. Health professionals should establish uniform medical coverage policies for football even at this age level. RECOMMENDATIONS FOR MODIFICATIONS: Injury surveillance for youth sports is gaining momentum as an important step toward formulating injury prevention methods. However, establishing patterns of injuries, taking preventive measures, and evaluating equipment and coaching modifications may take years. In addition to the objective findings of this study, our direct observations of community sports through 2 seasons showed areas where immediate modifications could reduce injury risk. The first recommendation is that youth sports leagues provide and require first aid training for coaches. Training could be done by sports medicine professionals and include recognition and immediate response to head, neck, and spine injuries, as well as heat-related illnesses. The second recommendation is that youth sports leagues have clear, enforceable return to play guidelines for concussions, neck and back injuries, fractures, and dislocations. The third recommendation is that baseball and softball leagues consider the injury prevention potential of face guards on batting helmets.
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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.
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To ascertain and compare the knowledge, practices, and training needs of pediatricians and family physicians regarding intimate partner violence screening and intervention. ⋯ Few child and adolescent primary care physicians routinely screen parents for intimate partner violence and most need more information on this topic. Residency training and continuing medical education on violence prevention, including screening and intervention skills in intimate partner violence, and office protocols for managing cases of domestic violence could increase screening rates.
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To determine the status of the hypothalamic-pituitary-adrenal axis in children who had meningococcal disease and were admitted to 2 regional pediatric intensive care units. ⋯ During the initial phase of meningococcal disease, raised cortisol and ACTH levels indicate an appropriate stress response within the hypothalamic-pituitary-adrenal axis. However, a substantial subpopulation (11 [16.9%] of 65) has evidence of adrenal dysfunction during this period. Morning cortisol values in the initial phase of meningococcal disease could be used as a potential early index of AI.