Pediatrics
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Review Meta Analysis
Ethanol locks to prevent catheter-related bloodstream infections in parenteral nutrition: a meta-analysis.
Patients with pediatric intestinal failure (IF) depend on parenteral nutrition for growth and survival, but are at risk for complications, such as catheter-related bloodstream infections (CRBSIs). CRBSI prevention is crucial, as sepsis is an important cause of IF-associated liver disease and mortality. We aim to estimate the pooled effectiveness and safety of ethanol locks (ELs) in comparison with heparin locks (HLs) with regard to CRBSI rate and catheter replacements for pediatric IF patients with chronic parenteral nutrition dependence. ⋯ In pediatric patients with IF, EL is a more effective alternative to HL. Adverse events include thrombotic events.
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Randomized Controlled Trial Multicenter Study Comparative Study
Nasal continuous positive airway pressure with heliox in preterm infants with respiratory distress syndrome.
To assess the therapeutic effects of breathing a low-density helium and oxygen mixture (heliox, 80% helium and 20% oxygen) in premature infants with respiratory distress syndrome (RDS) treated with nasal continuous positive airway pressure (NCPAP). ⋯ Heliox increases the effectiveness of NCPAP in the treatment of RDS in premature infants.
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Multicenter Study Comparative Study
Multicenter analysis of quality indicators for children treated in the emergency department for asthma.
To test the hypothesis that an association exists between process and outcome measures of the quality of acute asthma care provided to children in the emergency department. ⋯ We found no clinically significant association between process and outcome quality measures in the delivery of asthma-related care to children in a multicenter study. Although the quality of emergency department care does not predict successful discharge, other factors, such as outpatient care, may better predict outcomes.
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Multicenter Study Comparative Study
Perioperative methylprednisolone and outcome in neonates undergoing heart surgery.
Recent studies have called into question the benefit of perioperative corticosteroids in children undergoing heart surgery, but have been limited by the lack of placebo control, limited power, and grouping of various steroid regimens together in analysis. We evaluated outcomes across methylprednisolone regimens versus no steroids in a large cohort of neonates. ⋯ This multicenter observational analysis did not find any benefit associated with methylprednisolone in neonates undergoing heart surgery and suggested increased infection in certain subgroups. These data reinforce the need for a large randomized trial in this population.
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Multicenter Study
Association of center volume with mortality and complications in pediatric heart surgery.
Previous analyses have suggested center volume is associated with outcome in children undergoing heart surgery. However, data are limited regarding potential mediating factors, including the relationship of center volume with postoperative complications and mortality in those who suffer a complication. We examined this association in a large multicenter cohort. ⋯ These data suggest that the higher mortality observed at lower volume centers in children undergoing heart surgery may be related to a higher rate of mortality in those with postoperative complications, rather than a higher rate of complications alone.