Pediatrics
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Randomized Controlled Trial Multicenter Study
Clonidine as an adjunct therapy to opioids for neonatal abstinence syndrome: a randomized, controlled trial.
To determine if oral clonidine would reduce the duration of opioid detoxification for neonatal abstinence syndrome. ⋯ In this randomized, double-blind trial, adding clonidine to standard opioid therapy for detoxification from in utero exposure to methadone or heroin reduced the duration of pharmacotherapy for neonatal abstinence without causing short-term adverse cardiovascular outcomes. A larger trial is indicated to determine long-term safety.
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The purpose of this work was to evaluate the impact of the implementation of a ventilation protocol driven by registered respiratory therapists on respiratory outcomes of premature infants with birth weight < or =1250 g. ⋯ In this study, we were able to demonstrate for the first time a significant improvement on the weaning time and duration of mechanical ventilation with the implementation of a ventilation protocol driven by a registered respiratory therapist in the premature population. Based on our experience, other institutions can customize ventilation protocols to their local practice. However, a prospective, randomized, controlled study should be planned to evaluate long-term outcomes such as BPD and neurodevelopment.
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This study investigates how pediatricians define palliative care and their preferences regarding the timing of referrals for children with life-limiting diseases. ⋯ Despite recommendations to refer children to palliative care early in the course of illness, most pediatricians define palliative care as similar to hospice care and refer patients once curative therapy is no longer an option. Creating a more-practical definition of care, one that emphasizes an array of services throughout the course of an illness, as opposed to hospice care, may increase earlier palliative care referrals for children with life-limiting illnesses.
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This is a summary of the presentation on special considerations in the respiratory management of spinal muscular atrophy, presented as part of the program on pulmonary management of patients with pediatric neuromuscular disorders at the 30th annual Carrell-Krusen Neuromuscular Symposium on February 20, 2008.
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Randomized Controlled Trial
Early systemic hypotension and vasopressor support in low birth weight infants: impact on neurodevelopment.
The duration and severity of systemic hypotension have been related with altered neurodevelopment. Cerebral circulation is pressure-passive in low birth weight infants with early systemic hypotension who receive cardiovascular support. The treatment of early systemic hypotension is controversial, because it has been associated with short-term and long-term morbidity in retrospective studies. However, there has been no prospective information on cardiovascular support for hypotension and morbidity. ⋯ Cautious use of cardiovascular support to treat early systemic hypotension in low birth weight infants seems to be safe. The question of whether raising systemic blood pressure to within a normal range will improve outcome should be examined by using appropriate study designs.