Pediatrics
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Randomized Controlled Trial Multicenter Study Comparative Study
Disability 3, 12, and 24 months after traumatic brain injury among children and adolescents.
To examine disability in children and adolescents after traumatic brain injury (TBI) across the spectrum of injury severity. ⋯ Children with moderate or severe TBI and children with mild TBI who had intracranial hemorrhage had substantial long-term reduction in their quality of life, participation in activities with others, and ability to communicate and care for themselves.
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Randomized Controlled Trial Multicenter Study Comparative Study
Randomized trial comparing 3 approaches to the initial respiratory management of preterm neonates.
We designed a multicenter randomized trial to compare 3 approaches to the initial respiratory management of preterm neonates: prophylactic surfactant followed by a period of mechanical ventilation (prophylactic surfactant [PS]); prophylactic surfactant with rapid extubation to bubble nasal continuous positive airway pressure (intubate-surfactant-extubate [ISX]) or initial management with bubble continuous positive airway pressure and selective surfactant treatment (nCPAP). ⋯ Preterm neonates were initially managed with either nCPAP or PS with rapid extubation to nCPAP had similar clinical outcomes to those treated with PS followed by a period of mechanical ventilation. An approach that uses early nCPAP leads to a reduction in the number of infants who are intubated and given surfactant.
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Randomized Controlled Trial Comparative Study
Hypotonic versus isotonic maintenance fluids after surgery for children: a randomized controlled trial.
The objective of this randomized controlled trial was to evaluate the risk of hyponatremia following administration of a isotonic (0.9% saline) compared to a hypotonic (0.45% saline) parenteral maintenance solution (PMS) for 48 hours to postoperative pediatric patients. ⋯ Isotonic PMS is significantly safer than hypotonic PMS in protecting against acute postoperative hyponatremia in children.
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Multicenter Study
Inpatient costs and charges for surgical treatment of hypoplastic left heart syndrome.
Hypoplastic left heart syndrome (HLHS) is one of the most serious congenital cardiac anomalies. Typically, it is managed with a series of 3 palliative operations or cardiac transplantation. Our goal was to quantify the inpatient resource burden of HLHS across multiple academic medical centers. ⋯ Patients with HLHS demand considerable inpatient resources, whether treated with the Norwood-Glenn-Fontan procedure pathway or cardiac transplantation. Improved survival rates have led to increased hospital stays and costs.
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Multicenter Study Comparative Study
Reducing PICU central line-associated bloodstream infections: 3-year results.
To evaluate the long-term impact of pediatric central line care practices in reducing PICU central line-associated bloodstream infection (CLA-BSI) rates and to evaluate the added impact of chlorhexidine scrub and chlorhexidine-impregnated sponges. ⋯ Focused attention on consistent adherence to the use of pediatrics-specific central line insertion and maintenance bundles produced sustained, continually decreasing PICU CLA-BSI rates. Additional use of either chlorhexidine for central line entry scrub or chlorhexidine-impregnated sponges did not produce any statistically significant additional reduction in PICU CLA-BSI rates.